Using ICH CAHPS® Survey Data to Improve Patient Experience and Satisfaction with your Dialysis Center


Background

Now that we have 2012 results for hundreds of dialysis centers, we thought it might be useful to do some overall analysis of the results in aggregate. Our discussion of these results regarding the importance of individual satisfaction items is generally relevant to individual dialysis centers. However, the discussion of performance results does not necessarily apply to any individual center, but to the group on average.

We believe that if you are doing the ICH CAHPS® survey, or any patient experience / satisfaction survey, then you should be using the results for improving the experience and satisfaction of your patients. But, it’s not immediately obvious where to focus your attention. You can’t address every issue all at once.

  • What are the things that are going to have the biggest impact on patient satisfaction?
  • How are you doing on those things now?

To address these questions and give our clients the best possible guidance we have developed our powerful SatisAction™ statistical modeling system. The DSS SatisAction™ key driver statistical modeling system is a powerful, proprietary statistical methodology used to identify the key drivers of overall dialysis center ratings and to provide actionable direction for satisfaction improvement programs. This methodology is the result of a number of years of development and testing using health care satisfaction data. We have been successfully using and improving this approach since 1997. The model provides the following:

  • Identification of the elements that are important in driving overall ratings of a dialysis center.
  • Measurement of the relative importance of each of these elements.
  • Measurement of how well patients think the center performed on these important elements.
  • Presentation of the importance/performance results in a matrix or POWeR Chart™ that provides clear direction for member experience and satisfaction improvement efforts by the center.

Survey Instrument

The analysis is based on one dependent variable and 25 independent or predictor variables from the In-Center Hemodialysis CAHPS® survey.
The independent or predictor variable:

Q35 Rating of the dialysis center?

The dependent variables:

Q03 How often kidney doctors listen carefully?
Q04 How often kidney doctors’ explanation easy to understand?
Q05 How often kidney doctors show respect for what you had to say?
Q06 How often kidney doctors spend enough time with you?
Q07 How often kidney doctors really cared about you as a person?
Q08 Rating of your kidney doctors?
Q09 Kidney doctors informed about care from other doctors?
Q10 How often dialysis center staff listened carefully to you?
Q11 How often dialysis center staff explanation easy to understand?
Q12 How often dialysis center staff show respect for what you had to say?
Q13 How often dialysis center staff spent enough time with you?
Q14 How often dialysis center staff really cared about you as a person?
Q15 How often did dialysis center staff make you as comfortable as possible during dialysis?
Q16 Dialysis center staff keep information about you and your health as private as possible from patients?
Q17 Feel comfortable asking the dialysis center staff everything you wanted about dialysis care?
Q21 How often dialysis center staff insert your needles with as little pain as possible?
Q22 How often did dialysis center staff check you as closely as you wanted while you were on the dialysis machine?
Q24 How often the dialysis center staff were able to manage problems during your dialysis?
Q25 How often dialysis center staff behave in a professional manner?
Q26 Dialysis center staff talk to you about what you should eat and drink?
Q27 How often dialysis center staff explain blood test results in a way that was easy to understand?
Q32 Rating of your dialysis center staff?
Q33 How often get put on the dialysis machine within 15 minutes?
Q34 How often the dialysis center was as clean as it should be?
Q43 How often were you satisfied with the way they handled these problems?

Twenty-one of these questions involve rating scales. In most cases, the rating is of “how often” something was done with the scale never, sometimes, usually or always.

In four instances, questions 9, 16, 17 and 26, patients are asked to respond in a yes/no fashion.

What measures are important to patients?

The importance analysis involves a multi-step process where:

  • Factor analysis is used to summarize the predictor set into a more manageable number of composite variables.
  • Regression analysis is used to measure the relative importance of each item in driving overall satisfaction with a center.

Based on this statistical analysis, six items stand out in terms of their impact on the overall rating of a hemodialysis center. These are things where lower or higher ratings or just ratings in general have a big impact on the overall rating:

Q14 How often dialysis center staff really cared about you as a person?
Q12 How often dialysis center staff showed respect?
Q10 How often dialysis center listened carefully?
Q13 How often dialysis center staff spent enough time with you?
Q11 How often dialysis center staff explanations were easy to understand?
Q15 How often did dialysis center staff make you as comfortable as possible during dialysis?

In other words, these are the areas where ratings on the individual items have the biggest impact on the overall rating of the center. Other things equal, these are the things on which you want to focus to improve patient experience / satisfaction and thereby improve overall rating of the dialysis center.

What’s important to patients is generally consistent across dialysis centers, so you can take these things as important to your patients. These results should be roughly the same for patients of any dialysis center.

How are dialysis centers performing?

The other element of our analysis relates to relative performance of a dialysis center on these same 25 items. As noted above, our results for this analysis are based on an “average” dialysis center and do not necessarily apply to any individual center.

The top six items, based on performance, for our average center, in order of relative performance, from high to low are:

  • Q34. How often the dialysis center was as clean as it could be?
  • Q16. Dialysis center staff keep information about you and your health as private as possible?
  • Q17. Feel comfortable about asking the dialysis center staff everything you wanted about dialysis care?
  • Q25. How often dialysis center staff behave in a professional manner?
  • Q26. Dialysis center staff talked to you about what you should eat and drink?
  • Q15. How often did dialysis center staff make you as comfortable as possible during dialysis?

Conversely, the six items where an average dialysis center performs most poorly from low to high are:

  • Q43. How often you are satisfied with the way they handled problems?
  • Q06. How often kidney doctors spent enough time with you?
  • Q33. How often you get put on the dialysis machine within 15 minutes.
  • Q08. Rating of your kidney doctors?
  • Q21. How often dialysis center staff insert your needles with as little pain as possible?
  • Q13. How often dialysis center staff spent enough time with you?

The DSS POWeR Chart™

Results of the modeling are presented in a classification matrix. The importance and performance results for each item in the model are plotted in a matrix like the one shown below. This matrix provides a quick summary of what is most important to your patients and how your center is doing on those items. The matrix is divided into four quadrants. The quadrants are defined by the point where the medians of the importance and performance scales intersect. The four quadrants can be interpreted as follows:

  • Power.  These items have a relatively large impact on overall rating of center and your performance levels on these items are high. Promote and leverage strengths in this quadrant.
  • Opportunity.  Items in this quadrant also have a relatively large impact on overall rating of center but your performance is below average. Focus resources on improving processes that underlie these items and look for significant improvements in overall health plan ratings.
  • Wait.  Though these items still impact overall rating of center, they are somewhat less important than those that fall on the right hand side of the chart. Relatively speaking, your performance is low on these items. Dealing with these items can wait until more important items have been dealt with.
  • Retain.  Items in this quadrant also have a relatively small impact on overall rating of center but your performance is above average. Simply maintain performance on these items.

The results of this analysis can be displayed in a DSS POWeR Chart™ (see sample below):

Results for average center for 2012.

In the POWeR™ Chart below, you can see how the different survey items fall in the different chart quadrants for the “average center. For example, the quadrant at the lower right shows those items that are highly important to patients on which dialysis center performance is below average, the items included are:

  • Q14.  How often dialysis center staff really cared about you as a person?
  • Q13.  How often dialysis center staff spent enough time with you?
  • Q32.  Rating of your dialysis center staff?
  • Q07.  How often kidney doctors really cared about you as a person.
  • Q04.  How often kidney doctors’ explanation easy to understand.

These are the items where improvement is going to have the biggest positive impact on the patient experience and satisfaction.

The themes that we find in these items – caring, spending enough time, overall rating – can be elusive. However, studies show that simple things like involving family and friends in the patient’s treatment and care, showing respect for patient’s choices and listening carefully to patients’ aspirations and concerns have a big positive impact on these items. Keep in mind that “staff” is not just the doctors and the nurses. Staff includes social workers, billing representatives, housekeeping and maintenance, dietary aides, and all staff at the dialysis facility. It’s important that all staff showing care and concern for the patients. It’s also important to provide access to understandable information. This empowers patients to participate in their treatment and care.

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