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 offered by text and email have proven to be an effective strategy for directing patients to websites where they can leave public reviews. 

The imperative to measure patient satisfaction and use the data to create meaningful change in healthcare 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 from first interaction to last, 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 does not equal the other.
  • Organizations small to large still utilize paper surveys in some capacity but it 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 the survey and analysis process for staff.
  • Web reviews are a significant part of a patient’s decision-making process and will continue to grow in importance. Mobile surveys can be used to help drive web 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 1980 researchers developed the first patient satisfaction questionnaire, a 55 likert-scale 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 might be interested in our patients’ perceptions outside of checking the quality initiative box.

Satisfied patients lead to 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.

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 other parts of their healthcare experience are more likely to escalate even small perceived mistakes or neglect in their care. 

Medical practices with high patient satisfaction attract more patients and therefore, more revenue. Word of mouth is powerful and satisfied patients are quick to recommend their providers to others.

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.

What do physicians and providers think about patient satisfaction surveys? 
Physicians have some big feelings about patient satisfaction data and the role it should and shouldn’t have in determining the quality of the care they have provided or how they are reimbursed by payers. As patients have more access to information—valid or otherwise—it isn’t uncommon for a patient to seek medical care with a predetermined conclusion about their diagnosis or treatment. When a patient’s desires for specific testing or treatment don’t align with clinical best practice, frustration and dissatisfaction sometimes ensue. Still, physicians invest a lot of time, energy, and resources into collecting patient feedback and ensuring their practices meet 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 vendors offer a survey solution; finding options in the marketplace is easy but determining which solution and vendor will help you accomplish your financial, clinical, and operational objectives in the best way is more difficult. We’ll use the next few sections to examine survey options by type, design, and length.

Types of Surveys

Healthcare organizations of all sizes and structures 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. They are the leading distributor of CAHPS surveys, as 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 opportunities for measuring patient satisfaction in a quick, simplified, and efficient way so organizations 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 in both short and long form. Some medical practices distribute these during the checkout process while others mail them to patients after the completion of an office visit. It may be surprising to learn that paper surveys are utilized by large organizations as well as small practices, though they are definitely on the decline. This is likely because 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 who act on behalf of healthcare systems. 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 (once a phone survey begins the odds that the survey will end before it is completed are very low). 

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 bias with a phone survey. 

Web & Mobile Surveys

Web and mobile surveys offer organizations 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 of a patient’s visit—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 under-coverage or bias in who completes the surveys. Under-coverage refers to the risk that survey results may not be truly representative of the patient population due to the need for internet access. While it used to be true that underserved populations had less access to the internet and elderly populations had less comfort and therefore lower adoption of internet and mobile technology, recent research indicates that this is less true today. Access to the internet is now more widely available, even among underserved populations and mobile device use is growing across all age groups, including those over the age of 65.

How Long Should My Patient Satisfaction Survey Be?

Survey length is an element of your survey design that should help you accomplish something specific. Long-form, exhaustive surveys provide organizations in-depth insight into every crevice of their operation as seen by the patient—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 objectives for surveying patients.

Visit Survey

Our Visit Survey is designed to be quick and painless for patients to complete so healthcare organizations and medical practices can obtain from as many patients as possible. It’s designed to be seven questions, a length that is quick and 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, our Reputation Management survey is there to help them do this. 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. 

Mock CAHPS Survey

For the organization or medical group that is anticipating their upcoming CG-CAHPS scores and wondering where they may be vulnerable, a survey like this is helpful because it asks the same questions but without publicly reporting the results. Staying ahead of CG-CAHPS can help reduce uncertainty about performance and give organizations an opportunity to make improvements in areas of the patient experience that aren’t scored well. Because CG-CAHPS 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 all 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 of our customers find more important than customizing their survey. 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.

What Should My Patient Response Rate Be?

Survey response rates vary widely in healthcare, averaging anywhere between 3%-16%. Everything from survey type, length, distribution strategy, and timing can impact response rates for better or worse—here are some best practices for driving strong survey participation.

Five Strategies for Improving Patient Satisfaction Survey Response Rates

  • 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.
  • 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.
  • Keep it short: You can expect a 15% drop in response rate on surveys that exceed 12 questions or 5 minutes to complete.
  • 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.
  • Send the survey within 1 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.

How to Share 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, even office decor and layout can be part of the patient experience. It’s important to share patient satisfaction data 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.

Using Surveys to Improve Online Reviews

Surveys offer healthcare organizations a strategy for turning happy patients into advocates in the form of 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 make a selection. Data shows that consumers consider online reviews with the same weight 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 think to take this step. This is why surveys 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 reviews are a true representation of the care and service you provide. While we know it’s tempting to determine which patients are directed to review sites based on the likelihood that they’ll leave a positive review, here are two reasons we strongly discourage this practice.A balance of reviews, both the negative and the positive, reflect a realistic patient experience and patients know this. A practice with all four and five-star reviews won’t be believable because variation is expected is normal and expected. In other words, a perfect score isn’t believable and patients will disregard your reviews.

After working with customers of varying sizes and structures, we have developed some best practices that make Reputation Management a uniquely effective tool for improving both the quantity of online reviews and the average star 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. 
  • There’s a prompting to a specific review site. Best practice indicates you should be able to determine which site you direct a patient to and recommends periodically changing which review site you utilize so you don’t rely on one site for all traffic.
  • Every patient, by default, has anonymity. This practice drives higher response rates and honest feedback. Patients should have an opportunity to identify themselves if they would like follow-up, which gives providers and their staff valuable opportunities for service recovery and building/strengthening long-term relationships with patients.
Patient Who Won't No-Show Due to Reminder

Patient Satisfaction Surveys & The Digital Front Door

It’s common for organizations to tackle objectives one at a time, often seeing common challenges like patient no-shows, patient scheduling, check-in and registration, and satisfaction as stand alone projects. However, a comprehensive Digital Front Door strategy recognizes the relationship between all of these patient journey touchpoints and leverages their connections with technology. And not just any technology, intuitive 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 isn’t about a solution or a vendor, it’s 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 recognized 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 patient feedback to understand patient expectations at each step of the patient journey and pivot to meet those needs, making patient satisfaction surveys an integral part of a comprehensive digital front door strategy. 

Find a Partner, Not a Vendor

Consolidating your patient engagement solutions under one vendor ensures consistent messaging, gives you the opportunity to take advantage of bundled pricing, reduces setup fees, and makes integration much simpler. Using disparate solutions for each touchpoint in the patient journey means you’ll have to evaluate each one to see if it integrates with your EHR/PM system and go through a new integration/set-up for each.  In the event that you make a change to your EHR/practice management system, working with one patient engagement partner increases the likelihood that you’ll be able to make a smooth transition without interrupting your patient engagement processes.

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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