PROFESSIONAL ISSUES
Quality evaluations enhanced by patient
feedback
From secret shoppers to sophisticated surveys, patient
reports about their care experiences are providing insights
for quality improvement.
By Kevin B. O'Reilly, AMNews staff. Jan. 16, 2006
Hospitals that hire Barbara Gerber to show up in a wig and pose as a
patient to thoroughly document how well they treat their patients are
willing to pay a premium for the service -- up to $25,000 for dozens of
incognito visits and a voluminous report from the president of the health
care mystery shopping firm Devon Hill Associates.
The bill from the La Jolla, Calif.-based company represents a hospital's
investment in discovering what only patients can tell them about the
quality of care: Whether patients feel they are listened to, treated with
respect and able to share in medical decision-making.
"There's an interpersonal quality to patient care,"said Gerber, a former
hospital marketing director. "If people don't like the physician or nurse,
that may have some serious implications" for the quality of care.
Mystery patients aren't new to hospitals or even physicians' offices. But
there's a renewed focus to make patient-reported experiences a critical
part of quality evaluations.
Most recently, the National Quality Forum in December 2005 endorsed a
27-question survey that attempts to measure patients' experiences. The
Agency for Healthcare Research and Quality developed the
questionnaire, named Hospital Consumer Assessment of Healthcare
Providers and Systems, or HCAHPS.
"There was some sense in the past that all patients cared about was the
color of the walls and free parking," said Elaine J. Power, PhD, NQF's
vice president of programs. Now, she said, hospitals and physicians
appreciate that the core of a patient's health care experience can help
quality improvement efforts.
The National
Quality Forum
has endorsed
a survey with
27 questions
to measure
patients’ care
experiences. |
In Gerber's case, documenting the patient
experience goes beyond noting whether the
nurse remembered to smile or the physician
gently patted a shoulder. She and fellow
mystery patients -- who are supplied with
phony medical charts and outpatient orders by
hospital physicians -- document issues as
simple as a bed's guardrails not being raised
after a patient complained of dizziness or as
complex as appropriate triage care. |
At one hospital's emergency department, Gerber presented as a 54-year-old
woman with heartburn that had subsided. While the ED's intake clerk
asked patients to tell a triage nurse if they were having certain heart
attack symptoms, Gerber could not find one.
"I didn't get triaged for 30 or 35 minutes," Gerber said. "As a result, they
changed their whole triage system." Similarly, NQF officials hope that
patients' answers to the HCAHPS questions could help hospitals and
physicians improve quality and patient safety. HCAHPS results are
expected to be publicly available on the Centers for Medicare &
Medicaid Services' Hospital Compare Web site
(www.hospitalcompare.hhs.gov) in 2007, Dr. Power said. Hospitals can
volunteer to participate in the survey, which will be conducted via
telephone and mail.
The survey asks patients three doctor-specific questions: Whether they
believe physicians treated them with courtesy and respect, listened to
them carefully and explained things in a way they could understand.
Although most quality improvement initiatives focus on clinical
performance and safety measures, Dr. Power said the patient's
perspective can aid those efforts.
"A patient experience-of-care questionnaire can actually be one of the
ways of measuring whether those other parts of health care are being
addressed," she said.
A patient who
gives a
physician high
marks for
communication
is more likely
to comply with
physicians’
instructions. |
AHRQ is at work on a similar survey focused
on ambulatory physician care that it hopes to
present to NQF in March. Questions are
expected to cover areas such as coordination
of care, access to care and shared medical
decision-making, said Beth Kosiak, PhD,
senior social scientist at the AHRQ's Center
for Quality Improvement and Patient Safety.
"There's some information critical to the health
system and the practitioner that can only come
|
from the patient," she said. "Studies are beginning to show that patients
who rate their care experience morehighly often have better clinical
outcomes."
While there may not be a cause-and-effect relationship between patient
satisfaction ratings and health outcomes, the evidence shows a correlation,
according to Dr. Kosiak.
"For example, if you rate your communication with a physician more
highly, you're more likely to comply with what they say," she said.
Back to top.
Copyright 2006 American Medical Association. All rights reserved.
RELATED CONTENT You may also be interested in reading:
"Relationship" new buzzword in patient-centered care Jan. 16, 2005
Secret shoppers can scope out your customer service Column July 26, 2004
Comfortable investment: Making your office more patient-friendly March 17, 2003
Pleasing patients: Some easy steps to take May 27, 2002
Use a survey to find out what your patients think Column July 30, 2001
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