‘You can’t manage what you can’t measure’. This well-known quote by management thinker and ‘the founder of modern management’, Peter Drucker, is a great way to set the scene for this month’s article in our series on patient experience. You cannot know whether you are successful unless success is defined and tracked. To improve patient experience, we need to measure.
What are you measuring? To measure anything requires clear criteria to measure against. Earlier in the series, as part of defining the patient experience strategy, we discussed the importance of setting your vision, which describes what you want your practice/clinic/hospital to be and also your objectives to ensure you achieve this vision.
These will be important, as they will now become the basis for your measurement criteria. As you set out your measurement criteria, it is useful to think ahead about how the findings will be used. It is important to measure the right things that will allow you to track improvements. In the US, there are a set of trademarked surveys called CAHPS surveys, which stands for Consumer Assessment of Healthcare Providers and Systems. These have been created by the US Agency for Healthcare Research and Quality and are designed to report on the aspects of patient experience that are important. They are free to use and may well serve a useful purpose within the UK market too. The measurement criteria you choose will obviously depend on your own vision and objectives, but looking at the questions asked in the CAHPS survey is helpful for inspiration.
As an example, if one of your main objectives is to ensure that patients can book an appointment in a timely manner within your clinic or hospital, you may choose a measure such as the following:
In the last six months, when you needed care right away, how often did you get that care as soon as you needed it?
The patient would be prompted to choose from the following answers:
Another important objective for many healthcare providers is to deliver information in a way that patients can understand and an example measure, seen in the CAHPS survey, might be as follows:
During your recent visit, did your healthcare provider explain things in a way that was easy to understand?
- Yes definitely
- Yes somewhat
This same format of answers applies to other questions asking the patient if the doctor spent enough time with them, listened to them and respected them. While the CAHPS templates will provide you with assistance, it is important that your measurement criteria measure the aspects of your service that are important to you.
How will you capture the information? Having defined your measurement criteria, the next step is to decide how you will survey your patients and capture their responses. You will also need to decide whom you will survey. Will you ask every patient or a subset of your patients?
We all know that responding to surveys can be tedious, so your challenge is to ensure patients are surveyed in a manner that encourages participation. One important factor is to ensure patients are aware why. If they are being asked to take part and how the findings will be used to improve care If they understand the impact their feedback will have, they will be more likely to take part. It is also important to use several different means of engaging with patients, as some ways will appeal to some groups more than others.
Technology solutions: Technology offers us numerous options including email, SMS messages and the use of a computer tablet within the hospital or clinic environment. The beauty of using technology is that it reduces the burden on healthcare staff, but you should not rule out good old-fashioned paper-based surveys, as these may appeal to some patient groups more than technology, but it will, of course, be more time-consuming to collate the responses.
Surveys can be designed to give us data that can be presented in graphs and spreadsheets, which are easy to understand and to monitor trends over time to look for improvement. The most used survey tool in the UK is Survey Monkey, although there are lots of others. Survey Monkey offers a limited free service, but for a reasonable annual subscription, you can access numerous template surveys, some of which are designed for the healthcare sector, including the CAHPS templates described previously. Using technologies such as Survey Monkey to run your surveys also reduces the burden of analysis, as they contain embedded tools to present the data in manageable ways. If you create and run your own survey, you will need to plan for the overhead of collating the data into a useable format. There are also specialist companies focusing on the healthcare industry that provide measurement and analysis of patient experience and cater for all sizes of healthcare businesses, from individual consultants through to large healthcare establishments
Patient interviews: As well as surveys, you could also consider more descriptive patient engagement such as patient interviews and focus groups. The information gained will be harder to present graphically, but will undoubtedly offer some informative knowledge. An interview could even be an informal chat that takes place at the end of a consultation or during a ward round, with each patient being asked a consistent set of three questions and their answers being manually collated. You could also engage your medical PA in the process, asking them to ‘survey’ patients, by phone or email, following their appointment. Like all businesses, healthcare providers receive complaints from patients, and these can provide valuable insights into your patients’ experience and should be included as part of the data collected. At the other end of the spectrum from complaints, I am sure you receive ‘thank you’ letters and compliments from patients regarding the care you have provided. These also provide valuable insights and will highlight the most positive aspects of the patient experience you are delivering.
How will you analyse the data and present it? Once you have run your survey and the data is captured, it needs to be analysed and presented in a meaningful way to ensure it can be used to develop action plans for improvement. You will need to agree who will do the analysis and presentation and continue to do so on a regular basis. If you are using a survey tool, this may not be a significant overhead, but if you plan to run your own survey, the collation of the data will take some time to manage. The output produced should be presented in a manner that is easy to understand by you and the rest of your team. It should be in a format that allows for the measurement of trends over time, so ideally in a spreadsheet or a graph. And the more data that can be collected over time, the more informative the findings will be.
The next stage is to use this valuable information to produce improvement plans enabling you and your team to focus on a small number of areas, usually where you have received lower scores or less positive feedback than you would like to receive. For each of these areas, an action plan should be developed to ensure improvement over time, and this will be the subject of next month’s article. I look forward to answering the following questions next month:
- How will your improvement plans be developed?
- Who will own the improvement plans?
- How will you embed the focus on patient experience in your organisation?
- How to make patient experience a top priority for the long term