History and Timeline of the Whatcom County Pursuing Perfection (P2) Clinic Patient Satisfaction Survey.

Although still in the process of change, the Clinic PSAT has gone through a long journey.  This log is intended to describe some of that journey, not a comprehensive description but rather some highlights along the way.  Highlights that may help others build off of the challenges and success we have had.

Prior to the launch of Whatcom P2, PeaceHealth created a sixteen-question survey that was designed to measure the level of satisfaction of a patient’s office visit experience.  Whatcom P2 decided to build off of this fully functioning tool by adding 7 questions that specifically addressed the Pursuing Perfection promises made to the patients of this community.  It was decided to administer this new survey by implementing the use of TouchScreen technology.  The survey was to be web based, using the connectivity of PeaceHealth and HiNet.  The patient would be able to simply touch the monitor screen to log their responses.  With questions and response categories written in a large font and a user interface that seemed to have no barriers a successful implementation seemed easy as pie.  Only identified by clinic, the data would be extracted and then analyzed using Rasch methodology.  Every month, the clinics would receive a score between 0 and 100.  This score would represent the satisfaction level of the patient.  It was thought, as we implement the strategies and interventions of the P2 project, we will see scores climb.  Patients will become more satisfied.

That was the plan.

With a tight deadline in place, Touchscreen Go-Live in all clinics by August 5, 2002, we set the wheels in motion to make it happen.  Those given the new responsibility of implementing the survey naively felt that we would just walk over to each clinic, plug the device in, and turn it on….Presto, Good to go! 

Not quite. 

The barriers to implementation came fast and furious.  Beginning with the discovery that it had not been decided where in the clinic these devices should be placed and quickly moving to the identification of a lack of process to identify which patients would take the survey (ie Would every pt on every visit take the survey?  If not, how would they be selected? When during their office visit would they take the survey, etc).  Further more, some clinics did not have network connectivity in the area that had been selected for the device to be placed and some did not have proper furniture to place the devices on.

Quickly, we re-grouped and identified the issues and possible solutions.  A key note here is that in a time of extreme high stress the P2 team worked well together, staying on task and positive at all times.  Looking back, it was one of those moments where the power of the Team is really quite amazing.  The discussions were not about blame but instead they were about “What do we need to do to make this successful?”  Put into place during our team building retreat this was to be a real world test of our strength and commitment to each other and to the success of the project.  An excellent foreshadow of what our team dynamics would look like throughout the entire grant.

Over the next 8 weeks barrier after barrier was identified, addressed and solved.  Each week we felt as if Go-Live was to be “sometime early next week”. Some may look at the date of actual Go-Live, late October, and see it as not meeting expectations or even as a failure.  I think within the Project Team we look at it as a 100% success.  Together, Project Staff and Pilot Sites, acknowledged the barriers and created solutions.  Concerns were listened to and not ignored.  As a result we have a fully functioning tool in each pilot site with over 4 months of complete data showing PSAT scores for each clinic.

Within each month’s anlysis each clinic receives their overall score as well as a frequency distribution graph for each question showing the percentage of respondents to each response category.  Further more, each clinic will be receiving a run chart that charts their score over time.  This run chart will also points of interest marked.  These being large and small scale implementations the clinic has undertaken, ie the implementation of the Congestive Heart Failure Registry.  The hope with including these markers is twofold: build a historic timeline showing

An interesting note is that the story doesn’t stop here.  Listening to concerns about the questions specific to the Pursuing Perfection Promises we, as a group, decided to create a proposal of how we might evaluate how well these question work.  This proposal includes holding at least 2 patient focus groups where we will ask for patient feedback on what they think of the questions. We will compile and evaluate their comments and use their comments as the driving force behind any revisions we make.

More to come…..

8:27:36 AM     comment []   Google It!  

Learning from a patient focus group.

This past week we held our first of what we hope will be several patient focus groups to help us re-design the P2 specific questions on the Clinic Patient Satisfaction Survey.  The intent of the P2 specific questions is to help determine if we (Pilot Sites) are fulfilling the P2 Promises to Patients.

A few of the many highlights of this first group were:

P2 Survey Question: The evidence-based guidelines for diabetes (heart failure) that we used to develop my written Shared Care Plan were easy to understand.

It became obvious that the phrase “evidence-based guidelines” was not understood by all of the patients.  Even the patients that did know what evidence-based meant felt that they would not know if their doctor was using them or not.  Paraphrasing, it seemed that the patients all assumed that the doctor would not use guideline that were not evidence based.  The patients recognized that guidelines change over time and what was important to them AND what they felt better defined the intent of the question was replacing “evidence-based” with “up to date”.  A patient mentioned that they are aware of the ADA guidelines for diabetes and how they have changed over the years.  It was important to him that his doctor was using the most recent or “up to date” version.  It seemed that using the phrase “up to date” was in the minds of the patients analogous to the intent behind “evidence-based”.

P2 Survey Question: I have complete access to all of the clinical information, either about me or my health, that I need.

The big learning from patients on this question was that just because patients are given physical access to their clinical information, ie given a copy of there medical record or operation report, does NOT mean that THEY have access to it.  Meaning that the medical jargon is impossible for them to understand and having copies of their reports isn’t giving them access to anything because they can’t make any sense out of it. 

Complete access would mean having both physical access as well as being able to read and understand what has been provided to you.  I found this to be very insightful especially as we think about P2’s spread to non-native English speaking members of this community and to those that are illiterate.

We look forward to holding more patient focus groups.  I have a feeling we will refine our methods as we go and become a bit more efficient at getting more quality feedback from patients.  It is a challenge to provide enough context so that the patients can understand why it is that they we are asking for their help and at the same time leave enough room on the agenda to make sure we get all of their ideas and feedback.  We want the patients experience at these focus groups to not only be positive but empowering.  We want them to continue to want to participate because it is obvious that we can’t do it without them!

8:22:51 AM     comment []   Google It!