Practice Tips

Patient satisfaction is often used as a performance measure for the quality of the healthcare delivered at a particular location and organization. Patient satisfaction has implications on reimbursement, patient safety, brand reputation, and competition with similar healthcare organizations. Collecting patient feedback in the office setting is an important component in evaluating and improving the care provided. When patients give feedback, whether through a survey or through a complaint, the practice can use this information to examine and improve the services they provide.

Feedback

Practices can receive feedback about their services in different ways, including patient satisfaction surveys, patient complaints, patient compliments, or online comments on websites and social media. Whether the feedback is positive or negative, the information should be used to assess how your practice is perceived by the public and give you the opportunity to evaluate your processes and environment for improvements.

Surveys

Patient satisfaction surveys give your practice valuable feedback about the services you provide. Surveys can help you determine not only your patients’ perception of the clinical care they received but also the courtesy and effectiveness of your administrative support staff. Seeking feedback is a good way to demonstrate to your patients and their families that you value their opinions and are receptive to their needs. Using feedback as an opportunity for improvement demonstrates to your healthcare staff that working on increasing patient satisfaction is an important component and extension of their care delivery.

In order to obtain an accurate view of your patients’ perceptions, consider conducting surveys on a regular basis, but at least annually.

There are several types of surveys a practice can use; these include:

• In-office survey: While these might be convenient and low cost, you run the risk of patients being concerned about their anonymity, which will affect the information they provide to you.
• Mail survey: Permits the patient to remain anonymous, allows time for the patient to reflect on their experience, and is lower cost. Due to the number of steps the patient must take to get these back to you, return rates can be low.
• Telephone survey: Professional marketing firms and national vendors, such as NRC and Press Ganey, can be hired to complete these surveys for you, which can increase patient comfort in providing sensitive, challenging, or negative experiences.
• Website survey: Office practices with websites may have the capability to offer satisfaction surveys online. This can be another low-cost option, but it does involve additional steps for the patient, which could drive return rates down.
• Electronic survey: Typically delivered via a link to an email or cell phone, is easy for the patient to complete and offers more anonymity for patients to feel comfortable sharing sensitive, challenging, or negative experiences.

Reviewing and acting on survey data is the most important aspect of the process. If patients take the time to complete a survey, most do in the hope that their comments will make a difference in the care delivery of the practice.

In order to evaluate the data:

• Aggregate the survey data for comprehensive analysis.
• Bring the results back to your clinical, administrative support, and provider teams and discuss, looking for areas of improvement.
• Identify and prioritize areas for quality improvement initiatives.
• Try to align your quality improvement initiatives with your strategic aims.
• Initiate the changes using an evidence-based approach, such as Plan-Do-Study-Act (PDSA).

Complaints

When a patient’s or family’s expectations are not met, they may choose to voice a complaint verbally or in writing. While it can be difficult to receive a complaint, this should be viewed as another opportunity to not only address the specific concern of that patient/family but also to make overall improvements to the practice. Complaints can range from simple frustrations with perceived rude treatment by administrative support and clinical staff to concerns about unmet medical needs to allegations of negligence. Whatever the complaint, your practice should listen and respond in a timely manner to the concern and make the patient feel valued and responded to.

All staff members should receive education on effective communication and how to appropriately respond to patient complaints. Empathic listening skills are important tools to let patients know they are being heard and that their concerns matter. For more information on improving communication, refer to the MMIC Practice Tip: Strategies for Effective Communication

While it may be acceptable for administrative support staff to address minor complaints such as long wait times or difficulty obtaining convenient appointment times, it is important to establish guidelines to identify when to immediately involve management. When the complaint is related to clinical care, the physician should be made aware of the complaint and involved in the resolution.

Tracking, Trending, and Monitoring Complaints

Tracking and analyzing patient complaints can provide your practice with valuable information about how to improve patient care and satisfaction. Practices should consider using a centralized tracking system for all complaints to ensure follow-up and trend identification.

• Keep a record of complaints; list the action taken and recheck to ensure the response or the change is appropriate. For practices that do not have an electronic tracking system, see the sample Complaint Log at the end of this practice tip for an example of what and how to track manually.
• Identify patterns of complaints and implement corrective actions. Several complaints around the same issue or staff person may indicate the need for staff training or changes in processes.

Complaint Management

If your practice is part of a health system, refer to your organization’s policies and procedures for steps to follow in addressing patient complaints. Some practices that are part of a hospital health system may be held to accreditation regulations and state statutes regarding complaint and grievance management. See our associated practice tip, Complaints – Patients in Acute Healthcare Facilities

When responding to verbal complaints, remember to employ empathic listening skills. Listen to the patient without interrupting, maintain eye contact, and be mindful of your body language. Empathize with the patient and try to see the issue from the patient’s perspective. Work with the patient to resolve the issue and thank them for bringing the issue to your attention. While many verbal complaints can be addressed by talking with the patient, larger, more complex concerns may require further investigation and a written response.

When a patient sends a written complaint to your practice, it is appropriate to respond to the complaint in writing in a timely manner. Before responding, be sure to carefully investigate the complaint. This should include a review of the patient’s medical record as well as gathering input from the clinical or administrative staff who were involved in the patient’s care. After your review, determine your response to the concerns expressed. Be sure to thank the patient for sharing their concerns and explain any steps you have taken to address their concerns. Your response letter should not be filed in the patient’s electronic health record but should be kept in a separate quality improvement file.

If a patient complaint involves allegations such as inappropriate care, misdiagnosis, negligence, or a threat of litigation, or notification of a patient complaint to a Board of Licensure, contact your medical professional liability carrier as soon as possible for them to assist you.

Online Complaints

We are now living in a digital world, and patients may choose to voice complaints about your practice on the internet, such as through a Google review or on other social media platforms. While it can be frustrating to see negative comments about your practice online, practices must be cautious about how they respond to such reviews. Patient privacy laws, such as HIPAA, prevent healthcare providers from disclosing a patient’s protected health information. An appropriate response might be to acknowledge their concern and state that you would be happy to address their concern if they contacted your office directly.

Prompt and thoughtful responses to in-office patient complaints or conducting patient satisfaction surveys with appropriate follow-up can demonstrate to patients that your office cares about their patients and is willing to work with them to address concerns. When patients feel their concerns are addressed, they may be less likely to resort to posting complaints on the internet.

Resources

AHRQ (2023). CAHPS Surveys and Tools to Advance Patient-Centered Care. DOI: Consumer Assessment of Healthcare Providers and Systems (CAHPS) | Agency for Healthcare Research and Quality (ahrq.gov)

American Medical Association (AMA) (2023). Are physicians prohibited from responding to online patient reviews? DOI: Are physicians prohibited from responding to online patient reviews? | American Medical Association (ama-assn.org)

Maine Board of Licensure in Medicine (2023). File a Complaint. DOI: File a Complaint | Maine Board of Licensure in Medicine

NEJM Catalyst (2018). Patient Satisfaction Surveys. DOI: Patient Satisfaction Surveys | NEJM Catalyst

State of Maine Board of Nursing (2023). How to File a Complaint. DOI: How to File a Complaint: Discipline: Maine State Board of Nursing

State of Maine Department of Health and Human Services (2023). File a Complaint. DOI: File a Complaint | Department of Health and Human Services (maine.gov)