PI with Purpose

We are now approaching one year until the mandatory accreditation deadline of Sept. 30, 2009. Rather than remind you to get moving on this deadline, it’s time we review one basic accreditation requirement: performance improvement.

Performance improvement can go by many names — PI, quality improvement (QI), continuous quality improvement (CQI) and others. Most of us first heard of quality improvement standards when the auto industry adopted them in the ’80s, but PI has been a major tenant of accreditation since its inception in health care.

PI is usually one of the first challenges providers face with accreditation because it’s something they are unaccustomed to doing. As of this writing, CMS requires that providers track several quality measurements. The first, and, really, most basic measure, is customer satisfaction and complaints. Thus, your accreditor requires that you measure and track this indicator.

When I meet with providers about this accreditation requirement, one of the most common comments is, “We don’t need to measure performance improvement. If our customers didn’t like us, we wouldn’t be in business!”

Unfortunately, that’s not really the point. Of course you are in business day after day because you have customers. But if you don’t have a formal process of polling and measuring their satisfaction, you are operating on gut reaction and perception. It may not be very clear how satisfied your customers are, how your staff treats them, what you might do to improve, etc.

Are there issues you need to address because you haven’t given customers an opportunity to express their satisfaction or concerns in a non-confrontational or anonymous manner?

You might feel anxious about polling your customers, but think about how PI has become part of our daily lives and you will realize that your customers are very used to it. We don’t realize how often our customers participate in surveys, receive questionnaires or follow-up phone calls after an appointment, service or interaction. These days, collecting satisfaction information is not an imposition, or even unexpected. And face it, CMS is requiring it now, so you no longer have an option not to!

One main factor to keep in mind is that there is no reason to perform PI just for the sake of meeting a requirement. The goal is to learn and improve your business, services and outcomes.

When asking meaningful questions, you actually will learn what your customers think about your business and your staff. On your surveys, ask respondents to rate a statement on a 1-5 scale, with 5 being excellent, 4 being great, 3 being good, 2 being fair and 1 being poor.

Address areas that matter to customers with statements such as “Your order was delivered in the expected time frame” or “Your order was ready in a reasonable amount of time.” This way you have something to measure (the number of 4s or 5s, etc.) and something to improve (improving 4s to 5s).

Whether you are conducting telephone surveys or distributing written copies, ask or leave room for the respondent to add comments if they’d like, good or bad. Many will take the time to a compliment a staff member by name — and many find fault by name as well.

The most common concerns providers learn about are store, telephone and delivery staff members who are impolite or rude, delivery staff who are sloppy or track dirt and mud into homes. Everyone can get a bad survey now and then, but when several customers cite concerns about the same staff member, you have a real problem.

Then there are occasions when you learn things you never would have anticipated. One of my favorite stories is from a client who called to tell me that on the company’s initial survey, they received many requesting that management ask one particular delivery driver to stop leaving fliers for his wife’s cosmetic business when he made a delivery!

And sometimes, providers get concrete evidence about issues of which they are well aware. One provider I worked with is located adjacent to a hospital, and because the company has an open parking area, hospital visitors routinely park in their lot despite signs telling them not to.

The provider complained year after year to hospital administration about the issue with no resolution. The company knew the lack of parking was its biggest verbal complaint, but once they implemented satisfaction surveys, they found that 80 percent of all respondents cited the lack of parking as their only complaint. Close to 20 percent of these customers wrote in comments noting they took their business elsewhere when the parking lot was crowded.

The provider finally had the needed ammunition to go to hospital administration with documentation about the business the company was losing as a result of the parking issue. Very quickly thereafter, the hospital assigned a security guard to patrol the lot at the busiest times of the day, and the problem was quickly solved. (Remember the hospital must be accredited, too, and understands PI and improving outcomes.)

If you are already accredited, have you learned interesting tidbits through your satisfaction surveys? Were there any real surprises? Is it more of what you already knew? Tell me anything interesting you’ve learned and I will share it in this column.

We get the best education from our peers and by sharing our experiences — good or bad — with one another. I’d love to hear some of the things you’ve found out.

Mary Ellen Conway, RN, BSN, is president of Capital Healthcare Group, LLC, Bethesda, Md., which provides health care management expertise in accreditation preparation and survey follow-up, operations assistance, design of quality improvement programs and outcome measures. She can be contacted by phone at 301/896-0193 or through www.capitalhealthcaregroup.com.