Patient satisfaction data enhanced by software
Patient satisfaction data enhanced by software
Fuller picture of patient experience emerges
Decision support software used at the Cleveland Clinic Foundation, for years instrumental in reducing lengths of stay and cutting costs, is now being used to gather valuable, detailed information about patient satisfaction.
"One of the big issues not only here, but at many other places, has been how to continue to improve patient satisfaction," says Dale Konrad, CHAM, MBA, director of special projects for the foundation. "Access managers should be some of the key people involved in finding solutions to improved patient satisfaction."
Most of the 900 or so health care facilities using Transition I, a decision support software product of Transition Systems Inc. (TSI) of Boston, use it only for budgeting and financial matters. It’s the kind of program formerly known as a cost accounting system. But the wealth of demographic, clinical, and financial data the system processes makes it an invaluable resource in other areas as well, Konrad says. "We have found that the biggest bang for the buck has been when it’s used in clinical and operational areas."
According to a TSI spokesperson, the company’s decision support software can range in price from $150,000 to $1.5 million, depending on the type of product, and the size and type of institution.
Until recently, the Cleveland Clinic, like many health care institutions, used only a traditional patient satisfaction questionnaire sent to patients after discharge from a nursing unit. It has 64 questions with ratings ranging from excellent to poor and covers the following areas: admission process, ancillary services, billing, daily care, discharge process, food, housekeeping, information, living arrangements, nursing care, and physician care.
There was no way to profile the patient answering the survey other than by the nursing unit from which he or she was discharged, and the DRG. "It was pretty limited information," Konrad says.
But for the past six months, the Clinic has been experimenting with putting respondents’ medical record numbers into the TSI system to find factors or variables other than just the nursing unit that might influence the patient’s satisfaction level. Experience has determined that it’s more effective to enter what’s called the "total process indicator" an average of the responses to 42 questions in 11 categories than it is to include the entire survey information, he says.
"An outside company gives us an average of those categories, then we attach it to the patient profile in TSI," Konrad explains. "We’ve been able to answer many questions that we never before were able to link back to the patient."
For example, "As the length of stay increases, does the percent of satisfaction decrease?" and "As the charges increase, does the percentage of excellent rankings decrease?," Konrad explains.
The real plus provided by a decision support system is that it takes information from all the front-end and billing systems, and also includes the direct cost of all services rendered, he says.
"This system is the best of all worlds. It can look at demographics, marketing, insurance, referring physician, diagnoses, and procedures it holds everything. We know under all circumstances what it costs us to provide health care on an individual or general basis."
The Cleveland Clinic, which has about 46,000 admissions and 1.2 million clinic visits a year, has broken down the population it serves into seven market areas, Konrad notes. Using TSI, it can review patient satisfaction survey respondents by market area to determine if the area people come from has any influence on how they respond. In fact, he says, data have shown that expectations of a patient’s stay may be affected by the distance he or she has traveled. "We have found trends by market areas," Konrad adds. "For those areas that don’t vote as high, we know to work out some kind of approach to improve in that area."
Although the traditional patient satisfaction surveys show only the nursing floor from which the patient was discharged, use of TSI enables the Clinic to look at satisfaction in relation to all areas in which a patient received care. If the patient spends time in the intensive care unit or has surgery, that can be figured into the final equation.
At the Clinic, as is true at many health care facilities, every department is a "cost center," and these cost centers combine to make "resource consumption areas," Konrad explains. For example, the costs of operating 35 medical/surgical units roll into one medical/surgical resource consumption area, and the costs at all the laboratories at the Foundation 20 or so equal the pathology resource consumption center.
"We’re able to view the services rendered and the charges from all resource areas," Konrad says. "Another question we’re now asking is, Does utilization of certain resource consumption areas in the organization have any impact on patient satisfaction?’" Through use of TSI, there is evidence it does. "We have determined that there are three or four resource areas that have impacted the way a patient votes. "If people use that resource, there is a higher percentage of excellent’ rankings."
TSI also enables the Clinic which ranks in the top 20 hospitals nationally in terms of complexity of cases to look at patient satis-faction in terms of case mix, Konrad says. "There is a big difference between those who vote excellent’ and otherwise, according to case mix."
Demographic factors such as age, race, and gender also can be reviewed in relation to patient satisfaction, he says, as can the way in which a person enters the facility through clinic referral, the emergency department, hospital transfer, or HMO. "We saw some definite differences month after month by mode of entry. We’re learning about factors that we’ve never been able to tap before," Konrad adds. "We’re now able to view all these variables and identify areas of weakness or strength, and then develop target areas to improve the overall satisfaction rankings."
In the next two years, he says, use of the Clinic’s decision support program will be expanded to the other nine hospitals in its health care system. Access managers would be well-advised to determine if their organizations have decision support systems and, if so, volunteer to get involved in investigating the innovative ways they can be used, he suggests. He recently made a presentation on the subject at a joint conference of the Greater Northwest Access Management Associa-tion and the Washington Health Care Access Management Association, held in Stevenson, WA.
"Health care is like any other business in that you want to constantly make improvements and discover areas in which you can make a difference," he says. "As competition increases and more and more health care systems are developed, a key difference among systems will be how the client is treated. Patient satisfaction will continue to be one of the major indicators of quality in health care."
[For more information, contact: Dale Konrad, director, special projects, Division of Finance, Cleveland Clinic Foundation, Mail Code W-23, 9500 Euclid Ave., Cleveland, OH 44195. Telephone: (216) 444-8836. Fax: (216) 444-9140.]
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