How to improve through patient satisfaction surveys

An effective program for patient feedback can yield lasting benefits.


Implementing and utilizing patient feedback can strengthen your operations — whether your goal is to satiate a MIPS improvement activity or to satisfy a genuine interest in what your patients think.

Surveys offer patients an outlet to share their individualized experiences with the practice and its employees. Responses to the survey allow practice personnel the opportunity to actively listen to patient concerns and act accordingly. This article discusses the vital importance of such surveys and offers tips on how to develop an effective program for patient feedback.

Identify the delivery vehicle

Once you decide to implement a survey, it is then necessary to choose the delivery vehicle (for example, email or in-office questionnaires). Thankfully, many third-party, communication-driven tech companies can assist here. Many of these companies can fully integrate with your practice’s EMR software so that much of the survey process can be automated.

Whether you choose to work with a third party or conduct the survey with in-office resources, it is important to customize the survey to your practice’s specific needs. For example, you may want to survey patients who have visited your office for a comprehensive examination but maybe not a pterygium excision. Or, to go a step further, you may want to send separate surveys to the various appointment types to receive custom tailored feedback.

Choose the sample size

The greater the number of patients surveyed, the more statistically significant and accurate the results will be. The goal of any survey is to accurately sample the overall population without actually surveying the entire population, which would be nearly impossible.

A good rule-of-thumb is to touch approximately 65% of your patient base within each defined population. After identifying who you would like to survey (such as patients who visited for a one-year follow-up), you must receive enough responses to have confidence in your findings. The minimum number of responses for a “statistically significant” survey depends on many variables, such as available population size, your acceptable margin of error, confidence level, sample size, and even the estimated response rate. This is true with any quantitative study. Most consumer statisticians recommend a minimum of 200 responses, yet many of the variables mentioned above could easily affect that number.

Also consider the implications of over-surveying patients. It is better to survey patients only once per measurement period. This ensures accurate, well-sampled results that your practice can stand behind and base decisions off.

Develop survey questions

Once you decide on a delivery vehicle and patient characteristics, develop questions. Consider the following categories of questions:

Multiple choice questions/statements. These questions are popular, as patients can usually answer quickly and easily. For example:

Appointments are available within a reasonable time frame.

__ Strongly Disagree

__ Moderately Disagree

__ Slightly Disagree

__ Slightly agree

__ Moderately Agree

__ Strongly Agree

Multiple choice questions can provide a snapshot or average score in a specific area. Keep in mind the data are limited to the fixed answers you provide.

Open-ended questions. Open-ended statements, as opposed to direct questions, are often a trusted tactic for eliciting explicit and honest feedback. A simple statement like, “Tell us about your experience,” seemingly docile and innocuous, may open a floodgate into an ocean of unfulfilled needs and irrational expectations around wait times, the quality of service, etc.

While disheartening, a patient’s frustrating experience in the practice may be easy to minimize as an anomaly. This is where the patient satisfaction survey is of great value. It can define patterns of behavior within the practice. Subjective offerings that are consistent in nature and display a similar theme are an invaluable tool to improve operations. We often make decisions based on what we think our patients expect — these surveys give us an opportunity to read the thoughts of our patients.

Net Promoter Score (NPS). A common customer satisfaction benchmark, transcending all industries, is the NPS. Used to gauge loyalty, your NPS is obtained by asking a question similar to, “On a scale of 0 to 10, how likely are you to recommend us to a friend or colleague?” The patient then responds by selecting their likelihood on a Likert scale (with 10 meaning extremely likely).

The respondents are classified into three groupings. Active promoters (9-10) are those who are enamored with your practice. They are your biggest fans and loyal. Passive patients (7-8) are indifferent and would be willing to switch providers if an opportunity presented itself. Active detractors (0-6) aggressively try to discourage others from visiting your office. Determining your practice’s NPS is a great way to turn a subjective metric into a useful benchmark. The NPS is even more useful when it is used to drill-down to a specific provider, location, or service.

Act on survey data

The primary benefit to integrating surveys is direct patient communication. For each response, thank the patient for taking the time to complete the survey. Respond to the patient in a positive, upbeat tone. For example, if a patient commends your practice for a shorter than expected wait time, you may respond: “Thank you for taking the time to complete our survey. We recognize that having the best physicians and providing exceptional care is only part of the equation. That is why we focus on the overall patient experience within our practice. We truly appreciate you allowing us to care for your vision.”

Whether reading the unbridled verbiage of an open-ended, satisfaction survey respondent or a less-than-stellar NPS, it is imperative that you take the opportunity reach out to and engage with the patient. Letting the patient know you are sincerely interested is one of the most impactful actions you can take and will yield great dividends.

Outside of directly communicating with the patient, the responses can also be used in mediums such as celebratory, company-wide emails and practice newsletters. One of the most rewarding parts of this exercise is having the opportunity to celebrate those health-care professionals who are praised for going above and beyond. Patients may even offer to replicate their testimonial for your website or social media site.

Internally, review the responses on a case-by-case basis. Testimonials and other assorted feedback as individual case studies within the group can encourage discussion and inspire staff to think through specific, real-life scenarios. What could we have done better? Is it possible that other patients share the same perspective?

Reap tangible benefits

At University Eye Specialists our survey responses and our net promoter score(s) have yielded perceptible results. For example, our senses have been heightened towards patient wait times and flow efficiency. Survey reviews helped us determine where and when our bottlenecks occur so that we could adjust staffing, room utilization, and physician schedules accordingly. We now have the ability to monitor flow through audit and observation, and we have the advantage of being able to read the subjective comments and experiences of our patients. Feedback from patients who were “surprised how fast they were seen” boosts morale. Consistent statements like this, coupled with clinical observations, let us know we are on the right track.

Also, survey feedback regarding tertiary operations such as optical, front office, call center, etc., enable us to celebrate excellence and grow stronger teams. Our respondents allow us to view their thoughts, reveal their psychographics, and are both educational and inspirational. We must value the voice of our patients.

Why it matters

How are you measuring patient satisfaction? Are you relying on subjectively whimsical interoffice comments, or are you actively gauging your net promoter score? If your practice does not conduct patient satisfaction surveys, you are missing countless occasions to recognize employees and discover opportunities. When measuring the overall health of your practice, is there a better tool than the real-time thoughts of the patients who trust you with their care? The practice that seeks patient satisfaction as a tangible goal — and not just a hopeful byproduct of good health care — can harvest lasting benefits. OP