The ongoing patient satisfaction survey has become a staple of the health care industry's efforts to gather data on provider performance and identify service areas needing improvement. While these surveys provide a valuable historical measure, they often lack immediacy. Patients are asked to rate and remember events that may have occurred weeks or months ago. In addition, unless a more timely method of gauging patient satisfaction is in place, the lag time between survey administration and analysis may cost the organization valuable time that could be used to correct small service problems before they become major issues.

For one health care provider, a way to get immediate feedback from patients is by using an Opinionmeter, a stand-alone polling machine made by Opinionmeter, Inc., Berkeley, Calif. John Maio, manager of diagnostic imaging, Kaiser Permanente Hospital, Oakland, Calif., has used Opinionmeters to gather patient satisfaction information and also for employee surveys. Placing the survey machines in the waiting areas of various departments, Maio has collected patient responses to brief questionnaires about their just-completed visit. "When I saw the Opinionmeter demonstrated, it occurred to me that I could get rich data at the point of service, as opposed to data from a questionnaire that is mailed out to people a long after their interaction with hospital staff," Maio says.

"We get six-month-old data from member patient satisfaction surveys that are used across the region, which includes 2.5 million members, spread across 23 different facilities. Well, that's pretty tough to work on because I don't know what has happened since the time the survey was taken. With the Opinionmeter, I can get information and try to act on it immediately."

For example, as part of the center's New Practice Models customer service effort, Maio met with members of the pediatrics department at the Oakland facility to identify things the staff could do to improve patient satisfaction. "We devised a survey to be administered on the Opinionmeter that had four basic questions: Were the receptionists helpful and courteous? Did the nurses introduce themselves to you? If your appointment ran late, were you kept informed? And, what did you think about your overall visit, using A - needs improvement; B - met my expectations; C - exceeded my expectations," Maio says.
The short questionnaire was displayed on a panel attached to the Opinionmeter. Respondents used the keypad below it to enter their responses. In two weeks, Maio received 300 responses on one Opinionmeter, 184 on another and 225 on a machine in his own department, which he used as a control to show staffers that the high response numbers weren't just from kids pressing the machines' buttons.

(If a patient enters responses outside the range of possible answers, their survey won't be recorded. In addition, if a respondent doesn't complete the survey, the responses won't be saved. "You can also require people to enter their ZIP code or medical record number, for example, so if kids are pressing the buttons, it's not going to correlate to an active patient and you can just throw that response out," Maio says.)

Introductions are important

The survey showed that even something as simple as a doctor or nurse introducing themselves seems to have a strong effect on satisfaction. "Of all the patients who were introduced, I looked at their answers to the other questions and their satisfaction levels in those areas were about 40 percent higher than those who said nobody introduced themselves," Maio says.

"It was interesting to crosstab the responses of those who were happy with the service and those who weren't because you could see the answers to the questions that made them formulate their opinion. Of those who liked the service, 90 percent were introduced to the nurse, 90 percent had someone follow up with them if their appointment was running late, 90 percent said receptionists were helpful and courteous. So it's pretty easy to deduce that if you want to have high patient satisfaction these are the areas that can contribute to that."

He was also able to refute employee claims that only disgruntled patients take the time to do the survey, seeing it as a way to vent their displeasure. "The remarkable thing was, 67 percent said their visit was satisfactory or exceptional, and only 33 percent said it wasn't."

When he's preparing to place an Opinionmeter in a department waiting room, Maio says he tells the staff what the survey focuses on, rewarding them if they can raise satisfaction to certain levels.

"It's like a test where the professor gives you the answers beforehand. I don't want people to have to guess how to change their behavior, I'd rather tell them, 'Here's the answer and let's see how good you can do at it.' "

Employee surveys

The Opinionmeters have been valuable for employee surveys as well, Maio says. He places the survey machine in his office, facing it away from him so employees know he can't see what their responses are. "The meter is pointed away from me. It doesn't emit any sounds that let me know which buttons they're pressing. They complete the survey and they check their name off the list and go. I tell them I'm not interested in an individual's answers, I'm interested in overall numbers."

He's tried other methods, such as having employees E-mail comments to him, but employees are understandably nervous about anything with their name attached to it. "In the past, people didn't want to say anything about co-workers or managers for fear of retribution. But now I can get good data on what the whole department is saying and the areas that these people need to work on. It's a good way to get people to give me information on anonymous basis that I can use to make their work environment better and to make patients' lives better."

Maio knows there is the chance that some employees might stack the deck against co-workers whom they dislike. He also knows that employees could secretly complete surveys to make their own performance look good. So he tries to ensure a large sample.

"By and large, people have been surprised. They were afraid fellow employees would rip them to shreds but people actually have good things to say. If you use it as much for a reward as you do for trying to improve things, it's a great tool."

Positive comments

One outgrowth of the initial experience with the Opinionmeter was devising a vehicle for employees and patients to make positive comments about staffers. Now, specially labeled phones near some reception areas go to a voice mailbox, where callers are instructed to leave their comments. The messages are later printed and displayed and also placed in the employee's file.

"The comment system been well received, because there was no mechanism like it before. In many cases when you do employee evaluations, only the bad things are documented. This is a way to note when someone does something good and keep a record of it in their file."

Rather than seeing the Opinionmeter as a watchdog or a test of employee performance, Maio views it as a part of his effort to serve both the medical center's customers and its employees. "I have 116 employees in my department, and we do about 170,000 imaging cases per year, so it helps me show the staff how focused I am on finding out what patients want, and to have them understand that I'm focused on what they as employees want from me.

"In my position, I'm supposed to have vision and leadership capabilities. I think the important thing is letting the staff know that basically I'm their secretary. They need to tell me what's going to make their job easier. I'll filter that with my own vision and we'll move ahead together. Unless I do that and show them that I'm interested in their work environment, there's no way I'm going to get them to change their behavior."