Literature review of satisfaction surveys Throughout the past decade, patient satisfaction has increasingly become a priority in many

healthcare organizations. Ensuring the satisfaction of patients is important to a healthcare organizations long-term survival and overall success. Since many of the products and services offered by competitor healthcare organizations are similar, having high patient satisfaction ratings is one way in which an organization can differentiate itself from others and achieve a competitive advantage (S SS!. The patient satisfaction survey is the most commonly used tool to collect information an organization needs to understand and evaluate satisfaction (S SS!. These surveys may help to teach organizations about their patients and provide patients the opportunity to e"press their thoughts regarding their e"perience with the practice and providers. #rganizations use satisfaction surveys for various reasons including to identify ways to improve patient service and care. $ccording to S SS, a software products company that delivers statistical product and service solutions for survey research, satisfaction surveys are used to meet certain ob%ectives which include understanding the e"pectations of patients, determining the ability of the organization to meet their patients e"pectations, developing service or product standards, calculating trends, establishing goals, and evaluating the impact of change. rior to conducting a

patient satisfaction survey, it is vital that an organization be prepared and that they embrace a &uality improvement culture. 't has been shown that patient satisfaction is a measure of the &uality of services being provided ((hite, )***!. $ patient satisfaction survey can help to show patients that a healthcare organization is interested in &uality and

in ma+ing improvements. 't demonstrates an organizations commitment to its patients (,uzzatto, -../!. The main criticism of patient satisfaction surveys is that their results are unreliable. 'n order to get the most out of the data, an organization should use statistical analysis to interpret survey responses into meaningful information. 0randi (hite in her article 12easuring atient Satisfaction3 4ow to do it and why to bother,5 suggests that organizations +eep several things in mind for statistical reliability of their satisfaction surveys. These guidelines include determining an appropriate sample size, distribution method, considering the response rate and the actual number of responses received ()***!. 6espite this drawbac+, the benefits of conducting a patient satisfaction survey are great to a healthcare organization. These benefits include improving patient loyalty, reacting to changes in the mar+et, identifying new opportunities, retaining or gaining mar+et share, increasing revenue, and reducing costs (S SS!. Review of Questionnaires atient satisfaction surveys are derived in a variety of ways for use in multiple healthcare settings. Some organizations embrace a universal or generic type of &uestionnaire that may be used in outpatient and inpatient settings. #ther &uestionnaires used are patient specific, where the survey is designed for patients in a particular setting or specialty. Survey instruments which are generic allow comparisons among many different healthcare settings, but may lac+ in the validity of the content compared to that of specialty or patient specific &uestionnaires. #ften patients are not consulted when choosing the most appropriate survey tool and the choice is made solely by the professionals within the organization. 7nfortunately, there are few studies conducted on

whether one &uestionnaire is better than another ( eytremann-0ridevau", -../!.

atient

satisfaction &uestionnaires may also be designed to strictly measure satisfaction, which is often criticized for being an ambiguous term, or they may directly report on patients actual e"periences. 8egardless of the tool chosen, it is important for professionals choosing a patient satisfaction survey instrument to ensure that the data collected will be measurable and useful for &uality improvement efforts. #ne study conducted involving two psychiatric inpatient facilities compared satisfaction &uestionnaires specifically designed for psychiatric patients to those which were generic patient satisfaction &uestionnaires. The investigators wanted to +now if one was better than the other in evaluating patients satisfaction in the psychiatric setting. Their findings showed that one was not advantageous over the other but that each did have drawbac+s. $lso, it was shown that the generic instrument was more desirable when comparing medical services or hospitals ( eytremann-0ridevau", -../!. #ther ways in which &uestionnaires may differ are loo+ing at how they are administered. Studies have been done on the effectiveness of a computerized &uestionnaire versus the traditional paper-and-pen method. Some of the advantages of a computerized &uestionnaire, specifically using touch-screen technology, include shorter time to complete the survey, faster data analysis, and overall easier for patients to use. The 9onsumer $ssessment of 4ealth roviders and Systems (9$4 S! 4ospital Survey is a standardized survey developed by the 9enters for 2edicare and 2edicaid Services (92S! and the $gency for 4ealthcare 8esearch and :uality ($48:!. The 9$4 S 4ospital Survey is designed to as+ patients to report on various aspects of their health care e"perience. The development of the survey was based on certain ob%ectives,

including to generate comparable data on patients perspectives of the care they received and to be able to ma+e comparisons among other hospitals, and to publicly report the data, giving hospitals motivation to initiate and continue &uality improvement efforts within their organization. $ccording to the %ournal article, Measuring Hospital Care from the Patients Perspective: An Overview of the CAHPS Hospital Survey Development Process, 1The 9$4 S 4ospital Survey is intended to become the standard survey instrument and data collection methodology for measuring patients perspectives on inpatient hospital care and reporting valid comparisons among hospitals5 (;oldstein, -..<!. 'n the future, ' thin+ that many hospitals will embrace this survey as it becomes the standard for measuring patients e"periences. $ hospital can only benefit from using the 9$4 S 4ospital Survey alongside their preferred data collection instrument. 4ospitals rely on various survey vendors to collect patient satisfaction data and the 9$4 S survey will standardize the instrument among the hospitals using different vendors. Survey Design $ two stage sampling method will be used to survey patients satisfaction in an outpatient pediatric clinic located in an academic teaching institution in a metropolitan area. hysicians, pediatric residents, nurses, medical students, and administrative

personnel all wor+ within the clinic doors. The practice sees patients up to )= years of age and in a variety of specialties, including primary care, infectious disease, adolescent medicine, and endocrinology. #nly primary care patients who have been seen in the clinic within the past year, #ctober -..< to #ctober -../, will be eligible to participate in the satisfaction survey. rimary care patients were chosen because they ma+e up the

ma%ority of the visits to the clinic. To ensure that a representative population is chosen, patients who meet the above criteria will be randomly selected from the primary care database. The practice averages >>> primary care visits in a given year. Therefore, a sample size of >>> will be chosen. The survey will be conducted by sending a mass mailing to the chosen survey participants as+ing them to rate their overall satisfaction with the practice. The following descriptors will be used from which to choose a response, highly satisfied, satisfied, neutral, dissatisfied, and highly dissatisfied. This will complete stage one of the survey. To save the organization money, save the survey respondent time, and to +eep patient anonymity to a minimum, the mass mailing will include both stages of the survey and only those rating their satisfaction level with the practice as either highly satisfied or highly dissatisfied will be as+ed to complete the bottom portion, the second stage, of the survey. Each patient, or family, responding to the first stage of the survey as highly dissatisfied and completing and responding to the second stage of the survey, will be sent follow-up surveys every four months for a period of eight months, resulting in three time periods of analysis. 6ue to the nature of the practice, a pediatric outpatient clinic, the survey will be addressed to the parents or careta+er of the patient. The practice hopes to have a response rate of ?.@ or better.

Two Stage Sample Survey Tool 6ear Aamily Than+ you for choosing Smithtown ediatrics for your health care needs. (e hope that your physicians and staff provided you with e"cellent care and that all of your needs and e"pectations were met. (e are committed to providing &uality medical services to all of our patients. (e value your input and would greatly appreciate your feedbac+. return this survey at your convenience. Please indicate your overall satisfaction with our practice o o o o o 4ighly Satisfied Satisfied Beutral 6issatisfied 4ighly 6issatisfied lease complete and

If you selected Highly Satisfied or Highly Dissatisfied, we would appreciate you answering the additional questions below ! "as scheduling an appointment simple and undemanding# o Ces o Bo 'f no, please describe >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> $ %& Please indicate your waiting time before seeing a physician at your last visit ''''''''''''''''''''''''''''''''' (& Did this waiting time seem acceptable to you# o Ces o Bo ) "as your provider courteous# o Ces o Bo 'f no, please describe >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> >

* "ere other clinic staff courteous# o Ces o Bo 'f no, please indicate who was involved and describe >>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > + "as the cleanliness of the practice acceptable# o Ces o Bo 'f no, please describe >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> , "ould you recommend this practice to others# o Ces o Bo Than+ you for completing this survey. Smithtown ediatrics

Data %nalysis