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  • Constructing an Ophthalmology-Specific Patient Survey

    Sara Rapuano Sara Burns Rapuano, practice management consultant, discusses how to design and evaluate a well-constructed patient survey.

    What are the questions we should ask our patients in order to specifically understand how we are meeting their needs?

    There are lots of companies that specialize in measuring patient experience and are ready and able to send out patient surveys and provide your practice with dashboards full of statistical information based on the results of those surveys.

    However, first you should spend some time thinking about what questions will yield useful feedback that will guide you in taking the steps necessary to create a better experience for your patients.

    The Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CGCAHPS) has thought about these questions for years. Although some of the CGCAHPS questions seem aimed at primary care settings, we can use their insight to construct an ophthalmology specific survey. 

    Elements of a Patient Survey

    I will highlight three key components of CGCAHPS surveys which should be part of a well-constructed ophthalmology survey.

    1. Questions should be aimed at these areas:

    • Access to care
    • Provider communications
    • Diagnostic test results
    • Office staff
    • Overall provider rating

    2. Responses should be standardized.

    Although many surveys ask us to answer our agreement on a scale of 1 to 5 or 1 to 10, some patients find they have to refer back to the scale repeatedly while completing the survey. Best practice is to use qualitative responses.

    • Option A: Never, Sometimes, Usually and Always – this option surveys a continuum of care.
    • Option B: Strongly Agree, Agree, Disagree, Strongly Disagree – this option is more targeted towards a patient’s experience on a particular day of service.

    Option A is used in the CGCAHPS surveys, which are widely used by primary care specialists. If you are a retina-only practice, you may choose Option A for your patient survey since many of your patients return on a regular schedule for intravitreal injections. Option B, however, may be more appropriate for most ophthalmology practices.

    3. Our goal should be to increase our “top box” scores.

    We want a high percentage of “always” or “strongly agree” scores. Any score below that represents an opportunity for improvement.

    For more information about CGCAHPS surveys, I recommend “The CGCAHPS Handbook: A Guide to Improve Patient Experience and Clinical Outcomes,” by Jeff Morris, MD, MBA, FACS, et al. This book not only explains the types of questions that should be asked, but also does an excellent job of providing strategies to improve your patient care experience.

    Survey questions should be clear and concise so that patients of all ages and educational backgrounds will be able to understand and respond to them. They need to be phrased so that the answers “strongly agree, agree, disagree, strongly disagree” are appropriate answers. 

    I would suggest limiting surveys to a maximum of 10 questions. Here are some suggested questions by category:

    Access to Care

    1. When you called our office to make an appointment, was the time frame of the scheduled appointment what you needed?
    2. When you phoned the office during regular office hours with a medical question or prescription refill request, were your needs addressed in a timely manner?
    3. If you sent an inquiry via our patient portal, did you receive a timely response?
    4. When you arrived for your visit, were you seen in a prompt and efficient manner?

    Provider Communications

    1. Did your provider listen to you carefully?
    2. Was provider concerned about the functional impact of your ocular complaints?
    3. Did the provider seem aware of all the information gathered and testing performed by other staff during your visit?
    4. Did your provider explain things in a way that was easy to understand?
    5. Did your provider spend enough time with you?

    Lab/Diagnostic Testing Services

    1. Was the reason for testing services explained to you before the test was performed?
    2. Did you feel the technician performing the test was adequately trained?
    3. Were the test results and resulting your treatment plan explained to you?

    Office Staff

    1. Were the clerks and receptionists in this office helpful?
    2. Did the clerks and receptionists alert you to any applicable self-pay amounts due or referral requirements prior to the day of service?
    3. Did the clerks and receptionists treat you with courtesy and respect?
    4. Were the technicians in this office knowledgeable?
    5. Did the technicians explain their role in your care process?
    6. Did the technicians treat you with courtesy and respect?

    Overall Provider Rating

    1. Did your technicians, doctors and other members of your eye care team introduce themselves and explain their role in your care?
    2. Did you feel that the office overall was well-run and maintained?
    3. Would you recommend this office to a friend or family member?

    If you have an optical shop. You may add some questions specific to the optical shop, such as:

    1. Did you find an appropriate selection of frames in our optical shop?
    2. Did the opticians provide product information to help you select your frames and choose appropriate lens options?
    3. Did the opticians treat you with courtesy and respect?

    Alternative Survey – Net Promoter Score

    You could also consider starting with one question to obtain a Net Promoter Score (NPS). Used across many industries, Fred Reicheld and Bain and Co. created this metric to rate the overall patient or customer experience. It measures the patient’s entire experience with your office, not just a recent interaction.

    Question: On a scale of 0 to 10, with 10 being highest, what’s the likelihood that you would recommend our practice to a friend or colleague?

    Categorize the results into:

    • Promoters (scores 9-10) – Patients who are likely to pass on referrals and maybe post a positive review on line
    • Passives (scores 7-8) – Patients who may not be totally satisfied, but also are not leaving you
    • Detractors (Score 1-6) – Patients who had a poor experience and will likely tell others or post negative reviews on line

    Percentage Promoters - Percentage Detractors = Net Promoter Score

    For example, if you received 25 responses to your survey, and five were promoters, 18 were passives, and two of them were detractors, your NPS score would be calculated this way:

    Percentage Promoters  5/25 = 20%

    Percentage Detractors   2/25 = 8%

    Net Promoter Score      20% - 8% = 12%

    If your promoter score is positive, you are a growing business, and if it is negative you are likely a contracting business.

    If you choose to use this one question approach, best practice is to add a text box where patients can explain their responses. The comments will help guide you in selecting questions for a more comprehensive survey.

    Remember, if the survey is too long, patients may not complete them. Also, patient survey design should not be a “one and done” project. It should be an iterative management tool that affects change.

    We should ask questions and use the answers to design staff training programs and consider operational changes. After implementing training or changes, we should ask for patient input again and maybe redesign our surveys to delve deeper into certain areas.

    Although we want to use the information gathered by CGCAHPS standardized surveys and many external patient care consulting companies to inform our survey design, we should not be afraid to try different surveys at different times of year. You may be surprised at the results.