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Three Steps for Improving Patient Satisfaction

‘White paper’ helps health systems to better understand patient experience

In an effort to improve patient satisfaction, most hospitals rely on the national Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey to gauge patients’ perspectives on care. But a new white paper from McKinsey&Company says that while the survey findings provide insight into the patient experience, the survey tool isn't designed to provide the high-level details that hospitals need to link patient satisfaction with business performance.

The paper describes a comprehensive approach that health systems can use to better understand the patient experience and thereby improve patient satisfaction. This approach is based on the experience of companies in other industries that were able to markedly improve customer satisfaction levels.

McKinsey research in numerous industries has shown that companies that routinely achieve high customer-satisfaction scores rely on best-practice measurement systems that:

  • Link improvements in the customer experience with desired business outcomes (e.g., repeat sales)
  • Enable the companies to identify the most important drivers of customer satisfaction and measure ongoing performance in those areas
  • Uncover operational insights that enable the frontline staff to make continuous improvements in the customer experience 

1. Link patient satisfaction to business outcomes

The first step for health systems, the paper says, is to determine the business outcomes they most want to focus on (e.g., total patient volume, patient retention, or the percentage of commercial patients). They should then conduct research to investigate the types of questions that will best enable them to gauge patient satisfaction in a way that ties into those objectives. For example, a major U.S. health insurer discovered that customer agreement with the phrase “[company name] is the insurer for me” predicted loyalty in one of its most important member segments better than agreement with any other phrase did. Because member retention in that segment was one of its business objectives, the insurer then focused its efforts on how to increase the percentage of people in that segment who agreed with the phrase.

Next, health systems should conduct additional research to identify the factors that most strongly influence how patients respond to the chosen questions and the specific metrics that would enable them to assess performance in those areas. Over time, the combined data should permit the health systems to develop robust measurement systems that can uncover operational insights and enable continuous frontline improvements. Health systems should repeat this fundamental research every few years so that their understanding of the patient experience is always current.

2. Identify the strongest influences on patient satisfaction

To determine which factors most strongly influence patient satisfaction, health systems must accurately understand the “end-to-end inpatient journey,” from preadmission scheduling and testing through follow-up care, as well as the role that price, service offerings, physician referrals, and brand play in determining where patients seek care, the paper advises.

The inpatient journey should then be broken down into discrete elements to identify the factors that can influence patient satisfaction at each step of the journey. Both clinical and nonclinical factors should be included. In-depth qualitative research (e.g., focus groups) and quantitative research (e.g., patient surveys) should then be conducted to pinpoint which factors most strongly influence satisfaction levels in ways that correlate with desired business objectives.

When conducting this research, two points are worth remembering, the paper says. First, the factors with the strongest influence often vary by market and patient segment (e.g., expectant mothers, cardiovascular patients, and emergency room patients). Thus, the journeys along different care pathways should be mapped separately to determine which factors influence each one. For example, a hospital in a competitive community that views its maternity services as a way to attract and retain patients would need to understand which elements of care during pregnancy, childbirth, and follow-up have the strongest impact on new mothers’ satisfaction levels.

Second, what patients say is important to them may not correlate with how satisfied they actually were with their inpatient stay. In McKinsey’s 2014 Consumer Health Insights Survey, for example, the company asked participants who reported having been hospitalized within the past 3 years to identify which factors were most important in influencing their satisfaction with their hospital experience. The company then compared those responses with the participants’ reported satisfaction levels to determine the relative (or derived) importance of each factor. The match-up was inexact. For example, most participants said that the outcome achieved was the strongest determinant of their satisfaction with care. However, empathy from nurses turned out to have a greater impact on actual satisfaction levels. Health systems need to understand the derived importance of various factors if they want to ensure that their improvement efforts yield significant results, according to the paper.

3. Uncover operational insights

It is not sufficient to identify the factors that matter most, the paper says. Those factors must be broken down into their constituent parts — ideally, ones that can be monitored regularly. For example, if nurse empathy has a strong impact on patient satisfaction, health systems should track such things as total nursing time spent with each patient and timely responses to call buttons. Similarly, if the most important factor influencing satisfaction with emergency care is how quickly patients see a provider, health systems should routinely measure the average “door to doc” time.

Metrics such as these become key performance indicators (KPIs) that can be used to change behaviors in ways that improve the patient experience, the paper notes. The KPIs should, ideally, be assessed daily and the results reported to the individual hospital units. The findings help the frontline staff determine where changes are needed and then test the changes to understand the impact they are achieving. Thus, the KPIs are an important complement to the monthly patient feedback survey scores. Although those surveys are the most important gauge of patient satisfaction, it may take weeks before the responses are processed and reported to the frontline. In contrast, KPIs allow the staff to make real-time adjustments to their activities and weave continuous improvement into daily operations. As a consequence, patient satisfaction is no longer just a marketing initiative but a component of the organization’s culture, the paper observes.

Improving the patient experience can help health systems achieve their business objectives as well as increase their Medicare revenue, the paper concludes. In some cases, it could also have spill-over effects, such as better clinical care delivery. The three key steps outlined in the paper can help health systems deepen their understanding of the patient experience and identify the most effective ways to increase patient satisfaction.

Sources: McKinsey&Company; August 2015; and FierceHealthcare; August 20, 2015.

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