Dare County: Patient Satisfaction and Community Surveys

Summary

Impact Statement:

A local health department in North Carolina used PDSA cycles and lean/kaizen approaches to improve their clinic client and community satisfaction survey tools and data collection process. This provided a system-wide framework to enable the organization to better understand their customers’ needs, identify areas for improvement, and assure they were meeting the needs of their community.

Summary:

Staff at Dare County Health and Human Services used a variety of quality improvement (QI) tools and methods to improve the feedback provided to the agency from patients and the community in an effort to evaluate and make improvements to programs and services with consideration of their feedback. The agency improved its patient satisfaction and community (nonpatient) survey tools and the data collection processes. This allowed for staff to collect more data and receive higher-quality data. Staff also developed data analysis and sharing processes and implemented an improvement process based on the quality feedback from consumers and the community. These processes were either nonexistent or in need of drastic improvements.

Organization that conducted the QI initiative:

Dare County Health and Human Services

Citation:

Willingham, L. Public Health Quality Improvement Exchange. Dare County: Patient Satisfaction and Community Surveys. Wed, 11/15/2017 - 16:23. Available at http://phqix.org/content/dare-county-patient-satisfaction-and-community-surveys. Accessed April 19, 2024.

Background and Aim

Aim statement:

The agency aims to improve its clinic patient satisfaction and community survey tools and data collection process (Phase 1) by August 2013 and to develop a data analysis process and implementation of improvements based on quality feedback from consumers and the community (Phase 2) by January 2014. This is important because it will help the agency continually improve the services it provides to ensure that they meet the community's needs. The agency will use QI methods and tools to understand the current process and identify ways to improve.

Need For The QI Initiative:

Support for the project included a strong QI team, accreditation support, four benchmarks associated with this process (benchmarks 27.1, 27.2, 27.3, and 30.8), a large gap between current and desired status, a project that can be completed in 2–3 months, low resistance from staff, and feedback from clients/the community that could help direct the agency to other QI areas/projects.

Area for Improvement:

The areas for improvement were the patient satisfaction survey and the community survey. Both surveys were outdated and not user friendly. The processes by which the surveys were administered were not efficient. There was no consistency in when the surveys were handed out, and staff never received any information about the results of the surveys. No follow-up was being completed with the data, and no improvements were made as a result of the data. The entire process needed to be improved. The agency wanted to get better feedback from consumers and the community, better understand the needs of consumers and the community, improve the survey tools, improve the survey processes, improve the survey analysis, and change implementation processes.

Root Cause:

The root causes included the following: • poor survey tools • poor data collected • lack of consistent data collection processes • lack of process for implementing improvements • no roles or responsibilities established • no department-wide support • no team approach

Planning and Execution Details

QI Implementation:

1st Plan, Do, Study, Act (PDSA) Cycle: Step 1 • Patient satisfaction survey; get patient feedback on the survey. • Agency staff gave the patient satisfaction survey to 10 patients and asked them to complete it and provide input on how to improve it. Then, as a team, staff made some of those improvements to the survey. 1st PDSA Cycle: Step 2 • Patient satisfaction survey; get staff input on the survey. • Agency staff took the revised survey and asked 10 staff members to complete it and provide input on how to improve it. Then staff revised the survey further. 1st PDSA Cycle: Step 3 • Patient satisfaction survey; patient focus groups with the “new” survey. • The agency had two focus groups with four patients in each, and they talked about the survey and ways to improve it. Then staff made some more edits to the survey. 1st PDSA Cycle: Step 4 • Patient satisfaction survey; staff focus groups on the “new” survey. • The agency had two focus groups with four staff in each, and they talked about ways to improve the survey and made some further changes to the survey. At that point, staff felt as though the survey was ready to be used. Staff followed this pattern with the second PDSA cycle using the community survey. 2nd PDSA Cycle: Step 1 • Community survey; get community input on the community survey. • The agency asked five community members to take the community survey and provide input on how to improve it. 2nd PDSA Cycle: Step 2 • Community survey; get staff input on the “new” community survey. • The agency asked five staff members to complete the community survey and provide input on how to improve it. Staff then made edits to the survey. 2nd PDSA Cycle: Step 3 • Community survey; test the “new” community survey with community focus groups. • The agency had two focus groups with community members. Staff asked them about ways to improve the survey, then revised the survey based on their answers. 2nd PDSA Cycle: Step 4 • Community survey; test the revised community survey with a final round of staff in staff focus groups. • At this point, staff believed that the community survey was ready to be used. Staff never call the surveys final because every year, they are revised, and staff discuss ways to update and improve them.

Focus activities

Administration:

Customer Service/satisfaction

Data collection and management/Information Technology

Quality Improvement and Accreditation Readiness

QI Methods:

Lean/Six Sigma

Model for Improvement

PDCA/PDSA Cycle (Plan, Do, Check/Study, Act)

Rapid Cycle Improvement

QI Tools:

Surveys

Other QI tools:

Value stream map

PDSA worksheet

Eight wastes worksheet

Standard work

Gemba walk and gemba walk worksheet

QI Tool Documentation:

vsm_data_collection_form_patient.pdf

vsm_data_collection_form_community.pdf

sustainability_process_plan.pdf

staff_satisfaction_survey.pdf

spread_plan_c&c2013.pdf

qi_project_c&c.pdf

patient_survey_gemba.pdf

newspaper_dare_7_24_13.pdf

charter_c&cqi_2013.pdf

Initiative Dates:

8/1/12 to 9/1/13

Initiative Duration:

Between 12-18 months

Methods of evaluation:

As part of the Center for Public Health Quality (CPHQ, http://centerforpublichealthquality.org/) QI 101 program, the agency staff created a detailed measurement plan consisting of a balanced set of process, outcome, and balancing measures that they tracked throughout the project. These data were summarized and shared with all staff to assess progress toward the measurable goals outlined in the aim statement. In addition, staff collected qualitative and quantitative data demonstrating the need for the project at the beginning, along with before/after data specifically related to the PDSA cycles throughout the project.

Supplemental Materials:

Report

Storyboard

Supplemental Files:

Attachment	Size
timelinej.jpg	1.29 MB
storyboard2013.pdf	14.55 MB
qi_program_timeline.pdf	122.92 KB

Results

Measurable QI Outcomes:

Measure: staff satisfaction with current surveys and processes • Operational definition: the opinion of clinic and HEO staff regarding satisfaction with the current process for collecting feedback from patients and the community • Baseline - Patient: 28% of staff were satisfied with the current process - Community: 15% of staff were satisfied with the current process • Goal: 40%, 40% • Post-data: 87.5%, 87.5% Measure: staff familiarity with current surveys and processes • Operational definition: the opinion of clinic and HEO staff regarding familiarity with the current process for collecting feedback from patients and the community • Baseline - Patient: 54% of staff were familiar with the current process - Community: 22% of staff were familiar with the current process • Goal: 60%, 60% • Post-data: 81.3%, 75.1% Measure: increase the number of patient satisfaction surveys completed • Operational definition: the number of physical patient satisfaction surveys completed • Baseline: 35 • Goal: 70 • Post-data: 115 Measure: increase the number of community surveys completed • Operational definition: the number of physical community surveys completed • Baseline: 5 • Goal: 25 • Post-data: 76 Measure: increase the response rate of community surveys • Operational definition: the number of community surveys completed compared with the number of surveys administered • Baseline: 5% • Goal: 50% • Post-data: 75%

Other QI Outcomes:

Other QI outcomes included the following: • Staff gained QI skills. • The team approach worked well. • Regular staff communication worked well. • QI culture has improved. • Staff feedback is all positive. • Needed processes were established. • Sustainability is key.

Lessons Learned, Observations and Insights:

Lessons learned from the patient satisfaction survey included the following: • Communication was key. • All staff emails and huddles were vital. • More “stars” and reminders needed to be provided in toolkits. • Toolkits really helped staff feel supported. • The HEO role was important to lighten the load on the agency staff and make them feel supported throughout the agency. • Providing incentives to patients as a thank you was very well received. Lessons learned from the community survey included the following: • Get surveys to school nurses earlier. • Do not rely on interoffice mail to school nurses at various school locations. • Try to get a better idea of the number of surveys needed (the agency underestimated). • School nurses were asked to have all surveys turned in to the HEO by a specific date, so the HEO knew when to expect them.

Future Plans:

As part of the CPHQ QI 101 program, the team involved its sponsor and the process owner (a manager of the process that was addressed) in creating a comprehensive sustainability plan to organize efforts. The agency used CPHQ's sustainability checklist to create the plan. The plan/checklist is attached in the QI Tools section. Sustainability Plan • Roles and responsibilities were established. • Policies and procedures were documented. • Job descriptions were documented. • The team supports the initial year of the project. • Team meetings are held once a year to review, update, and tweak the process. • Reminders are built into the events calendar.

Training and Preparation

Information about the Community

Information about the Health Department

QI Staff Information

Accreditation Details

Collaborations

Contact Information of the Submitter

Submission Status:

Completed

Comments

I am actually from a local

I am actually from a local health department in NC also and was fortunate enough to be coached by a Dare County staff member in my early QI 101 training. Patient satisfaction ended up being what our health department worked on also and Dare County was a huge help in sharing their knowledge on what they had already accomplished. This information is great. What a great way to display your successes for others to learn from. Great job!

Link to the resource where this submission is also published:

http://www.centerforpublichealthquality.org/index.php/theqitoolbox/qi-project-profile-tool

Dare County: Patient Satisfaction and Community Surveys

Summary

Background and Aim

Planning and Execution Details

Results

Training and Preparation

Information about the Community

Information about the Health Department

QI Staff Information

Accreditation Details

Collaborations

Contact Information of the Submitter

Comments

I am actually from a local

Laura, could you tell me more

Is there more information on

I found the resources here to

Great Project. How do you

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Dare County: Patient Satisfaction and Community Surveys

Summary

Background and Aim

Planning and Execution Details

Results

Training and Preparation

Information about the Community

Information about the Health Department

QI Staff Information

Accreditation Details

Collaborations

Contact Information of the Submitter

Comments

QI Spotlight