Surveys point the way to better home health and hospice care

Among the various methods home health and hospice agencies can use to gain insights from patients and caregivers, surveys can be one of the most effective. But many consider surveys like CAHPS simply a means to meet compliance requirements and avoid penalties. Using surveys consistently, in addition to CAHPS surveys, to capture patient feedback can give you actionable insights to improve performance, ratings, and most importantly, patient care. You just need to determine what you want to measure and what you do with the feedback. Here’s a brief guide to getting the most out of patient feedback to drive better outcomes and business decisions.

What’s the “why” behind your survey?

The management guru Peter Drucker said, “If you can’t measure it, you can’t manage it.” That’s key to the whole purpose of surveys — getting information in a way that you can effectively measure how you’re doing. What’s going well and where do you need to improve? Surveys are an effective way to conduct research you can use to drive your vision and strategy, improve processes and provide better care.

Before you begin any survey, plan what you want to measure. Are you looking to get feedback about a specific process or program? Do you want to evaluate performance or make improvements? To get the kind of data you’re looking to collect, you’ll need to tailor survey questions to drive those results. It’s also important to think about comparisons and benchmarks, especially if you want to compare yourself with the outside world or other agencies. To do that, you’ll need to ask questions in a standard way to be sure you’re comparing apples to apples and oranges to oranges.

Who should you ask?

No matter what kind of survey you want to conduct, you’ll need to identify who will get it. Are you going to survey patients, family members or caregivers? Will you need to include others? For example, if your recipients have memory care issues, will you survey both the resident and their guardian? In hospice care, will you survey the patient, who is receiving care, or the caregiver, who is providing care? In the case of bereavement, do you want feedback from all family members receiving bereavement services or just those who participated in a specific event?

Once you’ve identified your main audience, it’s time to determine who the survey should be sent to. Depending on the size of your organization, you may have a large group of patients or residents to survey. But should they all be providing feedback? It depends on what you’re asking. While CAHPS surveys have definite requirements around who can receive the survey, there is more flexibility for ad hoc surveys or check-ins, and you’ll want to select the population that will give you data that are viable.

Once you’ve determined who can be in the survey, it’s time to choose the specific individuals who will get it. Whether you’re surveying the entire population or just a percentage, you’ll want to make sure selection is random so you’re not hand picking who you want to hear from, which is considered bias.

If you’re looking for specific information though, you may only want to target a subset within your larger population. For example, if you want to get feedback about activities or events, you only want to survey those who attended.

Survey questions: what kind, how many, in what order?

There are lots of options when it comes to the type of questions and how many to ask. The order of questions is important too. Since some survey recipients won’t finish the survey, you’ll want to put the most important questions first. Place controversial or demographic questions near the end of the survey to avoid offending respondents or turning them off to the point where they choose not to take your survey.
How many questions you ask can impact survey completion rates. Respondents may be more apt to take a quick survey with just three questions than one with 47 questions. So, balance the information you need to get with the length of the survey.

Choosing the right questions and wording them carefully is essential to getting the data and insights you want. Standardized question sets are designed to give you viable data and insights that are based on comparable data and established benchmarks. When conducting your own surveys though, you can develop questions based your agency’s specific interests and needs. How you phrase the questions will determine to a large extent the answers you get. If respondents aren’t clear about what you’re asking, they won’t know how to answer. It’s best to avoid “double barreled” questions that ask for feedback on more than one thing. For example, “How responsive was the team, and did someone follow up with you in a timely manner?” Yes or no. This question can cause confusion. If the team was responsive, but didn’t follow up, the respondent isn’t doesn’t know whether to answer yes or no.

Another component to consider when developing survey questions is the response options. Again, to avoid bias and the perception that you’re leading respondents to provide a positive answer, ask neutral questions and offer a range of responses. For example, asking “How satisfied are you with your team’s responsiveness?” and then offering a range of responses (very satisfied, satisfied, somewhat satisfied, not at all satisfied, or doesn’t apply) can lead to appropriate and unbiased feedback. Giving respondents an out like “doesn’t apply” ensures they won’t provide an answer to questions that don’t apply to them.

Survey administration

Regardless of what type of survey you’re doing, you’ll want to consider the different administration methods and costs associated with each. While face-to-face and phone surveys can give you the opportunity to probe more deeply, respondents may be less likely to give you an honest response. Mailed surveys are easy to complete but have an increased cost and can take more time for feedback to become available. Online options where you email a link to a web-based survey are relatively easy for patients to complete at their convenience.

You’ll also need to assess the internal resources you’ll need to conduct surveys. Do you have staff to take care of the administration, collect the feedback and compile results in a meaningful way? Depending on the scope and frequency of surveys, this can become a real burden on staff and leave you with less time for patients, especially given today’s staffing shortages. Outsourcing your surveys to experts like HEALTHCAREfirst can give you more time to focus on patients and improve employee job satisfaction.

Privacy is another essential component of survey administration that can improve response rates, but anonymity and confidentiality are two different things. One way to achieve purely anonymous feedback is to print out surveys that have no identifying bar codes and give them to patients to complete. Results can then be associated with a specific location or branch, but not to individual patients. This protects patient confidentiality since feedback is shared only when the patient gives permission.

Frequency and timing of surveys

How quickly you get feedback will determine how well you can integrate the information into your decision making. If you’re doing a one-time ad hoc survey to quickly gather information, you’ll want to think about how soon you’ll be able to collect and analyze the information to deliver it back in a timely way. With regularly scheduled surveys, you’ll want to avoid survey fatigue — bombarding patients and residents with too many surveys. Instead, balance the frequency to get a constant flow of data from different subsets of your population. This is a good way to get the information you need while respecting the time of survey recipients.

Finally, be sure to set expectations and communicate when you need surveys completed so you get feedback in time to act on it.

Analyzing results

Analyzing your results – whether from CAHPS surveys or current patient feedback – is key to refining your processes and operations to improve care and outcomes. Take the time to do agency specific statistical analysis. This is where you’ll identify what’s working and where you need to improve. What are your top drivers for satisfaction? Which questions have the biggest impact on your overall satisfaction scores? What opportunities do you have to make improvements?

Seeing the gaps and analyzing your results helps you figure out how and where you need to improve. Once you’ve identified your performance gaps, you can figure out how to address them, then collect feedback around those projects to see if they’re having an impact. This way, you develop an ongoing cycle of process and performance improvement driven by data. Based on what you’re seeing, you can determine what measures you need to look at next to collect the right data to further improve performance, operations and outcomes.

Along those lines, it’s important to base decisions on the data you collect rather than what you assume to be happening. “I feel like this will change X, Y and Z because it just makes sense” won’t get you far. To understand what is true, you need to hear what your patients and caregivers have to say and measure your performance to drive improvement.

How you communicate and present survey results will determine how well the information can be used to drive the strategy and vision for your agency. It also has a huge bearing on the confidence people have in your survey results. This is where HEALTHCAREfirst really shines. For example, we’ve created a senior living dashboard for one of our customers based on the analysis of survey results. The dashboard distills essential information onto one page that can be specific to an entire campus or just one facility. Side-by-side comparisons of departments makes it easy to see top and low performers, so you’ll know where to focus to boost satisfaction and net promoter scores.

You can present results from home health and hospice CAHPS surveys in similar ways to glean deeper insights. For example, you can compare teams or locations to see how they’re doing with publicly reported composite records and the individual questions that drive those. The key is to drill down to see individual scores, but also to identify trends over several months to see what’s driving performance.

When analyzing survey results, find opportunities where you have the biggest opportunity to improve. For example, if a question results in 99.4% positive responses, it may be more beneficial to look elsewhere for opportunities to improve. See how you compare with others around specific measures and work on what’s negatively affecting your scores.

Individual comments can give you more context around the issues respondents may be experiencing, so it’s important compile and review them. As part of our services, HEALTHCAREfirst transcribes, codes and groups comments so you can slice and dice the data in different ways. For example, you can filter this data to give kudos to staff where it’s deserved and identify global issues that may be affecting each team.

Get expert help to get more from your surveys

Understanding your CAHPS scores and patient feedback survey results can be one of the most effective ways to improve your operations, performance and ratings. But surveys can be time-consuming and costly to conduct on your own. Look to HEALTHCAREfirst to do more with your surveys. We began as a survey company focusing on the FEHC from NHPCOs family evaluation of hospice care and grew to become a CAHPS vendor for home health and hospice. We currently work with more than 2,500 agencies and administer 1.2 million surveys each year, processing 5,000 surveys each day. We also have a unique system for processing handwritten comments, manually transcribing and coding them before sending them back to you. We also offer bereavement surveys, manage HIS to help drive hospice clinical quality, and compile information using survey feedback, claims data, HIS and OASIS data to give you a comprehensive view of your agency’s performance. Do more with your survey data. Connect with us today.

By:
Liz Silva, Product Manager, Survey Services
Lavin Graviss, Director, Operations & Survey