Using public reports of patient satisfaction for hospital quality improvement

Health Services Research, June, 2006 by Judith K. Barr, Tierney E. Giannotti, Shoshanna Sofaer, Cathy E. Duquette, William J. Waters, Marcia K. Petrillo

Leadership and Support for QI. In answer to a question about the designated hospital QI leader, respondents identified a position (e.g., QI/QA director or vice-president), a department (e.g., Q I/QA Department) or committee (e.g., Performance Improvement Committee). While some respondents identified executive level staff (e.g., CEO, COO, VP) as the champion for QI, there was little consensus on this question; and responses varied within and across hospitals, reflecting different perspectives. Sources of support within the hospital were identified by respondents' numerical ratings of the amount of support from key hospital staff for QI activities and for using patient satisfaction data to drive QI, as shown in Table 2. While there was some variation in responses among hospitals, the overall averages for all hospitals show a clear pattern with the greatest support from the board and senior management and the least support from the medical staff. Confirming these ratings, over half volunteered that organizational commitment was an impetus for QI.

   One hundred percent support from the Director level.
   I would say that senior leadership in general ... all are
   definitely advocates for patient satisfaction surveys.

   I think the medical staff [are least supportive], because
   they're not necessarily intimately involved ... they don't
   see the direct impact on them.

   The physicians don't want to listen to it because they all
   have a certain scientific bent to them ... they all start
   arguing what the data is.

Barriers and Facilitators to QI. Despite support within the hospitals for QI activities, respondents also described barriers to implementing QI activities, related to hospital resources and the environment. While most agreed that the hospital provided enough resources for the QI process, they cited insufficient capital finance and funding for infrastructure, along with staffing issues, as barriers to QI, resulting in difficulty prioritizing with limited resources to implement changes needed to achieve significant improvements. Several respondents mentioned specific OI data needs, such as software, automated data systems, assistance in analyzing the data, and translating the data into actionable information ("ability to abstract the right data to analyze processes"). About half of the respondents commented on the need for staff training and insufficient time for staff to do all that is expected of them, such as collecting QI data.

Several respondents noted a perception of staff resistance in the internal environment. Examples were lack of staff commitment to QI goals and concern about being held accountable. Also mentioned was the need to promote staff understanding and "buy-in" for the QI program through education, involvement on committees, and employee surveys. Responses indicated that successful QI programs require widespread support for QI, a culture and leadership fostering QI, and a team approach.

   It's not an active resistance to this particular measure; it's just
   sort of a difficulty with one more thing to add into people's
   schedules.

   We need to change their attitude in what responsibilities they need
   to take action to make it better within their departments ... It
   lies in each individual....

   We had to change our culture and make performance improvement more
   of a priority. I think that the more data you give people that's
   meaningful, the more interested they are in working with you.