Stanford Health Care takes pioneering step on patient surveys to improve care

The patient survey that shows up in your mailbox or your email inbox has become so routine after an appointment or hospital stay, it’s hard to believe that most hospitals and clinics have been sending them out for only about 15 years.

The surveys became a Centers for Medicare & Medicaid Services requirement for hospitals in October 2006; after that time, most health systems across the country, including Stanford Health Care, also began using them to improve patient care. Most organizations work with a single private company to collect data on patient feedback and hospital performance.

Now, patient experience leaders at Stanford Health Care are taking a new approach. They’re the first academic medical center to use Qualtrics for the entire survey system. And they’re redesigning the survey questions with help from a social psychologist and professor of humanities and social sciences at Stanford University.

Associate editor Mandy Erickson spoke with Alpa Vyas, Stanford Health Care’s vice president and chief patient experience officer; Mysti Smith-Bentley, executive director of service excellence; and Justin Ko, MD, MBA, the physician leader in safety, quality and performance improvement for the Department of Dermatology and the medical director of service excellence, to learn more.

1. What have you learned from patient surveys, and what do you still need to learn?

Smith-Bentley: When we first started conducting surveys, we saw a really steep improvement in patients’ satisfaction with our care. Their responses helped us address things like wait times and staff interactions. We’re really good at measuring the encounter in the clinic, but we don’t know what happens in between visits — like when a patient has a question for the physician or needs to refill a prescription. We realized we need to know how our patients are faring all the time.

2. Why did you decide to overhaul the survey system?

Vyas: One problem is that most of the current surveys ask questions that don’t pertain to the patient’s most recent experience. Also, the paper surveys tend to be really long.

A lot of the questions, such as “How well did staff work together?” are too vague for us to do anything with. Each patient interprets that question differently. We need more targeted information that we can respond to quickly.

We want more actionable data, in real time: With the new system, we’ll learn results from the surveys almost immediately, not weeks later. That includes comments patients write about their experience.

Ko: I want to know how a change in the way we schedule a follow-up appointment influences the patient experience — not in one month, but today. I want to know how a new virtual platform is affecting patients’ access to care. Perhaps most importantly, we want to hear from all our patients, to make sure we have representative feedback from the diverse community we treat so we can address the issues that matter to everyone.

3. What changes is Stanford Health Care making to its surveys?

Vyas: The surveys will go out immediately, most by email, though some will be on paper and mailed. Eventually, we’ll send text messages. We’ll be able to cast a much wider net — the survey will go to more people.

We will ask each patient fewer questions but still get the same amount of information. For example, if we have 20 questions we want to ask, we can ask half of the patients 10 of those questions and the other half the rest of the questions. With more surveys, and better response rates — which we expect with shorter surveys — we can get the same number of answers to each question.

Also, we’ll ask questions tailored to the patient’s most recent encounter with Stanford Health Care. If they had a visit with their primary care physician, that’s where we’ll focus our questions; we won’t ask if their hospital discharge instructions were easy to follow.

Finally, a faster turnaround time will allow us to address problems right away.  

4. How do you ensure you have well-designed surveys?

Smith-Bentley: We’re working with a survey-design expert at the Stanford University School of Humanities and Sciences to develop customized questionnaires. We’re conducting interviews with patients to find out what’s most meaningful for them and looking at how patients interpret the questions. We want to make sure the patient understands the questions the way we intend for them to be understood.

For example, in surveys, when we asked emergency department patients, “Did staff care about you as a person?” we thought we were asking whether staff members were being caring and kind. But after talking with patients, we realized that’s not how they saw the question. Patients were thinking about how long they had to wait and whether they received test results quickly.

5. How will these changes improve patient care?

Smith-Bentley: There will be a much faster response time: The new system will put insights into the hands of our care leaders on their phones and tablets so they can make improvements right away.

The new survey will ask patients what really matters to them. During our research, when we spoke with chemotherapy patients, we learned that food was really important. Some of them have to sit through eight hours of treatment, and having nutrition helps them get through it. We could have food delivered to patients while they’re undergoing the treatment.

Ko: Everyone who works at Stanford Health Care is here because they want to provide the best care possible to our patients, and this move is an important step toward that. It’s not about a score or a ranking; it’s about understanding what matters to our patients and providing our teams with the data, tools and insights to improve care. It’s about providing a better experience through the entire care journey. 

For any questions or comments, please reach out to patientexperiencereporting@stanfordhealthcare.org.