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The Impact of Satisfaction Surveys on Quality Improvement

The Impact of Satisfaction Surveys on Quality Improvement. OCTOBER 23, 2008. Mary Tellis-Nayak RN, MSN, MPH Vice President of Quality Initiatives. mary@myinnerview.com. 715-848-2713. Objectives. The participant will be able to:

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The Impact of Satisfaction Surveys on Quality Improvement

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  1. The Impact ofSatisfaction Surveys on Quality Improvement OCTOBER 23, 2008

  2. Mary Tellis-Nayak RN, MSN, MPH Vice President of Quality Initiatives mary@myinnerview.com 715-848-2713

  3. Objectives • The participant will be able to: • Describe how satisfaction surveys fit into a quality improvement framework • List three things most important to nursing home residents and families in Wisconsin • Identify two areas where employees’ satisfaction with their workplace relates to residents • Describe how to use satisfaction data to improve the quality of life for their residents

  4. Outline • Overview • Satisfaction surveys as framework for QI • Why is resident satisfaction important for quality of care? • Listening to the voices of Wisconsin families and residents • The relationship between resident and employee satisfaction • Integrating satisfaction data into your QI program

  5. To provide long-term care leaders evidence-based management tools to better achieve their organization’s goals

  6. Sources of data • Largest private dataset of resident and family satisfaction in nation • From mailed resident and family surveys returned to third-party • Respondents rate communities using four-point scale (excellent, good, fair or poor)

  7. My InnerView will support you to advance excellence

  8. Satisfaction Surveys: A Framework forQuality Improvement

  9. Quality control • Quality control is the ongoing effort to maintain the integrity of a process to maintain the reliability of achieving an outcome

  10. Quality assurance • Retrospective review or inspection of services or processes that is intended to identify problems

  11. Quality improvement • Quality improvement is the purposeful change of a process to improve the reliability of achieving an outcome • The continuous study and improvement of a process, system or organization

  12. My InnerView’sevidence-basedpath to quality Evaluateoutcomes:measurevariation Collectdata:ensure validity,organize Turn plan intoaction: improveprocess Turn data intoinformation:benchmark, studyvariation Turn knowledgeinto plan:apply new wisdomto process Turninformation intoknowledge:study currentprocess

  13. Complaints that reach you: Tip of the iceberg! 5% complain to management 45% complain to frontline staff 50% have problem, yet don’t complain Good quality is good business (TARP studies)

  14. Quality pyramid Loyalty Scale 100% Very Satisfied Satisfied Dissatisfied 0% Unanticipated quality Customer-driven quality = Desired Community standards = Expected quality Regulations = Basic quality

  15. When you don’trememberanything,you’re satisfied!

  16. Loyalty isgenerated bymemorable thingsthat happen thatwe didn’t expect. These cause person to give scoreof “Excellent,” not “Good”

  17. The relationshipbetween satisfactionand occupancy

  18. “Research shows that, in most industries, there is a strong correlation between a company’s growth rate and the percentage of its customers who are raving fans — that is, those who say they are extremely likelyto recommend the company to a friend or colleague.”

  19. The importanceof “Recommendation” “Recommendation” is touchstone to determine significance of your scores on all other items

  20. The importanceof “Recommendation” • Provides crucial information • Tells you loyalty of respondents • Correlates to other quality outcomes: • All items in survey • Occupancy • Quality indicators • Employee satisfaction • That is why this question is used for Priority Action Agenda

  21. If you want to grow your business exponentially,you must get serious about building and maintaining loyal relationships with your customers • Loyal customers are easiest customers to serve • Long-term customers tend to spend more with you than new customers • Happy, loyal customers purchase other products or services in company’s line • Satisfied, loyal customers recommend company’s products or services FREDERICK RIECHHELD: “THE LOYALTY EFFECT”

  22. Why is willingnessto promote your company such a strong indicator of loyalty and growth? FREDERICK RIECHHELD: “THE ONE NUMBER YOU NEED TO GROW”

  23. Because whencustomers recommend you,they’re putting their reputation on the line. They will take that risk only when they are loyal.

  24. “In most of the industriesstudied, the percentage of customers who were enthusiastic enough to refer a friend or colleague — perhaps the strongest sign of customer loyalty — correlated directly with differences in growth rates among competitors.”

  25. We do not know what process(es) to improve (QI) unless we know what is important to our internal and external customers and how they evaluate our performance in these areas

  26. AN EXERCISE:WhatMatters Most

  27. QUADRANT ANALYSIS: TWO KEY CONCEPTS 1. How residents, families and staff rate your care and services Your average score on each item: 1 – 4: “Poor” “Fair” “Good” “Excellent” Rank order all items by average score: 1 – 100: Lowest to highest ranking score 2. How much each item influences residents, families and staff to recommend to others Correlate each item with “Recommendation: 0 – 1: No correlation to strongest correlation Rank order all items by correlational strength: 1 – 100: Lowest to highest ranking correlation

  28. Recom-mendation Goal Item score QUADRANT AND ACTION PRIORITIES Successes A. Secondary strengths B. Primary strengths 1 - Lowest to highest ranking score  100 You can meet customer expectations Challenges C. Secondary opportunities D. Primary opportunities 1 ----- Lowest to highest ranking correlation ------ 100 You have little control over customer expectations

  29. WISCONSIN Voice of Residents andFamily Members

  30. SKILLED NURSING RESIDENT AND FAMILY Survey items Choices/preferences Respectfulness of staff Respect for privacy Resident-to-resident friendships Resident-to-staff friendships Meaningfulness of activities Religious/spiritual opportunities Quality of RN/LVN/LPN care Quality of CNA/NA care Quality of rehabilitation therapy Adequate staff to meet needs Attention to resident grooming Commitment to family updates Competency of staff Care (concern) of staff Responsiveness of management Safety of facility Security of personal belongings Cleanliness of premises Quality of meals Quality of dining experience Quality of laundry services

  31. WISCONSIN RESIDENTS What matters most 1 - Choices/preferences 14 - Competency of staff 15 - Care (concern) of staff 9 - Quality of CNA/NA care 8 - Quality of RN/LVN/LPN care 2 - Respectfulness of staff 16 - Responsiveness of management 12 - Attention to resident grooming 17 - Safety of facility 11 - Adequate staff to meet needs

  32. WISCONSIN FAMILIES What matters most 15 - Care (concern) of staff 14 - Competency of staff 1 - Choices/preferences 8 - Quality of RN/LVN/LPN care 16 - Responsiveness of management 9 - Quality of CNA/NA care 2 - Respectfulness of staff 17 - Safety of facility 11 - Adequate staff to meet needs 5 - Resident-to-staff friendships

  33. RESIDENT

  34. FAMILY

  35. RESIDENT FAMILY A B 8 2 8 10 2 13 17 15 19 17 SECONDARY STRENGTHS PRIMARY STRENGTHS 15 5 7 14 13 10 7 5 4 14 9 9 3 3 6 6 4 1 1 19 16 12 20 18 SECONDARY OPPORTUNITIES PRIMARY OPPORTUNITIES 16 21 22 22 12 21 18 20 11 C D 11

  36. Quality ofRN care Respectfulness of staff Care (concern)of staff Competencyof staff Quality ofCNA/NA care RESIDENT FAMILY A B 8 2 8 10 2 13 17 15 19 17 SECONDARY STRENGTHS PRIMARY STRENGTHS 15 5 7 14 13 10 7 5 4 14 9 9

  37. Safetyof facility Resident-to-stafffriendships RESIDENT FAMILY A B 10 13 17 19 17 SECONDARY STRENGTHS PRIMARY STRENGTHS 5 7 13 10 7 5 4

  38. Attention toresident grooming Choices/preferences Responsivenessof management Adequate staffto meet needs RESIDENT FAMILY 3 3 6 6 4 1 1 19 16 12 20 18 SECONDARY OPPORTUNITIES PRIMARY OPPORTUNITIES 16 21 22 22 12 21 18 20 11 C D 11

  39. Re-enterquality improvement • In the aggregated report from Wisconsin,the question that addresses “Choicesand preferences” (Q1) is in Quadrant Dfor both families and residents • How does an organization use QI to address this issue? • Remember definition: The continuous studyand improvement of a process, systemor organization

  40. How do you improve theprocess of “CHOICE”? • What, today, are the areas in our home where residents have the opportunity to choose? • What are the areas where they want the opportunity to choose and they don’t have it today? • Within those areas, what are the options they want to choose from?

  41. Why do you feel that this facility is not meeting your choices and preferences?

  42. Look at the possibilities: • Bathing times — shower, bath • Meal times • Food choices • Dining choices (with whom, types of service, etc.) • Activities • In the facility — in the community — religious • Choices around ethical and end of life issues • Pureed foods vs. normal consistency • Antibiotics vs. not taking any • Hospitalizations

  43. How do I get answers to the “why” questions? • Hold focus groups with residents and/or families • Create a follow up questionnaire and distribute it to residents/families • Hold discussions about “choice” at resident council and family council meetings • LISTEN to the interactions between residents, families and staff • Let your residents and families know you listened to what they said on the surveys and you want to take action to improve

  44. What next? • Gather answers to “why?” • Organize them and identify trends and patterns • Do they focus on dining or bathing or end of life? • Did you hear any specific ways you could meet residents’ needs for choices and preferences? • What processes impact resident choices? • What can we do to change and improve these processes to allow for resident choice?

  45. My InnerView’sevidence-basedpath to quality Evaluateoutcomes:measurevariation Collectdata:ensure validity,organize Turn plan intoaction: improveprocess Turn data intoinformation:benchmark, studyvariation Turn knowledgeinto plan:apply new wisdomto process Turninformation intoknowledge:study currentprocess

  46. What about employees? • Most of the most highly correlated items from “What matters wost” in Wisconsin have to do with the relationship between the resident and the staff • Care and concern • Competency • Quality of CNA/RN/LPN • To try to improve resident and family satisfaction without addressing the needs of employees is impossible

  47. SKILLED NURSING Voice of Employees

  48. AN EXERCISE:WhatMatters Most

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