Measuring Patient Satisfaction – Part 1

Due to the increased availability of phlebology services available in most communities as new vein practices are popping up seemingly everywhere, patient satisfaction measurement needs to become a high priority within your internal marketing efforts to fend off competition. Patient satisfaction should be at the core of every medical practice, which leads to clinical and financial success. The benefits of having satisfied customers, as discovered by the business sector, have even more pronounced applications in health care, where quality outcomes has always been an explicit goal.

This article will help you understand how to measure patient satisfaction more effectively and manage it as well. Managing patient satisfaction involves creating an organizational structure within your practice that uses feedback from patients surveyed to focus on better meeting patient needs – and more effectively competing in a crowded phlebology marketplace.

When attempting to measure patient satisfaction, it is helpful to keep in mind that patient satisfaction has some intangible elements. Satisfaction is a clearly subjective perception of the patient who receives a clinical service. The typical patient enters a medical practice with needs, wants and expectations. The extent to which your phlebology practice fulfills the needs of the patient defines the degree to which the patient will be satisfied. Relative success or failure on these three dimensions dictates the relative satisfaction of the patient.

In 1982, Thomas Peters and Robert Waterman introduced to many what was a refreshing concept regarding American business. The concept stated very simply that certain outstanding (“excellent”) companies outperformed, outsold, and outproduced their competitors because they had created and nurtured a uniquely positive corporate culture. Within this unique corporate culture employees were more innovative, more productive, and more responsive to their customers.

The total effect of all of these superior efforts of employees within these corporate cultures was growth where others contracted, profits where others lost, and significant successes where others failed. The lesson learned is simple – stay close to your customers. Not only do successful vein practices listen to their patients, many get their best ideas in process improvement from patients and employees.

There are consequences to having dissatisfied patients. If a patient is dissatisfied with the care received at your vein practice and seeks future care somewhere else, their entire network of family and friends may not consider your practice for future services. As patients talk about their bad experiences, even more people may decide to seek treatment elsewhere. Most vein practices cannot replace lost patients fast enough to stem the inevitable tide of negative feedback. Quality perceptions and patient satisfaction are closely tied to the profitability of your vein practice. Low perceived quality in any context leads to decreased return visits and new patient referrals, in much the same way as poor patient satisfaction.

Those providers in a vein practice who keep the patient satisfied will see an enhanced image of quality as a direct and immediate consequence. Just as tangible, however, will be the positive financial aspects on increased utilization, market share and profitability.


Dimensions of Patient Satisfaction
Although most patients are generally satisfied with their office visit, they are not uniformly satisfied will all aspects of the care they receive, and therein lies the challenge. How much service is enough to elicit high satisfaction among patients to keep them coming back, and just what kind of service is that?


The evaluations patients offer of physicians revolve around two major themes: the clinical aspects of care and the communication ability or “bedside manner” of physicians. Most patients have great difficulty in evaluating the clinical aspects of the care they receive and find it easier to form opinions on the interpersonal skills, or lack thereof, of the physician providing care.

The patient enters into the physician-patient relationship with little knowledge of health care and some anxiety about the potential prognosis. The physician’s ability to communicate effectively about the nature of the illness and to demonstrate the appropriate concern toward the patient’s outcome becomes important in establishing the patient’s confidence and ultimate satisfaction.

Other factors also affect evaluations of the physician – patient relationship. The amount of time the patient spends waiting in the waiting room or exam room has been demonstrated to have a negative correlation with ultimate satisfaction with the physician. Communication has less impact on those patients who see their physician with greater frequency.


Nurses / Medical Assistants
Above and beyond quality of communication, patients also attach importance to the promptness or friendliness of nurses and medical assistants. In fact, the rapport nurses & medical assistants enjoy with patients is highly correlated with the overall experience perceived by patients.


Survey Formats
You can solicit feedback from patients in a variety of ways: phone surveys, paper surveys, electronic surveys, focus groups or personal interviews. Most practices elect to use paper or electronic surveys since they are usually the most cost-effective and reliable approach. Phone surveys yield similarly reliable results and have the added value of allowing you to probe for more specific information.

With a paper or electronic survey, you have the option of creating a questionnaire from scratch or using a product that’s already been developed by an outside vendor. Most experts recommend the latter because the product has likely been tested and validated. Whether you choose to do it yourself or turn to the experts, keep it simple.


Areas of Focus
Practices have three general goals when they interact with patients: to provide quality health care, to make that care accessible, and to treat patients with courtesy and respect. Your survey questions, then, should cover each of the three areas: quality issues (i.e., is the patient satisfied with his or her medical care?), access issues (i.e., is it easy to make an appointment?), and interpersonal issues (i.e., are the physicians and staff caring and compassionate?).

You may be tempted to think that access issues are less important than quality (after all, what does waiting time have to do with competent medical care?). But understand that your patients think otherwise. Data from the National Committee for Quality Assurance (NCQA) has shown that patients place access issues at the top of their list of what makes them satisfied. Yes, it’s important to make the right diagnosis and to prescribe the right treatment, but if your patients don’t put that until number seven on their top-10 list of what makes them satisfied, you can’t say one through six are irrelevant. Access issues matter to the patient, and if you ignore that, you’re in trouble.

Ask the essential question. Overall, how satisfied are you with your physician?

Word questions carefully. Survey questions should be brief and easy to understand.

Use consistent scales. The majority of questions on a patient satisfaction survey should be answered using a scale. The most generally used and accepted scale that you’ll see quoted in literature and utilized by the NCQA is the five-point scale. Most utilize a five-point scale that ranges from “excellent” to “poor.”

Collect demographic data. At the end of your survey, you should also collect patients’ demographic information, so you can identify how certain groups of patients responded to a particular question. You may, for example, want to include a question about the patient’s health plan so you can track whether satisfaction scores vary from plan to plan.

Strive for anonymity. Generally, patients are more likely to answer survey questions honestly if they believe their identity is protected. Make every effort to keep the entire survey process anonymous. Patients should be able to complete their surveys in private and return them without fear of being identified.

Response rates. Twenty to twenty five percent is a typical response rate for a mailed survey. To bring your response rate to that level, mail the survey with a postage-paid reply envelope and a cover letter from the physician(s) that explains the importance of patient feedback to the practice.

Analyzing the data. Analyzing the data may be the most complex part of the survey process. If you don’t have someone in-house with strong analytic and database-management skills, you are prone to end up with a stack of surveys that are never analyzed adequately. If your practice does not have the time or resources to analyze your survey data, consider outsourcing this step to a firm that specializes in health care data analysis.


What do I do with the results?
While you don’t have to act on every suggestion that your patients give you, you should take action on the key items that are causing dissatisfaction. Remember that your goal is to improve quality, not to place blame.

  • Example #1. A concern of numerous patients was waiting time in the office. To improve in this area, the practice developed a “time-analysis worksheet,” which tracks patients’ visits by the minute from the time a patient arrived at the office, entered the exam room, was greeted by the doctor and so on. This information allows the physicians and staff to see how they’re spending their time and identify possible sources of delays.
  • Example #2. A review of survey results could demonstrate a need to thank staff for their efforts. “Overall, our patients are happy. It’s nice to know that there are many patients with a positive image and positive feelings about our office”.


Measure Key Performance Areas

The survey measures these specific performance areas:

  • Access to services (appointment scheduling, 
availability, check-in, waiting times, referrals)
  • Staff performance (courtesy, telephone manner, caring concern, professional services)
  • Communication (telephone, explanation of procedures and test results, after-hours contact)
  • Physician performance (time spent listening, answering questions and giving instructions, outcomes)
  • Environment (hours, comfort, parking, signage, access)


The survey also asks for “overall” satisfaction ratings for:

  • Your Physician / Your practice
  • The quality of medical care received


Two open-ended questions for verbatim comments about:

  • Willingness to refer family and friends
  • Suggestions for improving service


David Schmiege is the president and CEO of Vein Specialists of America Ltd., a practice management consulting and advisory firm. Please direct any questions you may have for Schmiege to 630-789-3636 or e-mail him at [email protected].


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