A kiosk of truth

MGMA Connexion, Aug 2005 by Sommers, Paul A, Dropik, Ron, Heilman, Greg, Hoyt, Suzannah M, Parker, Melissa J

Case study: A patient satisfaction system evaluating 'moments of truth' in medical care and service

Medical care historically has been protected from the patient satisfaction arena.1,2 Patients rarely question, compare or scrutinize the service they receive from physicians as they do from other products and services.

If health care consumers don't expect more than what they've been getting, why change?

Many health care organizations do not feel a sense of urgency to address patient expectations. Yet today, changing the focus of care toward the patient is a requirement to stay in business.3 Those in health care who do feel the urgency may want - or need - to differentiate themselves from the competition. We differentiated ourselves with the Moment-of-Truth United Family Practice Health Center (UFPHC) Patient Satisfaction Survey and program.4,5,6

Keep current patients and attract new ones

The survey's purpose is to collect and act on patient satisfaction information about the medical care and service experience the patient has at UFPHC. Resolving issues as close as possible to the time they occur epitomizes continuous quality improvement. The project's goal: to retain current patients and attract new ones by evaluating and resolving satisfaction issues.

We identify medical care and service delivery issues as close to their occurrence as possible. Then a UFPHC patient advocate works with each patient to resolve his/her problem. The effort spurs current patients to remain loyal and tell others about their experiences. We estimate the value of retaining one UFPHC patient/family in the UFPHC/Allina Health System as $76,000 over 15 years and $102,000 over 20 years. UFPHC retention rates range from 70 percent to 80 percent, defining an active patient as one who has visited his/her provider at least once in the last two years.

Medical practice organization and patient population

The medical staff comprises 12 primary care physicians, 18 family medicine resident physicians, two nurse practitioners, one physician assistant and three mental health professionals. Bilingual clinic employees are available. The clinic has a patient base of 13,000 that accounts for more than 50,000 annual visits. Nearly 2,000 patients are admitted to United Hospital of St. Paul each year. The patient population served by UFPHC mirrors the diversity of St. Paul, in addition to being disproportionately poor. Over the years, UFPHC has served an evergrowing number of immigrants, including Hmong, Russian, Somali, Eritrean, Central American, South American and Mexican populations.

The survey kiosk

To collect patient satisfaction information, we use a touch-screen kiosk developed by a wireless communications company. The screen displays the "moment-of-truth" patient satisfaction survey, offered in multiple languages to patients concluding their visit to UFHPC. After someone completes the two- to three-minute questionnaire, responses are automatically entered and stored into the secure database. The kiosk can send the data through an unwired cellular connection or through the clinic's wired Internet connection.

The system triggers an alert if the data indicate that a patient wants to be called within 24 hours of the visit. These alerts are provided by e-mail or by report generation at day's end and delivered to the appropriate person.

The surveys are not intended to collect information about employee performance. The process seeks to enforce the concepts of doing today's work today and continuous quality improvement. Actionable information received from a patient empowers a staff member to act in the patient's behalf to resolve issues.

The survey appears in languages representing the groups most often using the clinic and currently includes English, Somali, Spanish and Hmong. (Paper questionnaires are also available in each language.)

Up through April of this year, 1,569 patients answered the questionnaire.

Focus groups

UFPHC has been working with its immigrant patient communities to better understand ethnic and cultural differences and align medical care and services to meet their needs. After several weeks of monitoring kiosk results, we noticed that fewer nonEnglish-speaking patients - mainly Hmong, Somali, Hispanic and Russian - completed surveys than English-speakers, and the related scores were less satisfactory.

We conducted focus groups of clinic patients from these groups, using an outside facilitator with interpreters, to learn what clinic staff could do to better meet their medical care and service expectations. We also asked what it would take for each ethnic group to increase its use of the kiosk. During the focus groups, the ethnically diverse patients received information about why UFPHC sought their opinions and were shown how to use the kiosk. We completed focus groups in mid-February 2004.

Results

We combined the results of the kiosk survey (page 36) with information from the focus groups. We summarized data to provide UFPHC with baseline measures that could be rank-ordered and used to develop a comprehensive patient satisfaction improvement plan: