Assess your quality of care quotient.

"MY DOCTOR WAS SO COMPASSIONATE AND considerate that I feel I healed better because of this and with a more positive attitude ... he was very patient in explaining things to me ... he treated me like I was his number one concern."

--Satisfied patient

Large, single/multi-specialty group practices (SMGP's) are proliferating in contemporary big-business health care. Subsequently, patients now "shop" for physician groups in much the same way as they choose a financial institution--often becoming informed through identical marketing propaganda: billboard advertisements, radio and television commercials, and brochures, to name a few. A cursory glance through some of these media illustrate that many SMGP's marketing strategies center on the group's speed, efficiency, and productivity (e.g., protruding over a Midwestern highway, one group's billboard ad boasts "Need a doctor in a hurry? ..."). Consequently, quality care--as an asset worthy of publicity--is often either disregarded completely or redefined in economic terms in the fast-paced arena of market-driven medicine.

Yet, continually assessing quality of care is, perhaps, the most sound investment SMGP's can make. Such analysis can provide information that is crucial to making informed managerial decisions. Assessing your group's quality care quotient can strengthen its competitive edge by identifying unique strengths that can be marketed, recognizing and targeting areas of improvement, and comparing effectiveness of procedures. In addition, quality care assessment can provide your group with innovative ideas for meeting new health care challenges (e.g., one SMGP specializing in back trauma discovered, through patient satisfaction results, that they should consider replacing soft sofas in their waiting room area with lumbar support furniture conducive to surgery patients!)

This article delineates the process by which Physician Practice, Inc., a prototypical SMGP, implemented an analysis of its quality care quotient. Beginning with the distinctive method of physician, nurse, and patient involvement in survey construction to the intriguing results of the analysis, and finally to Physician Practice, Inc.'s response to the findings, this procedure may serve as an exemplar to physician groups concerned with assessing their own patient care.

The quality care assessment

Physician Practice, Inc. is a typical Midwestern SMGP, specializing in neurosurgical procedures. During a series of interviews, a gathering of Physician Practice, Inc.'s doctors, nurses, and patients helped provide input as to what type of questions would be most beneficial towards the goal of providing information for assessing the quality of care of the group's patients and their satisfaction of services. The uniqueness of this process lies in the group's participation in the customized design of the survey instrument (as opposed to a "leaving-it-all-in-the-hands-of-the-consultants" approach). This step of the assessment process is critical--a practice must customize the survey for its specific needs, otherwise the instrument may fail to capture pertinent information. Thus, Physician Practice, Inc. identified the following subject categories as potentially important influencers of patient satisfaction:

* office environment

* hospital environment

* patient education

* information dispersal 

* pre-operative patient nervousness

* perceived pain and pain relief

Results

With the assistance of an expert statistician, measures of each variable were developed to create a survey consisting of questions designed to elicit both quantitative and qualitative data. A cover letter accompanied the finalized survey, and was mailed to 486, randomly-selected post-operative patients.

One hundred and thirty of Physician Practice, Inc.'s patients responded to the surveys which queried about pre-operative, hospital, and postoperative satisfaction.

Patient education resoundingly demonstrated the highest correlation with patient satisfaction, as well as with other variables. For example, the influence of patient education exerted a substantial decrease in pre-operative nervousness and subsequent increase in overall satisfaction. Another segment of the survey asked patients about the hospital stay(s) they experienced under the care of physicians practicing at Physician Practice, Inc.

It is revealing that patients' reports of pain were directly related to their satisfaction with their preparedness and education in pain management. Patients' perceptions about feeling more or less pain than they expected significantly influenced their reported willingness to undergo the same surgery again (if ever necessary). This finding underscores the importance of education in pain management in reducing patients' pain relative to expectations. Patients who report experiencing less pain than they anticipated are more likely to be satisfied with their health care experience.

Finally, in assessing postoperative satisfaction and long-term satisfaction, a construct measuring perceived "gaps" in education--or, educational lacunae--was developed. The significant relationship between satisfaction and educational lacunae was most illumining for Physician Practice, Inc. Patients who reported not having any gaps in their education were also most satisfied. Moreover, analyses indicated that a single gap in education was significant in lowering patient satisfaction. This clearly emphasizes the importance of each step in the educational process and begs the question of where do the most gaps in patient education occur?

Measuring "satisfaction over time" revealed a statistically significant relationship between satisfaction and time since surgery--the longer the time that had elapsed since the patients' surgery, the less likely they were to be satisfied with their health care experience. This finding was particularly intriguing. The group's physicians speculated that several factors could account for a lack of satisfaction over time. Reasons might stem from the fact that often patients expect to be completely free of pain following surgery and/or that they do not modify their behavior to prevent the problem from recurring. Also, the physical and emotional pressures of returning to work, coupled with a decrease in caregiver support, were hypothesized as potential contributors.

Hence, the overall findings of the Physician Practice, Inc. assessment enabled the group's physicians (and other health care providers) to reflect on their approach to patient education and target current practices that need improvement. Rethinking the group's approach to long-term patient education was one of the important ideas resulting from the analysis. Physician Practice, Inc. doctors and nurses brainstormed together and formulated a tentative plan to implement a long-term education program that focused on four crucial variables: (1) the return of chronic pain; (2) behavior modification techniques; (3) the return to work; and (4) caregiver support.

Conclusion

Looming above the alternate-bound lane, on the same Midwestern highway mentioned at the onset of this article, another SMGP's billboard ad reads: Experts in Cancer ... Specialists in 'Care' The difference between the two messages is striking. Despite our modern desire for quick fixes, fast service, and disposable commodities, our need for caring, compassionate health care providers has not diminished. Assessing your SMGP's quality care quotient can prove as enlightening an experience as it did for Physician Practice, Inc.

Moreover, physician ownership of the survey instrument is the corollary to patient preparedness and education. Similar to the satisfied patient who is educated is the doctor who incorporates the final survey findings into practice, having been grounded in the pre-implementation process. In other words, motivation to change certain habits or protocols is critical. Creating and implementing a "quality care plan," based on the results of the assessment, will undoubtedly make patient comments--like the one opening this article--the norm, not the exception.

David R. Clupper, MS, is the Executive Director of HuMed Support Services, a Midwestern-based services company for physicians' groups. His expertise is in patient-centered assessment, survey construction, and customized research. He can be reached at 918/584-1206.

Jill Hawk Clupper, MDiv, is the Executive Director of HuMed Support Services. She specializes in creating supportive/healing-centered patient education pieces, informational brochures, and portfolios for physicians' groups. She can be reached at 918/584-1206.

Lori West Peterson, PhD, is Assistant Professor of Communication at the University of Tulsa. She specializes in the study of health communication, social support, and organizational communication practices. She can be reached at 918/631-3845.