Why Do You Ask?

Collecting accurate and actionable data starts with a patient-centric strategy.

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Patient surveys aren't new, take precious time, and may not always reveal actionable results.

Beyond asking the right questions, finding the answers you're looking for from patients requires commitment, genuine curiosity, and a solid understanding of how you are going to use the information you (hopefully) obtain.

"The structure of a patient survey really begins with how you plan to use the data you collect," says James R. Duncan, MD, PhD, professor of radiology at Washington University School of Medicine in St. Louis. "If the goal is to improve the patient experience, you need ongoing data collection — preferably collected frequently and with enough granularity — to assess whether or not your intervention has led to a measurable improvement."

For nearly a decade, hospitals have been using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey to capture and report patients' perception of their hospital treatment experience. Information collected from HCAHPS is reported to CMS and used by the agency for hospital incentives around improving quality of care, transparency, and accountability for services provided. Hospitals that fail to report HCAHPS patient perspective survey results can see their yearly payments reduced.

Now, with CMS tying patient satisfaction to reimbursement under the MACRA Quality Payment Program, it's critical that clinicians understand how to meet patient expectations and acccurately report patient satisfaction. The Beryl Institute defines a patient's experience as "the sum of all interactions shaped by an organization's culture that influence patient perceptions across the contiuum of care." Capturing that impact can be particularly challenging in radiology — where patients aren't always sure what their radiologist does for them.

“Radiology staff and leadership should take an active role in adopting and promoting surveys to assess patient satisfaction in both inpatient and outpatient settings.” – Jason N. Itri, MD, PhD

Asking for Understanding

A patient's experience and relative satisfaction with imaging can encompass the perceived effectiveness of services offered and received, empathy shown by physicians and other staff, comfort level, cost, convenience, and many other facets of the healthcare delivery system. With so much ground to cover in a survey, it's important to pin down what is important to patients and what they are willing to share.

The obvious reason for patient surveys is that they provide feedback on how well you are accomplishing your goals toward patient outcomes and experiences, says James V. Rawson, MD, FACR, chair of the ACR Commission on Patient- and Family-Centered Care. "But they can also validate that your activities toward improving the patient experience are successful from the patient's perspective," he says. "Survey data can help to identify things that you are either not addressing or not addressing well."

When you ask the right questions, you might learn how and why patients make certain healthcare decisions, what they value, and what they are willing to trade off, says Mary Jo Tarrant, ACR's director of portfolio planning and environmental intelligence.

"We ask patients questions and obserwve their reponses to better understand what drives their decisions, engagement, and loyalty," she says. "And the more we understand the patient in the healthcare delivery model, the more proactive we can be in delivering programs, tools, and solutions that impact patients in a positive way."

"Survey data can help to identify things that you are either addressing or not addressing well." — James V. Rawson, MD, FACR

Building a Survey

The Medical Group Management Association reports the overwhelming majority of its top performers — those who excel in operations, profitability, productivity, and value — use patient satisfaction surveys. So, if you aren't surveying patients already, you probably should be. A good starting point in designing a survey is recognizing that the purpose of researching patient experience is dependent on the actions you are willing to take based on your findings, says Tarrant.

"Radiology staff and leadership should take an active role in adopting and promoting surveys to assess patient satisfaction in both inpatient and outpatient settings," says Jason N. Itri, MD, PhD, a University of Virginia Medical Center radiologist. Survey data can help practices respond to patient complaints, gather benchmark and comparative data, and determine baseline performance measures to study the impact of service and quality initiatives, Itri says.

The Radiology Process Model, for instance, was developed at Massachusetts General Hospital as a survey to assess patients' experiences with radiology services. The pilot survey has shown that patients' answers reflect four main components: the patient's interaction with the patient-centered aspects of a facility, physicians, and staff; time-sensitive aspects of the care process; painful aspects of the exam; and fear or anxiety.

Choosing a Methodology

Consumers in the U.S., including patients, are most often surveyed using some type of online methodology, according to Tarrant. Patients are sometimes contacted and interviewed by phone, but that number is shrinking.

Research has shown that surveys conducted using kiosks in the medical or imaging facility where patients receive services lead to higher response rates than online surveys. Survey completion rates can be further improved by placing kiosks next to elevators.

Qualitative techniques include face-to-face exchanges, digital conversations through online bulletin boards and virtual focus groups, and hybrid surveys using both. Qualitative information is not meant to draw conclusions but rather to probe a question or an issue. Quantitative surveys are less personal and typically track concepts such as loyalty and satisfaction, with the goal of identifying levels of awareness, the positive or negative attitudes toward behavior, experience ratings, and degree of satisfaction or feeling of connection.

Regardless of the type of survey you use, your sample group should reflect the characteristics of the population it represents. Without a representative sample, practices cannot form accurate conclusions from the data they have collected, Tarrant says.

When sending out your survey, it's important too that your sample size is sufficient. Generally, a sample should be no smaller than 50 to ensure that the results are stable and your conclusions are reliable, Tarrant suggests. A well-contstructed survey, she adds, should take no longer than 10 minutes — 15 tops.

“We ask patients questions and observe their responses to better understand what drives their decisions, engagement, and loyalty.” – Mary Jo Tarrant

Recognizing the Challenges

Choosing the right type of survey to make results actionable won't make your task obstacle-free. It's worth noting, for example, that every stage of conducting a survey has an associated cost. "And the relatively high cost of surveys means they are typically done only periodically," says Washington University's Duncan.

In addition, it is important to realize that when you survey patients, you create an expectation that you will take their responses seriously, Duncan says. "Patients may become frustrated or discouraged if the information they have shared appears not to make a difference in practice or policy."

There is always the danger that the data you have collected are not shared with the right people, says Rawson, or that "no one is sure how to react to the data, and, as a result, no changes are made." Survey data must be reviewed in multiple settings and with multiple stakeholders (radiologists, staff, and administrators), he says, to gain understanding and create a plan.

Trying to glean more about what a patient wants, beyond their surface reponse, can help you tweak your practice in their favor, Tarrant says. For instance, look at all aspects of a patient's interaction with staff during a visit. One bad experience with one member of a healthcare team can lead to negative feedback that isn't representative of all services being provided.

Patient satisfaction is a measure of the quality of care you provide. It gives clinicians insight into various aspects of medicine, including the effectiveness of their care and their level of empathy. "Understanding patients as consumers," Tarrant says, "including their behaviors, attitudes, and motivations for radiology and general wellness decisions, is integral to delivering the best patient care."

By Chad Hudnall, managing editor, ACR Press

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