Patient Satisfaction Surveys & Online Reviews: A Guide to Getting Started, Improving Your Online Reputation, and Using Your Results Effectively

What Is A Patient Satisfaction Survey?

Patient satisfaction surveys are a tool used to collect patient feedback after a healthcare encounter. They are used for inpatient hospital stays, outpatient surgeries, diagnostic testing, physician office visits, and more. Patient satisfaction surveys offer both a qualitative and quantitative measurement of a patient’s interaction with healthcare providers and more recently surveys distributed by text and email have proven to be an effective strategy for building a healthcare organization’s online presence with web reviews.

The imperative to measure patient satisfaction and use the data to create meaningful change has taken on new meaning since the 1950’s, when the relationship between patient and physician was first examined. What started as a progressive strategy for determining how to create a positive patient experience is now largely mandated and incentivized by government quality initiatives and incentive-based payment programs. As an organization deeply rooted in connecting providers to their patients and helping practices continually optimize the patient experience, we want to help you dissect how we got to this point, explore best practices, and share some ideas for using results.

 

Executive Summary

  • Quality initiatives and incentive-based payment programs require and publicly report patient satisfaction data but patient satisfaction also plays a role in patient compliance, litigation risk, competing in the marketplace, and more.
  • Patient satisfaction and good medical care have a strong relationship but one is not solely indicative of the other; this distinction is important to physicians and providers because patients who want to dictate their own course of treatment often become disgruntled when the treatment they want isn’t in their best interest or isn’t consistent with clinical best practices.
  • Organizations small to large still utilize paper surveys in some capacity but this method is expensive, unreliable, potentially biased, and unscalable—much of the same is also true for phone surveys. Web and mobile surveys are the most timely, cost-effective, and scalable method for capturing patient satisfaction data, driving participation, and optimizing distribution, collection, and analysis processes for staff.
  • Web reviews are a significant part of a patient’s decision-making process and will continue to grow in importance. Mobile surveys are the best strategy for growing the quantity of online reviews and improving the average rating of online reviews.
  • Timing, length, and distribution of a survey all play in a role in survey participation rates.
  • Survey results can be used in a variety of ways to drive awareness, build your practice, improve your MACRA/MIPS scores, and more.
  • Different types of survey design offer benefits and advantages, look for a partner that offers flexibility and options to make changes as your needs change.
  • Patient satisfaction surveys are an integral piece of your patient engagement strategy. Look for a solution that is part of an integrated platform; a comprehensive strategy can be leveraged for increased ROI across all your patient engagement solutions.

Why Measure Patient Satisfaction?

Researchers have been exploring the relationship between physician and patient long before CMS began mandating its use as a measure of quality in 2006. In 1980 researchers developed the first patient satisfaction questionnaire, a 55 question Likert-type questionnaire that covered interpersonal manner, technical quality, accessibility, and convenience. The what and how of gathering patient satisfaction data has had a facelift since 1980 but many years of research have led to some key conclusions about patient satisfaction and why we should be interested in patient perceptions outside of checking the quality initiative box.

Satisfied patients are less likely to litigate. Patients who experience an overall positive experience are less likely to file a malpractice suit while patients who are already frustrated by their healthcare experience are more likely to escalate small mistakes or perceived neglect in their care.

Patient satisfaction data equips you to spend your process improvement resources where it matters most. There simply is no excuse anymore for guessing where to focus time, energy, and human capital towards improving the patient experience. With many cost-effective and accessible solutions for capturing this data, patients can tell you what matters to them and what doesn’t.

Satisfied patients have better outcomes. This is because satisfied patients are more likely to adhere to their medical care plans, which leads to better outcomes. Healthy patient populations also tax the healthcare system less, so resources are better utilized and the system is more efficient.

Medical practices with high patient satisfaction attract more patients and therefore, more revenue. Word-of-mouth is powerful because personal recommendations are more effective at influencing decisions that other forms of advertising or marketing. Social media and online reviews have changed the speed and reach of word-of-mouth, making it even more imperative that practices ensure patients have a great experience.

What do physicians and providers think about patient satisfaction surveys? Physicians have some big feelings about patient satisfaction data and the role it should have as a determinant of the quality of the care they provide or how they are reimbursed by payers. Because patients have more access to information—valid or otherwise—it’s common for patients to seek medical care having a predetermined conclusion about their diagnosis or treatment. When a patient wants  specific testing or treatment that doesn’t align with clinical best practices, frustration and dissatisfaction sometimes ensue. Still, physicians invest a lot of time, energy, and resources into collecting patient feedback and ensuring the care they provide meets the physical, medical, and emotional needs of their patients.

 

“I realized that we were guessing as to why patients come or go from our practice or what they do and don’t like about their care. I knew we needed data to know what patients are truly thinking”.
Theresa Lage

Marketing Coordinator, Obstetrics and Gynecology Care Associates

Begin Collecting and Measuring Patient Satisfaction

Determining what your survey should look like, how and when you should distribute it, and what you should do with the results can be overwhelming. Large research organizations, web design firms, EHR vendors, and many other types of organizations offer survey solutions; finding options in the marketplace is easy but determining which solution and vendor will help you accomplish your financial, clinical, and operational objectives is more difficult. We’ll use the next few sections to examine survey options by type, design, and length.

Types of Surveys

Healthcare organizations are utilizing everything from home-grown surveys  to detailed, exhaustive surveys distributed by large research organizations. Press Ganey, an independent research firm, has been a leader in measuring patient satisfaction for 30 years, and are the leading distributor of CAHPS surveys (CMS requires that CAHPS surveys be distributed by a third party organization). Their surveys are lengthy, thorough, and backed by years of study and best practice.

Where Press Ganey has led the way as a pioneer in the collection of patient satisfaction data, there are also opportunities for measuring patient satisfaction in a quick, simplified, and efficient way so feedback is more real-time can keep a real-time pulse on patient perceptions and build their digital presence through online reviews.

Paper Surveys

Believe it or not, paper surveys still exist, some medical practices distribute these to patients during the checkout process while others mail them to patients after the completion of an office visit. Though paper surveys are utilized by large organizations as well as small practices, they are on the decline and for good reason. Paper surveys are cumbersome to distribute and collect, expensive, difficult to validate, and carry a high risk of bias.

Phone Surveys

While phone surveys are also on the decline, they are still used across healthcare organizations and by research organizations. Phone surveys offer some advantages including the ability to verify and control who is completing the survey, the ability the clarify questions that are unclear or confusing, and a higher completion rate than paper surveys.

Phone surveys, however, are possibly the most expensive survey method due to the time-intensive nature of its distribution, requiring both a paid resource and the patient to connect over the phone at the same time. Because patients don’t often answer their phones or return calls like they once did, administering phone surveys is becoming more difficult and more expensive at the same time. It’s also worth noting that the tone of the surveyor, the process of clarifying questions, and the recording of a patient’s responses all introduce opportunity for surveyor bias.

Mobile Surveys

Web and mobile surveys are the most cost-effective and timely way to gather actionable feedback from patients. They are as convenient for the patient to complete as they are for the organization to distribute and because they do not rely on a person to conduct the survey, they can be completed any time of the day or night. 30%-40% of all web surveys are completed on a mobile device—and because web surveys can be distributed, completed, and collected within minutes—the time between the experience and the feedback is minimized, equipping healthcare organizations to respond quickly.

One of the commonly acknowledged drawbacks of online surveys is the risk of non-response bias due to the low adoption of mobile technology among older populations and limited access to the Internet in under-served populations. While this was once a valid risk, recent research indicates that this is less true today. It’s currently estimated that 95% of the US population uses a cellphone of some kind and 77% use a smartphone.

How Long Should My Patient Satisfaction Survey Be?

The length of your survey should help you accomplish something specific. Long-form, exhaustive surveys provide organizations in-depth insight into their operations through the eyes of their  patients—they are meaningful for specific and defined research. Short surveys are best practice for engaging the highest participation rate, directing patients to online review sites, and for obtaining real-time, actionable feedback from patients.

After working with organizations of all sizes and structures, we’ve arrived at three survey types, varied in length, to accomplish what our customers tell us are their most common and important objectives for surveying patients.

Visit Survey

The Visit Survey is designed to be quick and painless for patients to complete so healthcare organizations and medical practices can obtain feedback from as many patients as possible. It includes  seven questions, a length that is easy to complete on a mobile device and offers patients the opportunity to leave comments or request follow-up. Surveys like this are helpful when medical groups are looking for specific insight into where they should focus process improvement efforts before they turn their attention to improving the quantity and average rating of their online reviews.

Reputation Management

When a practice is ready to turn their patients into advocates, the Reputation Management survey is there to help. It mirrors the design of the Visit Survey but provides patients an opportunity to leave a public review on a specific review site, like Google, Healthgrades, or Yelp, selected by the medical practice or organization.

See Using Surveys to Improve Online Reviews for details about this survey types, how it works, and best practices.

Practice CAHPS Survey

For the organization or medical group that is anticipating their upcoming CGCAHPS scores and wondering where they may be vulnerable, the Practice CAHPS survey is helpful because it utilizes the same questions asked by CMS but without publicly reporting the results. Staying ahead of CGCAHPS can help reduce uncertainty about performance and give organizations an opportunity to make improvements in areas of the patient experience in time to impact their publicly reported results.

Because CGCAHPS is used by CMS to determine reimbursement, it’s important that healthcare organizations have access to a survey that mimics the same questions and gives them the best opportunity to obtain good results.

Customizing Your Survey

Children’s hospitals, FQHC’s, urban, rural, single-provider, and multi-specialty organizations all grapple with different challenges, making it tempting to customize a survey solution in the hopes of addressing the unique needs of an organization’s size, structure, and market. However, customization diminishes your ability to compare and benchmark performance across like organizations, something that most Relatient customers find more important. Customization also complicates the implementation process and makes it difficult to switch survey types if you change your mind about what you need later in the process.

Standardizing survey questions, length, and time of distribution gives organizations strategies that have been industry-proven to yield the best results and gives them the added advantage of being able to compare response rates and scores across industry segments that reflect similar organizational characteristics like size, structure, and market. This is true when standardizing questions, survey length, and timing of survey distribution.

Five Strategies for Driving Patient Satisfaction Survey Response Rates

Patient survey response rates average between 3%-16% and are impacted by survey type, length, distribution strategy, and timing —here are some easy ways to drive strong survey participation.

1. Make it accessible from a mobile device: make sure it’s optimized for mobile too. Try completing the survey yourself on a mobile device before distributing to patients.

2. Confirm phone number & email while your patients are in the clinic/office: There’s no better opportunity to verify contact info than when a patient is standing in front of you.  
 

3. Keep it short: You can expect a 15% drop in response rate on surveys that exceed 12 questions or 5 minutes to complete.  

4. Tell your patients you’ll be sending a survey: while you’re at it, let them know how much it means to you when they participate. 
 
5. Send the survey within one day of the patient visit: in order to have a real-time pulse on patient satisfaction, be sure to gather feedback while the experience is still fresh in the patient’s memory.

 

Sharing Patient Satisfaction Data With Physicians & Staff

Relatient customers are deliberate about sharing their patient satisfaction results with providers and staff because it helps them improve morale, address common frustrations, and direct improvements to the patient experience. For multi-location customers, the ability to segment their data by location and provider means they spend their resources more wisely because they aren’t guessing or making assumptions about which locations, providers, and parts of the patient experience need improvement. They talk about their results in staff meetings, post the data in employee areas, and email provider-specific data directly to providers.

Don’t forget about your staff. Patient satisfaction is impacted by more than the interaction with a provider—wait times, interaction with staff, and even office decor can play a role in the patient experience. It’s important to share patient satisfaction data and feedback with clinical and administrative staff as they often manage patient expectations and ensure patients are happy with their care and service in the office, survey data helps them anticipate gaps and fill them with better communication and improved processes.

“I segment my patient satisfaction data by provider and location so we can get right to the root of where there are problems.”
Carolyn Blue

Practice Administrator, Gwinnett Dermatology, P.C.

Using Surveys to Improve Online Reviews

Surveys offer healthcare organizations a strategy for turning happy patients into advocates through online reviews. Online reviews are an important part of a medical group’s or healthcare organization’s marketplace strategy as patients now use the Internet as their primary resource for researching healthcare providers before making a selection. Data shows that consumers value online reviews as much as they do personal recommendations. Furthermore, the ease of taking an experience—positive or negative—to the masses is now easier than ever thanks to the Internet, social media, and review sites.

While unhappy patients seem to naturally find their way to review opportunities, even the happiest of patients may not naturally take this step. This is why solutions like Relatient’s Reputation Management survey can be instrumental in helping practices establish or strengthen their online presence. This strategy isn’t about keeping unhappy patients from leaving an online review but rather it’s about leveraging happy patients to the same sites so your online presence is a true representation of the care and service you provide. While we know it’s tempting to segment which patients are directed to review sites based on their level of satisfaction, a balance of both positive and negative reviews reflects a realistic patient experience. A practice with all five-star reviews won’t build credibility online because variation is normal and expected. In other words, a perfect score isn’t believable and will cause patients to disregard your reviews.

After working with thousands of customers, we have developed some best practices that make Reputation Management a uniquely effective tool for improving both the quantity of online reviews and average rating.

The survey can be completed on a mobile device in less than one minute. In order to compete in an environment where patients are bombarded by surveys every day, making your survey short and simple will increase the likelihood that it will get answered.

The survey doesn’t utilize the same review site all the time. You should be able to determine which site you direct a patient to and should also periodically change which review site you utilize so you don’t rely on one site for all traffic. You can rely on all prospective patients to utilize the same resources during their research and creating a presence on more than one review site will help establish credibility as well.

Every patient, by default, has anonymity. This drives higher response rates and honest feedback. But patients should also have an opportunity to identify themselves and request follow-up, giving providers and their staff valuable opportunities for service recovery. Following up with patients after they participate in your survey also validates the time they took to share their experiences with you.

Patient Who Won't No-Show Due to Reminder

Patient Satisfaction Surveys & The Digital Front Door

A digital front door strategy recognizes the relationship between all the patient journey touch points, including patient scheduling, the appointment itself, registration and check-in, follow-up and feedback, and patient payments, and leverages their connections with technology that patients will use because it lives outside of portals and apps and doesn’t require the hassle of usernames and passwords.

A digital front door is a strategy for expanding patient access and understanding what patients want from their healthcare experience. Outside of emergency rooms and inpatient hospital stays, healthcare tends to operate within standard business hours. But patients rarely think about healthcare during those times, their triggers tend to take place in the middle of the night or on the weekends when no one is available to help with appointments, follow-up, or other common administrative functions. A digital front door also recognizes how patients prefer to communicate with their healthcare providers and incorporates patient habits and behaviors into processes, technology, and communication. This strategy relies on real-time feedback to understand patient expectations at each step of the patient journey and pivots to meet those needs—making patient satisfaction surveys an integral part of a comprehensive digital front door strategy. 

Find a Partner, Not a Vendor

There’s a lot to consider as you enter the vendor selection process, including how many vendors you should bring into your supply chain. Consolidating your patient engagement solutions to one vendor ensures consistent messaging, gives you the opportunity to take advantage of bundled pricing, reduces setup fees, and makes integration simpler. It also makes ongoing maintenance and support a breeze, ensuring that you’ll be able to take advantage of future updates without sacrificing usability or integration.

Survey products sold as add-ons to an EHR or practice management system can appear convenient but often  fail to deliver ROI. EHR and PM systems are built to be clinical data powerhouses but rarely are they designed around behavioral-based, patient-centered best practices. It’s also important to recognize that if you replace your EHR/PM system in the future, the add-on solutions will have to be replaced as well. 

Patient Who Won't No-Show Due to Reminder

Conclusion

Patient satisfaction surveys can be one of the most valuable tools available to you for maintaining a competitive advantage in your market, retaining current patients, and attracting new ones. In addition to helping you keep a current pulse on the health of your practice, web and mobile surveys offer your patients an intuitive path to leaving an online review, something they may not otherwise go out of their way to complete. A strong online presence includes honest feedback from all your patients and a star-rating that reflects the organic balance of feedback. You shouldn’t expect 5-star ratings 100% of the time and prospective patients don’t either, they are more interested in finding a representative spread of feedback from your current patients so they can trust the reviews they read and make an informed decision. 

While there are still organizations that design, distribute, and analyze their own patient satisfaction surveys, the tried and true best practices employed by partners who specialize in collecting patient satisfaction data can help you gain more ground faster and for less money. If you haven’t already, you’ll quickly learn that patient survey solutions are available from a variety of vendor types, including marketing and web design firms, research organizations and third-party CAHPS administrators, EHR and portal vendors, and patient engagement solutions. Each of these options is capable of meeting different organizational objectives, however a comprehensive patient engagement platform that includes patient satisfaction surveys will offer you the greatest flexibility, ROI, and operational efficiency by leveraging the best practices of patient-centered engagement across all their integrated solutions.

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