Optimizing Patient Feedback

Dr. Saud Ahmed, Associate Medical Director & Head - ENT, Head & Neck Services, Primecare Established in the year 2014 by a team of doctors, entrepreneurs and management professionals in Bangalore, Primecare now has a chain of hospitals, medical centres and pharmacies that aims to deliver high quality, evidence based, ethical and affordable healthcare to all patients.

The healthcare industry in India continues to grow at a tremendous pace owing to its strengthening coverage, services and increasing expenditure by public, as well as private players. With expansion, measuring the quality of health care becomes even more important because it tells us how the health system is performing eventually leading to improved care.

Patient Feedback is one important measure of quality of healthcare and provides opportunity for improvement, enhance strategic decision making, reduce cost, meet patients’ expectations, frame strategies for effective management, monitor performance of health policies and create provision of bench marking across institutions.

A Patient Feedback System consists of views & opinions of patients and service users on the care that they have experienced. Standardized questionnaires (either self-reported, interviewer administrated or by telephone) have been the most common assessment tool for conducting patient satisfaction studies. However, the traditional feedback systems have been lengthy questionnaires which occupy time and therefore compliance to the feedback becomes poor. Moreover, these questionnaires are challenged by lack of a universally accepted definition or measure. Therefore an ideal patient feedback system needs to be brief and less time consuming, yet providing meaningful information. This way more patients will be encouraged to provide feedback resulting in an increase in volume of feedback.

The Friends & Family Test
Since 2002, the Department of Health(DOH), UK, has launched a national survey program in which all National Health Service(NHS)trusts in England have to survey patient satisfaction on an annual basis and report the results to their regulators. The NHS Friends & Family
Test(FFT) was created to help service providers & commissioners understand whether their patients are happy with the service provided, or where improvements are needed. The FFT has been rolled-out across most NHS services, including community care, hospitals, mental health services, maternity services, GP and dental practices, emergency care, patient transport and more.

When a patient completes his treatment or is discharged from a service, he is invited to complete the FFT. He may be asked while still on the premises, or may be contacted within the 48 hours that follow. Some providers may offer to return the FFT by post, or give feedback over the phone or via their website.

"By combining the FFT with the NPS, an optimized feedback system could be generated which could be used as a benchmark for comparing patient-related quality of care across clinics & Hospitals"

The usual question asked is ‘How likely are you to recommend our service to friends & family if they needed similar care or treatment?’ The answer ranges from ‘extremely unlikely’ to ‘extremely likely’. The patient will also have the opportunity to explain his ranking by adding comments. This is important, because service providers can only make changes if they know exactly what is or isn’t working. Since its launch in 2013, more than 25 million pieces of patient feedback have been submitted making it the largest patient feedback collection in the world.

Net Promoter Score
Net Promoter Score(NPS)is a management tool that can be used to gauge the loyalty of a firm’s customer relationships. This was developed by (and a registered trademark of) Fred Reichheld, Bain & Company, and Satmetrix. It was introduced by Reichheld in his 2003 Harvard Business Review article ‘One Number You Need to Grow’. The Net Promoter Score is calculated based on responses to a single question: How likely is it that you would recommend our company/product/service to a friend or colleague? The scoring for this answer is most often based on a 0-10 scale.

Those who respond with a score of 9-10 are called Promoters, and are considered likely to exhibit value-creating behaviors, such as buying more, remaining customers for longer, and making more positive referrals to other potential customers. Those who respond with a score of 0-6 are labeled Detractors, and they are believed to be less likely to exhibit the value-creating behaviors. Responses of 7 and 8 are labeled Passives, and their behavior falls between Promoters & Detractors.

The NPS is calculated by subtracting the percentage of customers who are Detractors from the percentage of customers who are Promoters. Passives count toward the total number of respondents, thus decreasing the percentage of detractors & promoters and pushing the net score toward 0. NPS can be as low as −100 (everybody is a detractor) or as high as +100 (everybody is a promoter). An NPS that is positive (i.e., higher than zero) is felt to be good, and an NPS of +50 is excellent.

Applied to Healthcare, The NPS can measure the loyalty that exists between a Healthcare Provider and a Patient. Companies using the NPS often rely on various service vendors that offer a full suite of metrics, reporting, and analytics. By combining the FFT with the NPS, an optimized feedback system could be generated which could be used as a benchmark for comparing patient-related quality of care across clinics & Hospitals.

A feedback system on these lines will provide a valuable source of information for the Senior Management, Directors, Investors and other stake holders in the company to gauge the progress of the organization.