by Michele von Dambrowski

“While we are the market leader, we have a lot of competition,” says Scott Smith, chief operating officer for outpatient imaging at Memorial Hermann in Houston. The health care system operates 23 of about 250 freestanding imaging centers, many of which are independently owned, in the metropolitan area.

Memorial Hermann’s outpatient imaging division was registering a patient satisfaction level at the 17th percentile in January 2007, six months before the introduction of a comprehensive customer service program called “race to retail.” The initiative brought up scores significantly, but they did not approach the 65th percentile goal, according to Smith, who shared his company’s experience in a presentation at the Fourteenth National Forum on Customer Based Marketing Strategies, held earlier this year in Las Vegas.

Smith considers outpatient imaging a retail business because consumers have a lot of choices and ease of access is important. As such, a center can suffer business declines from poor customer service during the three to four weeks it takes to get feedback from a typical mail survey. “We spent a lot of time looking for alternatives,” he says, while working with the organization’s patient satisfaction measurement firm, Press Ganey, in trying to shorten turnaround time and finding a representative peer sample for benchmarking purposes.

Real-time feedback and service recovery
What Memorial Hermann wanted was “a standardized way to get immediate feedback from patients,” Smith explains. It also wanted a way to make amends to patients before they had a chance to talk to their doctor or a friend about a negative experience.

The solution, developed with Gelb Consulting Group in Houston, came in the form of a very brief (one minute or less) survey administered on one or more self-service kiosks in each of Memorial Hermann’s imaging centers. Patients who note they were somewhat satisfied or not satisfied with service are directed to a screen where they can key in a description of their problem. Their input is immediately e-mailed to one or more center managers, whose goal is to speak to patients within one hour and offer service recovery. “Sometimes we can intercept patients before they leave,” says Smith. “That [quickness of response] in itself impresses a lot of patients.”

When patients check in at a center, they receive a card that explains the survey’s purpose and supplies a password. In completing the survey, dissatisfied patients are asked for their name and phone number. Smith says that those patients who don’t provide that information aren’t contacted. However, the facility still can identify the individual and the problem.

Two of the kiosk questions – likelihood of future use and likelihood to recommend – nearly replicate the questions found on the Press Ganey survey. “These scores tend to trend,” says Smith, and consequently, the questions may be consolidated in the future. There’s also the ability to add customized questions. The final kiosk question asks patients if they want to recognize an employee. “Quite a few leave comments, and we actually share these with all of our staff,” Smith adds.

The kiosk application concludes by thanking patients for completing the survey and noting that they may receive a more detailed questionnaire in the mail. “We were concerned that the [kiosk survey] would dramatically depress responses from the Press Ganey survey,” says Smith. “If anything, our return rates have increased.”

Smith and center managers can view a regularly updated dashboard of results from the kiosk survey. “I’m more concerned with capturing all the dissatisfied patients than with the total number who complete the survey,” he says. The point is “to perform service recovery” with unhappy patients, which should positively affect Press Ganey scores. Smith acknowledges that educating staff about the survey’s purpose is critical, pointing out that employees would rather have dissatisfied patients leave rather than complete a survey.

Outcomes
In the first few months of the initiative, Smith says, the outpatient imaging centers saw a 5 percent to 10 percent survey completion rate. The responses now number at least 15 percent and can reach 50 percent in some locations. Most important is the uptick in overall Press Ganey scores, which had hovered in the 54th percentile before the introduction of the kiosks. They have since surpassed the 65th percentile and have approached the 85th percentile.

In addition, some of the mail questionnaire participants have remarked positively about the response they received to their concerns at or shortly after their center visit. The few participants who question the need for a second survey have positive Press Ganey scores.

Smith says the cost of the survey design and programming ran less than $75,000, an amount that also included some community survey and benchmarking work. The hardware is significantly higher – about $5,000 per kiosk.

Lessons and considerations
Smith points out that the institution of Memorial Hermann’s fast feedback tool required some experimentation, and there is room for improvement.

A user-friendly kiosk. Smith is dissatisfied with Memorial Hermann’s present solution, which doesn’t have a typical keyboard. Because of the free-text nature of some of the questions, a simple touch-screen solution isn’t an option. “What might work best is the combination of a touch screen and a full-size keyboard,” he says. He notes that some locations have found a PC with an Internet connection has worked well, although space considerations limit that option everywhere.

Location. The freestanding, wireless kiosks had to be shifted to different areas to find the ideal spots for patient access. Smith points out that the traffic flow and multiple exits in each center weren’t designed with the kiosks in mind. Placing the kiosks in changing areas presents a problem by overlooking those patients who don’t have to change for their procedure. Many of the centers now have two kiosks, and some should have three, he says.

Staff education and survey promotion. Employees need to promote survey completion, especially when faced with a disgruntled patient. Smith says that Memorial Hermann is also experimenting with signage that shows a picture of the center manager and kiosk. Patients receive both the explanatory card at registration and a thank-you card signed by a staff member at the end of their visit. Linking the survey with the word “checkout” also tells patients that feedback is part of their center visit.

Memorial Hermann will roll out the kiosk survey concept in its 27 sports medicine centers and in its outpatient laboratories. “There has also been talk in doing something similar in our emergency rooms,” says Smith.