How to measure Patient Satisfaction?

The first step towards the goal of a patient experience continuous improvement implies having in place a good system to measure it. Because measuring patient satisfaction is a condition for being able to improve the experience systematically. 
Although, by itself, it is not sufficient to drive the improvement, it is necessary as a base for a patient centric organisation. It enables staff, managers and executives to continuously improve all the aspects of care and is the most powerful tool quality teams have in order to allocate the resources of the organisation to what really matters to patients.

Who needs to measure patient satisfaction?

According to “What Matters to Patients?” research:
Hospital management and policy makers should make use of the data collected to support the management and improvement of frontline services.
Middle managers and clinical teams should monitor quality of care as often as they monitor budgets. They need relevant, accurate, timely, frequent information from their own patients to compare their own services with others and make improvements. This means access to ‘near real time’ feedback, based on standard questions.
Finally, methods of collecting and reporting patients’ feedback should be tied as closely as possible to clinical services so that clinicians identify with the results. 

What do you need to measure patient satisfaction?

You need to commit resources to developing a system for collecting, analysing, interpreting and reporting on patient satisfaction data.
This may include:   
  • Staff with dedicated responsibility for overseeing and coordinating the work and providing expertise 
  • Protected time for staff to review feedback and learn from patient satisfaction.
  • A budget for training, creating feedback materials and drawing on external expertise
  • A dedicated technological platform to listen to patients through dedicated channels, collect the feedback in a systematic way, help analyse and distribute the information. If you want to learn more about the most advanced dedicated patient satisfaction measurement platform: RateNow Health Track 

What to measure about patient satisfaction?

In order to obtain a complete picture of the patient experience, you need to collect data from a range of different sources, including:
  • Surveys, as a primary source.
  • Patient stories.
  • Complaints.

What characteristics should this information have? 

Ideally it should be: 

  • Continuous: A modern feedback system allows comparisons over time. During the year, patient experience is fluid and dynamic. Also, there might be seasonal biases. For example, seasons and holidays affect the number of consultations and staff availability, which in turn affects waiting times and other satisfaction metrics. Therefore, feedback should be collected regularly and systematically. Limiting information collection just during a specific time could result in biassed conclusions and wrong decisions. That is why it is important to collect information during all the patient's journey.
  • Segmented: It is essential to guarantee the possibility to segment data by specific services and as close to the clinical teams as possible (so that the feedback is as direct and relevant as possible). For example, the heads of the clinical units should receive weekly reports about their services experiences. Likewise, at a managerial level, the system should allow comparisons among services and organisations.
  • Real time: Experience and memories dilute as we move away from the ‘moment of truth’. If we do not want to have a distorted view of what happened, we must ask questions as close as possible to the moment of the experience. 
  • User-friendly channels: Surveys should not be “intrusive” and tiresome to complete. New technologies allow a more humane and comfortable approach to the patient. Some hospitals manage to distribute their surveys through patients' smartphones for them to answer at the time and place where they feel more comfortable. For example, via SMS, Email or through feedback terminals located in the same hospital premises’. 
  • Qualitative feedback: Extending the audit beyond quantitative indicators allows to understand the reason behind the numbers. Patient stories should become central in the experience analysis. Listening to the patient's own words means understanding what patients really perceive.

The four-step measurement process    

The four-step measurement process is a structured process for effective measurement. Following the four steps helps to ensure that any data that is collected from patients is used to make better decisions that, ultimately, improve services. The four-step process makes the link between data collection, analysis, finding and reporting patterns.

The chapter has been written in collaboration with RateNow Health’s research team. The methodology has been developed taking into account the latest guidelines of patient experience practice gathered by the NHS in the "Patient Experience Book" and refined through the experience of quality teams from hundreds of European health organisations. 

Step 1: What services should be measured? 

Think carefully about what it is you are trying to improve. Together with your team ask: ‘What are the services we want to audit?’
  • Start with a handful of key services: Focus first on the most relevant patient journeys or processes and then expand the audit gradually to more specific ones. E.G: Start with outpatient consultations, inpatient care, emergency and ambulatory surgeries since they probably represent the bulk of services in numbers. 
  • Learn and then expand the audit: Once the system is up and running expand the audit to more processes such as Radiology, Farmacy, Rehabilitation, Oncology, Laboratory, etc.
Patient experience measurement specialists, like RateNow Health, are able to offer you specialised programs for up to 30 different hospital processes or services. Learn more here.

Step 2: How to design a patient satisfaction survey?

Once you have chosen the patient journeys you want to measure, design the surveys that are able to evaluate each and every step of the experience (the touchpoints). 
A perfect patient satisfaction survey should:  
  • Cover all touchpoints. Use the patient journey map to highlight each touchpoint. Your survey should ideally cover all the touchpoints of the experience from beginning to end, or, at least focus on the most relevant ones. Remember that the experience starts before arriving at the hospital and ends after the patient has left the facility. E.G: Ask how easy it was to fix the appointment, or how accessible are the facilities, or if all the necessary information was given for a thorough follow-up. 
  • Ask about functional and relational aspects. One of the most outstanding results of the study “What matters to patients” from London’s Kings College is that patients are as interested in relational aspects as functional ones. The patient satisfaction survey must include key relational aspects such as: how the patient has been treated, if he felt involved in the decisions, if it was easy for them to understand the professionals. Click here to read more information about what matters to patients. 
  • Net Promoter Score (NPS). Once limited only to private health organisations, more and more public institutions include in their surveys Customer Experience Indicators like NPS. The NPS is a recommendation index with several advantages: it has been proven to be more realistic than a mere satisfaction question (CSAT) because it asks for an active involvement of the patient, that of “recommending” the service it has experienced. It also opens up to a more “competitive” point of view among providers of care. Which is particularly useful in a scenario where the choice between private and public service is going to be more and more realistic for the patient. And finally it allows us to benchmark the service vs the industry performance, answering the question: is the quality of the service we offer above or below the average? Click here for more information about NPS.
  • Rely on peer-reviewed templates. Questionnaires should not be a work of imagination. On the one hand they should be informed by rigorous standards established in international methodologies such as PREM (Patient Reported Experience Measures) in order to be comparable among others. On the other side they should be adapted to the technology you use to distribute them. In fact certain channels such as feedback terminals require a short and to the point questionnaire whereas feedback retrieved from your own smartphone allows a more extensive survey. 
  • Adapt templates to your needs. You should take advantage of templates as much as you can but don’t forget to adjust the questionnaires to the “language” of your patients and tweak it to your specific needs. For example: Do you need evidence to give impulse to a project related to the payment services? Add a specific question about it in your questionnaire and use that input in order to push forward the project and to know what you need to solve.  

RateNow provides survey templates inspired by the latest scientific PREM methodology, reviewed by the expertise of hundreds of quality teams and carefully adapted to the type of channel you will decide to implement. Our templates are designed to cover 6 key blocks in order to maximise the quality and quantity of feedback: 1. Welcome 2. Segmentation 3. Ratings 4. NPS 5. Contact Details 6. Greetings.

Step 3: How to distribute surveys? Use the right channels

State of the art voice-of-the-patient programs imply:
  • Access to all patients. Patients want to be heard and health organisations need to give them a voice. People are used to giving feedback for far more trivial transactions than health related experiences. This is why we strongly recommend making surveys accessible to everybody, not only a statistical significant sample. 
  • Continuous tracking. Annual surveys are statistically significant only within a specific time frame and not every variation over time is to be taken into consideration. Satisfaction is a living thing and needs to be tracked periodically.   
  • Seamless and accessible surveys. Patients should receive a survey as soon as their experience is over. Ideally it should be sent between 1h to 24h after the patient leaves the hospital to maintain a suitable recency. The survey should be as user friendly as possible, incorporating gamification techniques. The aim should be to reach high usability standards and avoid any friction. In fact, any additional effort required reduces the participation rate. This is why we try to avoid, where possible, paper and telephone surveys.
  • Automate the process. You should rely heavily on automation because your time is the most scarce asset of all. Furthermore manual processes are priority- and person-dependent and can fall at the bottom of the list when facing urgencies. Spending a fair amount of time to automate the processes at the beginning frees precious resources for the future. 

Choose the right channels. In order to make sure that the right channel is chosen, you need to take into account factors like which type of experience are you evaluating (“transactional” such as a outpatient consultation vs “high involvement” such as an Inpatient care) the length of the experience (quick vs long) and the volume of users involved (massive traffic vs light). You will find our detailed recommendations in the next paragraph. 

Depending from the hospital service you are targeting, our recommendation goes to: 
  • SMS: Suitable for high involvement, long journeys such as inpatient hospitalisation and outpatient surgeries. It grants the highest participation rate thanks to its immediacy and accessibility. The patient can comfortably fill it at home. Although it implies a cost, it is usually marginal. Hospitals usually have a very good database of patient’s phone numbers as the same medium is already used to send appointment alerts or test results. Due to its impressive participation rate some organisations find it worthwhile to invest more resources in this channel and audit all processes with SMS, including outpatient consultation. 
  • Emails: They have the same accessibility and are catered for the same type of services as SMSs. They have low or no cost associated but their participation rate is lower than the SMS for the saturation of the channel. Furthermore not everybody has an email address and hospitals do not always collect this personal data consistently. 
  • Feedback terminals: They are highly recommended for high traffic, transactional services such as Outpatient Consultations and X-Rays. They grant voluntary and effortless access to all the patients. They are digital and very cost effective when dealing with a massive amount of users. Their participation rate, although lower than SMS and Emails, still grants statistical significance. 

Less used, but still valid for some specific projects, are the following channels: 
  • Traditional paper: Less and less used for the data entry effort required and the relative low participation rate. 
  • QR: Due to the technological bias, they tend to favour answers from a tech savvy target and, if not actively prompted, they suffer from an extremely low participation rate. 
  • Telephone interviews: They can be perceived as intrusive although qualitatively rich. Their cost per survey make them very expensive when used at a large scale.

Our experts carefully analyse all the above mentioned criteria in order to always offer the best option to each hospital. Most of the time it is a combination of channels and the aim is to get the best quality and quantity of feedback in each service. 

Step 4: How to analyse the patient satisfaction data? Analyse and distribute information

Once you have collected the data, you are ready to analyse and distribute it. 
  • Centralise the information in one single repository: Patient satisfaction information should be accessible to many different people in the organisation and the best way to make it possible is to have just one single repository. Retrieving the information and creating reports should be as user-friendly as collecting the feedback from the patient. The structure of the data should be clear, and the data should always be up to date. The feedback right where, when and how everybody knows it should be. Sometimes, shady information silos make most of the effort to collect it useless. 
  • Decide an analysis frequency: When to analyse data should be established in order to deploy the resources accordingly. The frequency should differ depending on the team it is going to analyse and the purpose. For example, we recommend the clinical services to analyse it weekly, the quality team monthly and the management team quarterly. 
  • From general to specific: Use a “funnel approach” when reading your data. Start from the general / global view and go more and more in depth till you get to the bottom of the issue. A typical analysis of patient satisfaction information starts from the satisfaction indicators such as NPS at a process level (E.G. Outpatient care). Do you notice a variation? Take a look at the same indicator at a service level (E.G. Cardiology). Do you find relevant differences among services? Isolate those with the greatest variation and start to evaluate the ratings of the different items you are asking. For example check the waiting time, the ability of the staff to solve the issue etc. Close the analysis reading the comments of unsatisfied patients in that specific service or unit to confirm your hypothesis. 
  • From quantitative to qualitative: Do not limit your analysis to quantitative indicators. Quantitative indicators help you locate the problem. Patient stories help you understand what the problem is about. 
  • Distribute the information to the right stakeholders: The information should be distributed as widely as possible. For example, we recommend sending weekly detailed reports to the heads of clinical units, monthly detailed reports to the quality teams and quarterly high level dashboards to the management team. 
  • Distribute segmented information: The information should be carefully catered to each target in reach and depth. Let’s start with the reach: the head of a clinic department should receive only the information of his clinical department for him to focus on its systematic control. The hospital quality team should have visibility over all the hospital processes and services. And regarding the depth of the information, the management team should only see the macro satisfaction indicators, whereas the clinical head should also have access to all the qualitative opinions of the patients. 
  • Make the information part of the relevant forums: The most effective organisations include in a systematic way the right information in the right forums. For example, at a strategic level at the quarterly board of director meeting there should be a chapter about the key indicators from the different services. At a micro level, the head of the department should discuss patients' opinions with the caregivers and front-line staff more frequently.

Relying in real time business intelligence platforms specifically designed for the needs of healthcare industry such as RateNow Analytics is the best way to take the maximum advantage of your patient satisfaction data. Data is safely stored in one single repository, accessible in real time to all the organisation stakeholders and segmented to cater the need of information of each organisational department.  
The right data. To the right people. In real time! 

When do I stop measuring?     

The simple answer is ‘you don’t’. If you are consistently meeting your goal you should still check if there are further improvements to do, and make sure performance is not harmed by complacency. Be aware that the process of measuring does have a positive effect in keeping awareness high and demonstrating that the goals you are measuring are important. 

Using patient feedback to improve patient experience

Measuring patient satisfaction is only the first step towards a patient centric organisation that continuously improves its service. Read the dedicated article Improving patient satisfaction to understand how. 

Each hospital or clinic has specific needs and it is important to rely on experts in order to make the right choices, capitalise on the experience and avoid changes that can create tensions in complex organisations. Experience measuring system deployments can be delicate both for the organisation and the patients. At RateNow we specialise in reducing complexity and focus on swift, flawless implementations. If you have a patient satisfaction measuring a project in mind for your organisation, speak with our experts and they will guide you through all the options and the recommendations to make it a reality as soon as possible.  

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