At Saint Joseph's Hospital of Atlanta, improving customer satisfaction is one of the goals in the 356-bed facility's strategic plan.
It's also part of the hospital's employee-incentive program.
"We have tied increasing satisfaction to the overall incentive plan for the organization," said Linda Anderson, Saint Joseph's vice president of marketing, planning and managed care. "Unless we receive certain increases (in patient-satisfaction scores), nobody gets a bonus, (from) the CEO to the average nurse."
Over the past four years, Saint Joseph's has conducted various patient, employee, community and medical staff surveys. But, unlike many hospitals that conduct surveys and then shelve them, Saint Joseph's uses the information contained in such reviews to set goals for positive change, Ms. Anderson said.
While Saint Joseph's hasn't been able to measure improvements in financial terms, it has increased the number of patients covered under managed-care contracts to 17% of its total from 4% over the past three years, Ms. Anderson said. The hospital served 120,000 patients in 1993.
Its contracts help strengthen the hospital in a state where 8% of the population is covered by an HMO, according to Georgia Insurance Department data. Saint Joseph's is slightly above the average 1992 managed-care penetration of 15% of Atlanta's 400,000 population, up from 13% in 1991, according to a survey by the Sachs Group, Evanston, Ill.
"We use that (survey) information to demonstrate to payers that we are a preferred hospital in terms of patients and physicians," Ms. Anderson said. "Managed-care penetration (increases are) a good measurement of our success."
Ken Gary, chairman of the Atlanta Health Care Alliance, said large employers are looking for hospitals that provide good customer service as well as low prices. The alliance represents 22 Atlanta companies and has a provider council of 22 hospital chief executives.
"We support the use of (customer-satisfaction) surveys and encourage standardization and improved accuracy," said Mr. Gary, president of Georgia Power Co. "It won't make a contract, but it can break one."
To coordinate surveys and to improve accuracy, three years ago Saint Joseph's switched from written surveys to telephone surveys conducted by the Gallup Organization, Ms. Anderson said (See main story, p. 30).
Gallup's sophisticated statistical analysis of data allows Saint Joseph's to identify areas that make a difference in a patient's hospital experience, she said.
"People complain about food, but their concerns are mostly centered around nursing and interpersonal interactions," Ms. Anderson said. For example, patients most wanted nurses to explain their care and what will happen to them in diagnostic tests, surgery or therapy, she said.
Saint Joseph's uses the information to work one-on-one with nurses and other employees to improve those areas, Ms. Anderson said. "Improvement is made at the individual level," she said. "Each department sets goals and works out action plans."
Every day, Gallup researchers telephone a random group of Saint Joseph's patients and question them for 12 minutes about care they recently received, said David Jackson, who manages Gallup's eastern division healthcare practice in Columbia, Md. The numbers are crunched and the findings are sent to the hospital in various report forms, he said.
One problem with surveys is that scores generally plateau, she said. "In areas like food, the scores can only go so high, so we set goals that they need to maintain that level," Ms. Anderson said.
Over the past several years, medical staff surveys have changed from focusing on how physicians use services to queries into how managed-care plans affect them and their choices of hospitals, Ms. Anderson said.
"We used to focus primarily on competitive issues, such as where do physicians practice and which hospital has the best nursing care or cardiology care," Ms. Anderson said.
"Now we ask physicians a series of questions on managed care," she continued. "What plans are they part of? What percentage of patients are under managed care? If they don't come to Saint Joseph's, where does the patient go? What plans are physicians planning to use?"
The hospital uses that information in the strategic planning process to help guide decisionmaking, she said. "The surveys contain information that we wouldn't have any other way," she said.
Results from physician surveys have been surprising, she said. "Our younger doctors (under age 40) in particular are being directed elsewhere (to admit their patients)," Ms. Anderson said. The average age of the hospital's 700-member medical staff is 42, she said.
Saint Joseph's response has been to look at potential affiliations with other hospitals for the purposes of developing managed-care networks, she said.
Officials at Saint Joseph's believe subtle changes in patients' and physicians' attitudes can make the hospital more competitive.
"The surveys don't clinch the deal," Ms. Anderson said. "As a hospital (specializing in cardiology, oncology and orthopedics), our reputation is substantiated. After all the evidence we present, it gets back down to price."