Capture Real-time Patient Experience Feedback in Imaging

Asking patients for feedback on their imaging experience has always played a significant role in helping organizations define their quality metrics and enhance services.

Yet in today’s world, health care as a whole continues to struggle behind other service industries in being able to find the right way and timing to capture such valuable feedback. The confidential and intimate nature of a patient’s experience requires sensitivity along with thoughtfulness and yet more patients than ever before are using social media as a real-time platform to reveal the quality of their care while interacting with peers quite literally as its happening.

A recent study published by Academic Radiology  regarding patients’ breast imaging experiences on Twitter concluded that social media provides a platform for patients to share their experiences and reactions including humor, positive reflections, and the encouragement of others to do the exam. The study goes on to state that social media should be evaluated further as a potential tool for health care research.

The question then becomes how can imaging practices respond to the desire for real-time engagement in an effective way that is useful for both patients and practices?

“In the autobahn of communication, hospitals are driving a Model T,” said Eric LoMonaco, director of diagnostic and interventional radiology for Community Hospital of Monterey Peninsula (CHOMP) in California who recently spoke at the Society for Healthcare Strategy and Marketing Development (SHSMD) 2016 conference. Covering one hospital and 4 clinics, in 2013 LoMonaco’s group was using a system like most other hospitals at the time consisting of postprocedural patient surveys conducted by a third party source that compiled data, and sent reports back to departments four to six weeks later. Without the ability to address concerns in a timely manner, it was common to hear patients’ frustrations but difficult to hold staff accountable. “Patients had no way to reach an administrator in the moment, when it would have the greatest impact,” he said. A problem that led to many patients feeling his organization simply didn’t care.

Real-time Experience Tools Can be Individualized, Straightforward, and Cost Effective
To elevate the quality of imaging services, practices need to get the conversation started but with the right tools, on an individual-basis, and at a time that is most comfortable for the patient to discuss their experience. In addition, organizations need to be willing to act upon what those conversations reveal.

LoMonaco partnered with a consultant business focused on hospitality and developed a QR code system called Excellence 24/7 that obtains a singular response at a monthly cost of $3,000 per month.

“All I want to see is a happy face,” he said, of the code that uses a standard cell phone app to generate a form the patient can fill out at any time. Modern, different, and easily accessible, the system took off, according to LoMonaco, whose patients are able to initiate anonymous instant communication, receive immediate service recovery, and concerns can be immediately documented and shared with staff promptly. With high accountability and a shift to more positive feedback overtime, monthly surveys focused on overall quality revealed a shift from 77.2% in 2014 to 92.2% by 2016.  With time came the opportunity to celebrate staff performance while also having fun with the patients. It is not uncommon for LoMonaco to drive to one of his locations with an orchid in hand, provide much needed patient facetime to deescalate a situation, and leave the experience asking “is there anything more I can do for you before I leave?”

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With CMS basing 25% of hospital performance on the quality domain surrounding a patient’s perception of care, being able to diffuse situations, engage in real time, and offer service recovery opportunities quickly are an absolute must within imaging departments.  With outdated and cumbersome older reports, Sabiha Raoof, MD, chairperson of radiology, at Jamaica and Flushing Medical Centers in Queens, NY, sees the value in shorter real-time surveys with imaging specific questions.

“If you have 15 or 20 questions, patients will not fill it out,” said Raoof. Using an application initially rolled out on an inpatient floor called RateMyHospital, her areas designed five imaging-specific questions related to registration, procedure, and whether they would recommend the services they had had performed. With dialogue beginning at the front desk upon arrival, patients are made aware of the tool and receive the short survey three hours later if they choose to participate. The reports are sent to the administration team daily with the expectation that they perform service recovery within 24 hours of the service. Staff issues are addressed promptly and accountability is reinforced through the presentation of compiled feedback at monthly staff meetings.

Serving a diverse patient population, Raoof said the application is available in several languages and has created open communication among staff, patients, and the administration and created a better understanding of what patients are thinking as well as bringing it to the consciousness of the staff to do the right thing by the patient. With a higher than average response rate, around 15% and continuing to rise, Raoof said that since its role out in February 2016, the survey has revealed that, for their patient population, women are more likely to complete the survey and patients prefer to do surveys immediately following procedures instead of during.

Timing is Everything
“You are vulnerable when you are still receiving services,” said Lisa Mead, RN, MS, CPHQ, executive director of the patient safety organization for Strategic Radiology, one of the largest radiology groups in the country with 1500 radiologists performing over 25 million exams annually serving hospitals and outpatients nationally. Looking at baseline cultures of safety across her groups as well as providing communication tools to elevate the experience, Mead has seen various sample survey tools used across groups and said “high touch is the best way to deal with stuff as its going on, however the methodology is still weak.”

Currently finding the strongest patient response rate between 26% to 28% when utilizing a patient emailed survey postprocedure that offers the opportunity to speak to an administrator in real time; sampling iPad applications simply didn’t offer the same results. With a much lower participation rate, “patients may not necessarily want to tell the group information right away,” said Mead who finds that patient feedback during real time may not always be objective.

“The level of intimacy is like no other,” said Linda Craib, MBA, RN, entrepreneur and patient advocate regarding the patient experience. Inspired by her own experience as a patient, Craib is currently working with Catherine Everett, MD, MBA, president of Coastal Radiology in New Bern, NC to use a prototype app they created known as the Alea app. Created to start an interactive dialogue between staff and patients during the episode of care, the Alea app heightens staff awareness of potential service issues and offers staff the opportunity to deescalate situations before they become a real issue. It also allows patients to participate, engage, and modify their own experience in real time. Modifying Alea to serve the patient community, Everett is able to get informative data about her potential patient population ranging from communication preferences to accessibility issues.

“It is critical to ask the individual what they care about as a patient,” said Craib who believes that real-time patient experience survey apps should be viewed more as a shopper service focused on the end goal of shared decision making. Every patient population is different and every individual’s needs are different, she said after experiencing her app in action within an older beach community who were highly receptive to talking in person as part of follow-up focus groups. “Simply ask people what they want within a given population.”

Passionate about health literacy and individualized treatment planning, Craib sees promise in using such real-time survey apps to continue these vital conversations, reminding us all that “you only get one chance to make a good first impression within health care or you run the risk of losing a patient forever.”  Tools that can keep the lines of communication open not only validate the essential importance of a patient’s feedback; they encourage and empower patients and staff alike to collaborate.