Glad you asked

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Glad you asked
Glad you asked
Long a staple for gauging company performance in a service-based economy, customer satisfaction surveys now are becoming a standard data-gathering tool in the long-term care industry as well.

Facility operators have only to consider the various factors pushing the trend to realize the true importance of feedback from those they serve: Consumer-directed healthcare is gaining traction, the federal government is unveiling a “Five Star” rating system for nursing homes in December, the emphasis on pay-for-performance initiatives is growing, and trade associations are embracing the concept of “culture change.”

Some see long-term care's mushrooming interest in resident feedback as part of a natural evolution.
“Awareness of customer satisfaction has become pervasive among the general public,” says Brad Shiverick, chief quality officer for the Wausau, WI-based healthcare survey firm My InnerView. “For instance, after a recent trip I got

e-mails from the airline and hotel asking about my experience. This approach has extended to our profession, which has made a lot of strides in awareness.”

The numbers confirm heightened interest in satisfaction surveys among long-term care facilities. About one-fourth of the 4,000 nursing homes using the firm's assessment services conducted some type of survey last year, says My InnerView CEO Neil Gulsvig.

Across the eldercare spectrum, Gulsvig estimates that about 40% of facilities are surveying families and residents to some extent.

Support from trade associations at the national and state levels, which have formed a coalition-based campaign called Advancing Excellence in America's Nursing Homes, is bolstering the survey effort.

The campaign includes long-term care providers, caregivers, medical and quality improvement experts, consumers and government agencies, among others. The coalition's stated objective for the eight-facet initiative is to “strengthen the public trust in nursing home care by focusing on quality improvement and self-regulation” while “acknowledging the critical role of nursing home staff and consumers in improving quality of care and quality of life for nursing home residents.”

Association support

The American Health Care Association is one of the driving forces behind the initiative.

“We believe in satisfaction assessment—it gives you a good snapshot of what people are thinking,” says Tom Burke, an AHCA public relations director. “It can be used for a continuous quality improvement program, which is needed for a facility to analyze all aspects of its operation. That way, if one area is not pulling its weight, it is identified by the survey and appropriate adjustments can be made.”

Burke estimates that approximately 60% of AHCA members are using some aspect of My InnerView's services, though he says the association hasn't applied any pressure on them to do so.

“We don't prescribe what they have to do—our initiative promotes listening to customers as a way to provide quality services,” he says. “It is part of the culture change movement.”

Mountville, PA-based Holleran Consulting also is actively engaged in surveys. Managing Partner Lisa Lehman promotes the survey's value as an effective image-boosting tool.

“From an internal standpoint, when a community commits to doing a study like this, that commitment shows residents and family members that they are interested in their quality of life,” she notes.“That alone can only serve to improve one's image. However, it is then necessary to take the feedback seriously and integrate
it into planning activities. This approach can backfire if residents and family members feel the survey is just lip service and not embraced seriously by the management.”

Palpable results

Diakon Lutheran Social Ministries recently made resident satisfaction surveys part of its overall operation. In the year before Lutheran Services Northeast and Tressler Lutheran Services became one organization on Jan. 1, 2000, both affiliates conducted their first surveys with Holleran's assistance.

“Those surveys served as a great baseline for us,” said COO Mark Pile. “Because of the integration, we didn't attempt our next survey until 2005 and did another in 2007. We are now committed to doing them every two years, so we've budgeted for another one in 2009.”

Pile reports a 75% participation rate in its surveys, which he characterizes as a “reasonably good” response. The value produced by the surveys, according to Pile, is immeasurable.

“It gives us the chance to focus in on the things we're trying to improve on,” he says. “When we complete the survey, we go out to each facility and share the results. This helps us benchmark ourselves location by location” and “not only can we compare ourselves against others, but against ourselves.”

The results generally have been favorable for the Allentown, PA-based organization, and they are proudly distributed to residents and their families in a graphically appealing report.

Among the report's findings: Nearly 70% of Diakon's communities performed better than the national benchmark, with one achieving a 100% rating. In the four primary “indicators of overall satisfaction,” Diakon outperformed the national benchmark in all categories but one—and that difference was only by one-tenth of a point.

Yet operators also can learn which areas to work on. Identified areas of opportunity, for example, include “preparation of food and snacks” and resident-room comfort. Areas of strength are identified as “respect,” “service,” “safety from personal risk or harm” and “timeliness and quality of communication.”

The value of such information cannot be overestimated, operators say.

Survey structure

Putting together a comprehensive survey takes more than just a couple of hours' work, experts emphasize. Soliciting valuable, usable feedback from constituents takes methodical research gleaned from every area of the operation. Authorities also say that the survey needs to pose questions in a way that those answering them can easily understand.

Chip Kessler, general manager of Johnson City, TN-based Extended Care Products, has created 14 different educational programs for long-term care facilities on family education, staff training, census building and customer service. When advising facility operators on how to craft effective surveys, he has a specific set of guidelines for them to follow.

“I encourage the questions to vary—some asking for a ‘yes or no' response, while other questions ask the resident and/or family to answer on a scale of 1 to 10,” he said. “In addition, I suggest that the questionnaires do not ask for a signature or a person's name on them, but are filled out anonymously so that residents and family members feel free to list their opinions without the burden of having to ‘go public.'”

Five-star future

Political pundits are almost unanimous in their uncertainty over how the Centers for Medicare & Medicaid Services' “five-star” program, due out Dec. 18 (as of press time), will impact the resident satisfaction survey process.

CMS heralds it as a “groundbreaking” ranking system of America's nursing homes using star ratings (much like how travel guides rate hotels or critics rate movies). The agency will post the rankings on its Nursing Home Compare Web site,

According to facility advocates, CMS also was not going to add resident-satisfaction evaluations to the formula for creating the star ratings —something providers have been pushing hard for ever since the initiative was announced in the summer.

Although CMS asserts that the ratings will serve as an incentive for nursing homes to improve the quality of their services, there are skeptics such as AHCA's Burke, who question the need for it.

“We understand the value of conducting surveys, but the Five-Star system has an arbitrary nature to it,” Burke said. “No one really knows what kind of effect it will have at this point.”

Still, organizations such as the Alliance for Quality Nursing Home Care have expressed confidence in the initiative.

“The alliance has long believed that reliably measuring quality and publicly disclosing the results help consumers identify the facility that best meets their needs and expectations,” President Alan Rosenbloom said. “Disclosure of accurate information helps improve facility performance, increases overall accountability, and ultimately benefits consumer and provider alike.

“We believe CMS is committed to similar principles and strongly supports the concept behind the new Five-Star rating system,” he said.


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