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Our family doctor cements my loyalty as a patient every time I go to see him. He accomplishes this with one simple action combined with two sophisticated uses of patient intelligence. The simple action is to put notes into my care record that indicate what satisfies me. Currently, two of the notes in my record read: “Likes patient population statistics” and “Likes ideas that came from patients.” He has, for example, used both of these statements in a recent visit to diagnose and treat a sleep disorder I was experiencing. During our conversation, he asked one of the nurse practitioners to share statistics on the percentage of the clinic’s population who are experiencing the same type of sleep disorder, and then drill into the percentages for men vs. women and for men of my age group. This type of insight takes deep intelligence to be gathered, stored, processed and shared among the providers. This is business intelligence.

Taking this use of information one step further, our doctor then walked through a one-page sequence of events for my treatment. This included consult with a pulmonologist, an overnight study at a local hospital, education from a home health and medical equipment specialist, and finally follow-ups with both the pulmonologist and with him as my primary care physician. At each stage of this treatment, I was given information on what to expect and why, as well as homework I needed to do in preparation for the specific stage. He sealed the deal with me by telling me that this sequence of events originated with an idea from one patient, and has grown through refinements made in using it with a variety of patients over the past few years. This too is business intelligence.

The integrated delivery organization he works for has made it possible through extensive use of data analysis – its business intelligence – for him and for the care team that works with him to increase patient satisfaction. In effect, patient satisfaction is baked right into the service he offers, which has a number of clinical, operational, financial and personal benefits for his organization, for himself, for his team and, of course, for me as a patient.

This is just one micro-example of the use of business intelligence to increase patient satisfaction. The macro view of analytical support for patient intelligence is far more important. The benefits are enormous for the organization that not only gathers patient satisfaction data for use in quality, regulatory and pay-for-performance contract reporting, but also embeds satisfaction into its marketing messages, risk management practices, operational processes and everyday clinical care delivery.

What is Patient Satisfaction?
At first blush, patient satisfaction sounds like its cousin customer satisfaction. There are, however, significant differences between the two. Topping the list are the licensing and professional restrictions placed on healthcare providers, who must first consider what the patient needs before what the patient wants. In most businesses, trying to sell people what they need versus selling them what they want is an efficient way to go out of business because the competition will gladly reverse this order. I am free to buy just about anything I want in a grocery or hardware store without any regard to whether or not I need it. But I cannot just get an MRI scan or a prescription I saw advertised just because I want one.

In addition to these restrictions are the financial rules from payers, purchasers and the patients themselves. As a provider in a fee-for-service situation, another x-ray may be called for medically, and help the practice financially, but could very well be denied by the patient’s insurance plan. In a capitation situation, this additional x-ray comes out of the provider’s bottom line. Once again, need trumps want.
Patient satisfaction is the subject of numerous books, articles and studies. In Crossing the Quality Chasm, the Institute of Medicine identifies patient-centeredness as one of the six ingredients of quality healthcare. The book uses terms to describe this focus such as empathy, responsiveness to needs/preferences, involvement, respect, information, communication, education, emotional support, physical comfort, value, transparency and heeding expectations. Irwin Press (co-founder of Press-Ganey) discusses the importance of patient experiences and perceptions, and the need to go beyond technical quality to encompass service quality in his book Patient Satisfaction: Defining, Measuring and Improving the Experience of Care. Furthermore, the Gallup Organization has extended the concept of patient satisfaction to become patient engagement. In other words, involving the patient in their care and in the delivery of their care increases satisfaction, loyalty, cooperation and respect.

Common satisfaction measures were summed up in a recent study by DrScore and included:

• Accessibility – both physical access and financial access to care.
  
• Communication skills – of the doctors, nurses, PAs, NPs and others involved in direct patient care.
  
• Personality and demeanor – of the same group.
  
• Quality of medical-care processes – as provided directly to the patient.
  
• Care continuity – regarding the handoffs made provider-to-provider, as well as across time.
  
• Quality of healthcare facilities – in terms of having the appropriate equipment, supplies and peripheral resources available.
  
• Efficiency of office staff – in handling scheduling, billing, etc.
  

As you can see from these lists, the focus of patient satisfaction relies on providers going beyond the mechanical delivery of medical care to the delivery of a true health service.

Driving Forces for Increasing Patient Satisfaction
The list of benefits of paying attention to patient satisfaction is long and extends to virtually every corner of the healthcare organization whether hospital, physician practice, home health, long-term care and so forth. This makes sense, since the range of factors making up satisfaction is quite wide.

With greater patient satisfaction comes:

Clinical Benefits

• Greater patient trust and acceptance with treatment plans.
  
• Increasing buy-in for treatment plans more quickly, making best use of scarce physician time.
  
• Increasing trust, which allows physician to discover more factors that may affect the care needs of the patient.
  
• Enhancing patient involvement in their own care through preventative measures, corrective measures and so forth.
  

Operational Benefits

• Driving efficiency into the organization by focusing on what works well with patients, and eliminating what does not work well.
  
• Cross-over trust is enhanced. For instance, a good experience in scheduling appointments can cross over into a better experience with the care provider. In addition, a good experience with the patient’s PCP can cross over into a more positive experience with specialists that the PCP has referred.
  
• Increased internal support for other quality improvement efforts, such as timeliness improvement, care process improvement, etc.
  

Quality Accreditation Benefits

• Heightened ability to participate in quality accreditation measurement programs. For instance, the NCQA 2007 HEDIS Measures List has three measures that directly address Satisfaction with the Experience of Care, plus seven under Access/Availability of Care and four under Use of Services.
  

Financial Benefits

• Being compensated for services by health plans and purchasers who peg compensation in part to satisfaction scores.
  
• Reduced provider staff stress and turnover.
  
• Providing evidence of value of care to purchasers and payers.
  

Marketing and Promotional Benefits

• Increased likelihood for being referred for services.
  
• Increased propensity to return to the same hospital, same physician, etc.
  
• Improving word-of-mouth promotion of your organization.
  
• Better comparison against competitors.

Risk Management Benefits

• Reduced likelihood of malpractice litigation.

Regulatory Compliance Benefits

• Positive scores as reported by the government such as when the Centers for Medicare and Medicaid Services (CMS) posts satisfaction survey results on its Hospital Compare website.

Using Business Intelligence to Increase Patient Satisfaction
There are three key business intelligence applications that serve the purpose of increasing patient satisfaction:

• Patient Satisfaction Reporting. The collection of primary survey results and the subsequent reporting of those results is the most common form of patient satisfaction measurement. Business intelligence is useful with the collection of information from various sources (e.g., ambulatory care systems, hospital ADT systems, vendor-supplied satisfaction data collection systems), transformation of data into standardized measures and combination of data with other quality measures for storage and reporting. Perhaps the most valuable use of business intelligence processes and technologies is in the dissemination of satisfaction results to the wide variety of users of this data (e.g., quality accreditation organizations, pay-for-performance contractors, public reporting bodies, regulatory agencies, etc.). Collecting this data once and slicing and dicing it multiple times is a high return on investment approach.
  
• Patient Satisfaction Information for Patient Use. As described earlier in this article, patients are increasingly calling for greater involvement in their care. This requires newer forms of clinical, operational and business analysis to coordinate this increased involvement. In addition, patients are demonstrating a greater demand for evidence and statistical information to make informed choices on their care. A big part of this is evidence of the effectiveness and efficiency of the service that surrounds the primary care (e.g., the whole clinic visit versus just the specific medical treatment). Having this information available requires a high degree of analytical capability on the part of the healthcare organization.
  
• Patient Satisfaction Information for Provider Use. Possibly the most important use of patient satisfaction data (especially ideas that come from patients) is the use of this information to transform the services and the processes involved in patient care. This means that activities that were once thought important are now dispensed with altogether because they do not lead to better patient care and/or service. This also means that staff can be allocated more effectively. For example, for 90% of my visits to the clinic I see a nurse practitioner, physician assistant or a registered nurse instead of a physician. This is means that the physician’s time is being put to better use on more complex and urgent cases.

Next Steps
Increasing patient satisfaction is an obvious goal for healthcare organizations of all types, especially in these times of increased competition, increased scrutiny and increased demand for services. Plus, this factor in the total healthcare encounter is only going to become more important as patients become more accustomed to being “healthcare consumers” as a result of having to bear more financial burden for their medical care. It is becoming critical to pay attention to what your patients think of and are saying about your organization.

Business intelligence can help your organization compete on satisfaction, especially based on satisfaction analytics. This is true whether you want to improve your reporting, improve your patient involvement or improve your operational processes. Improvement begins with listening and rests on analyzing what you are hearing.

Thanks for reading!

References:
White B. Measuring Patient Satisfaction: How to Do It and Why to Bother. Family Practice Management; January 1999, Vol. 6, No. 1, pages 40-4.

Consumer-Directed Plans Begin Measuring Patient Satisfaction.

Patient Engagement.

Tarantino D. How Should We Measure Patient Satisfaction? American College of Physician Executives: Physician Executive; July-August 2004.

Isenberg S. How to Measure Your Practice's Level of Patient Satisfaction - Practice Management Clinic. Medquest Communications, LLC: Ear, Nose & Throat Journal; May 2003.

Zimowski J. Mining for Gold: Patient Satisfaction is Not Uppermost in Every Healthcare Financial Manager's Mind. But It Should Be. Healthcare Financial Management Association: Healthcare Financial Management; Dec 2004.

Barr J. Using Public Reports of Patient Satisfaction for Hospital Quality Improvement. Health Research and Educational Trust: Health Services Research; June 2006.

HEDIS(c) 2007 Summary Table of Measures and Product Lines.

The Seven Traits of Satisfied Patients.

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