What do you think: Can resident surveys improve care?

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The rolling boulder that is consumer and employee satisfaction research continues to gain momentum in long-term care.

It has become an integral part of accreditation and awards programs, as well as national quality improvement initiatives. States are starting to display satisfaction scores on their consumer websites—and are even experimenting with pay-for-performance programs.

More than ever before, providers have plenty of reasons to get ahead of the curve.

Experts say the bottom line in satisfaction research is, “Would you recommend us?” In its 2009 National Survey of Consumer and Workforce Satisfaction in Nursing Homes, the research firm My InnerView identifies the most powerful factors driving that decision. The report reflects the views of more than half a million nursing home residents, families and employees.

For both residents and families, the care or concern shown by staff ranked highest, followed by staff competency. Rounding out the top five for residents were attention to resident choices or preferences, nursing care and management responsiveness. For families, the other three were nursing care, nursing assistant care and respectfulness of staff.

There also was a strong connection between consumer satisfaction and employee satisfaction. For employees, the top drivers were management that cares and listens, and help with job stress and burnout.
In the continuing care retirement community setting, some additional factors come into play, says Lisa D. Lehman, president of the research firm Holleran.

“Fulfillment of the original contract is a key driver,” she says. “So are responsible fiscal management, effective management of changes and growth, and whether the community delivers on what its marketing materials promise.”

To apply this knowledge, providers need to understand how consumers and employees perceive their organization. Fortunately, there is no shortage of tools to gauge their satisfaction.

Choosing a tool

On one end of the spectrum are full-service research firms that help organizations design, administer, interpret and act on surveys with all the bells and whistles. At the other end are non-proprietary tools developed by universities and nonprofits that providers can administer themselves. Experts discourage providers from writing their own survey, because it might not measure what is intended.

The Advancing Excellence in America's Nursing Homes Campaign has developed a resource that describes several proprietary and free tools. The resource, as well as an implementation guide and webinar, is available on the campaign web site, www.nhqualitycampaign.org.Campaign Director Carol Benner emphasizes that satisfaction research is something all providers can do.
“There are some very good simple tools that you can download for free and administer in a manual way,” she says. Additionally, some research firms say they offer discounts to small providers that approach them as a group.

The American Association of Homes and Services for the Aging (AAHSA) offers guidelines on conducting satisfaction research as part of its Quality First initiative. It encourages organizations to survey residents, family members and employees in all levels of care and services. AAHSA also recommends using a survey tool that has been tested for accuracy, reliability and validity.

The guidelines emphasize that surveys should be completely anonymous so individuals feel comfortable responding candidly. They also recommend tools that allow comments to be entered in the survey and captured in a  summary report.

Ideally, providers will be able to benchmark their results against similar organizations. Some research firms have databases that allow providers to compare scores based on size, geography, ownership and other factors.

Reports of survey results should be comprehensive and easy to understand, the guidelines say. They should specify key areas of concern from which the organization can develop an action plan. Industry experts also recommend using a tool that is attuned to trends in the field.

“We're looking at more questions around wellness programs, education opportunities and community involvement,” says Susan Pearson, director of Life Services Network's Confidence Satisfaction Survey Program. Person-centered care is another area providers want to measure.

Engaging all

Promoting the survey ahead of time is very important, emphasizes Mary Tellis-Nayak, vice president of quality initiatives at My InnerView. Her firm provides clients with templates for posters and a personal letter from the administrator. The materials contain a picture of the questionnaire, so individuals will recognize it when it arrives by mail.

Darcy Watson, administrator of Westbury Health and Rehabilitation of McDonough in Georgia, has used My InnerView for several years. In addition to publicizing the survey with posters and letters, she hosts a dinner for families to answer any questions. Toward the end of the event, employees leave the room in case families want to fill out questionnaires on-site. To encourage participation in the employee survey, Watson holds a voluntary ice cream social for each shift.

Another factor influencing response rates is whether a questionnaire is user-friendly.

“We use a very large font and our survey only has 24 questions, so it can be completed in about 10 to 15 minutes,” Tellis-Nayak says.

The best way to generate a good response rate is by demonstrating that feedback makes a difference.

“Providers need to look for the low hanging fruit—things they can do quickly to show they've listened,” Tellis-Nayak says.

She encourages organizations to communicate survey results and the organization's action plan through resident council meetings, bulletin boards and newsletters. 

Use it or lose them


The most important part of satisfaction research is how organizations use the information. Experts say it is critical to weave satisfaction research into an organization's broader quality assurance efforts. 

Survey results should be highly visible within an organization and approached in an interdisciplinary way, points out Joe Carmichael, chief operating officer of My Inner-View research company. “When we look at which providers are constantly improving, one of the common threads is that satisfaction research is on par with other metrics,” he says.

Some providers conduct surveys several times throughout the year to capture the voice of new residents and families, he adds. They also use surveys to take a pulse check after a major staffing or operational change.
When using survey results to establish goals, external benchmarking is very helpful, adds Lehman. Research firms with experience in the field also can offer insight into best practices.

“It's important to get guidance on what's realistic, particularly if you want to tie survey results to incentives,” she says. “You have to make sure you have a very robust formula.”

A key part of any organization's plan should be communication with consumers and employees, emphasizes Mike Mutka, chief operating officer of Silverchair Learning Systems. He encourages providers to anticipate the range of feedback ahead of time and think through how to respond to different scenarios. 

A long-term care organization that receives great scores on dining might serve a special treat with a note from the dining services manager. Likewise, providers should acknowledge and respond to negative feedback—and in a timely manner.

“Often, it's as much about recovery as it is about the mistake,” according to COO Mutka. “If you come back with an excellent recovery, you can increase customer loyalty.”

Sometimes satisfaction research will illuminate areas of misunderstanding, adds Chip Kessler, general manager of Extended Care Products. For example, family members may complain a resident thinks the food is bland when, in fact, that resident is on a prescribed diet. Comments from families and residents can provide insight into areas where education is needed.

For all of these reasons, providers have much to gain by doing satisfaction research.

As Watson, the facility administrator, puts it, “I can't imagine doing any kind of quality improvement program without it.” 

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Ingredients for a successful satisfaction survey

-- A research-based tool
-- Advance publicity
-- Anonymous data collection
-- Meaningful reports
-- Benchmarking
-- An action plan
-- Timely communication

Source: McKnight's interviews, 2010 satisfaction survey

-- A research-based tool
-- Advance publicity
-- Anonymous data collection
-- Meaningful reports
-- Benchmarking
-- An action plan
-- Timely communication

Source: McKnight's interviews, 2010