This paper explores the current healthcare dynamic and particular measures of quality control, such as patient satisfaction surveying implemented by Lehigh Valley Physicians Group to improve Clinician and Group Consumer Assessment of Hospital and Providers and Systems (CGCAHPS) scores. In the current study,the survey was administered to willing patients in waiting rooms of medical practices using an Apple iPad. The survey consisted of 5 questions similar to those of CGCAHPS vendor, Press Ganey. Respondents were asked to rate their satisfaction of the practice on a Likert Scale ranging from very poor to very good. A total of 500 responses were collected which were used in comparison to the previous study done in 2012 using mean scores. One could hypothesize that mean scores of each question would increase because previously surveyed practices could have made changes to the running the practice, such as: courtesy of staff, putting delay boards in waiting room, etc. Our data showed 2014 Beryl Grant mean scores were lower than the previous study done in 2012, but the 2014 Press Ganey scores were higher than those from 2012. These incidental findings cause us to believe that it is because we surveyed more Community Practices, notorious for lower scores due to diversity of population, limited budget, and patient volume, that the Beryl Grant mean scores are lower despite the increase from 2012 Press Ganey scores. The results of this study gave us insight into importance of communication with patients through satisfaction surveying and Press Ganey data to better practices around the Lehigh Valley Health Network.
Keywords: patient satisfaction, quality control, survey research, CGCAHPS,
Lehigh Valley Physicians Group Patient Satisfaction Surveying: Quality Control of Primary Care and Specialty Practices
Our nation’s recent healthcare reform has brought patient satisfaction to the top of all health networks’ priority list. The Consumer Assessment of Hospital and Providers and Systems (CAHPS) survey, developed by the Agency for Healthcare Research and Quality(AHRQ) isused to capture patients’ perception of their hospital or clinical experience to improve their quality of health care. According to the Centers for Medicare & Medicaid Services (CMS) (2014), “The Hospital Consumer Assessment of Hospital and Providers and Systems (HCAHPS)survey was the first national, standardized, publicly reported data collection methodology that has allowed for hospitals to be compared on local, regional, and national levels.”With the recently mandated national implementation of this survey tool to improve quality of hospitals as well as determine a hospital’s reimbursement, Clinician and Group Consumer Assessment of Hospital and Providers and Systems (CGCAHPS) are also being used as the standard for measuring patient experience in a physicians’ office setting. According to Press Ganey CG CAHPS Fact Sheet (2014), current participation is required if your group practice has 100 or more providers associated with your Tax Identification Number. Lehigh Valley Physician Group (LVPG) is an 800-provider, requiring participation. Though CGCAHPS are not mandated by law for all, they will be in the near future. In 2012, The Beryl Grant Report conducted patient satisfaction surveyingat various practices of Lehigh Valley Physicians Group to gain better understanding of where Primary Care and Specialty Practices could improve in order to raise CGCAHPS scores. The survey was comprised of questions similar to those of the Lehigh Valley Health Network’s CGCAHPS vendor, Press Ganey. The goal of recent patient satisfaction surveying was to see if any changes in patient response scores could be noted.
We administered a 5-question survey to patients and/or family members who were being treated at one of the various Community and Medical Practices of Lehigh Valley Physician Group (LVPG). Both Primary Care Practices (Family, Pediatric, Internal Medicine, or OB/GYN) and Specialty Practices were visited. Survey responses collected would be compared to the previous study in 2012 as well as current Press Ganey mean score data.
All patients who entered the survey site medical practice were asked to complete the survey. Those who responded to the survey did so willingly. No incentive was offered for completing the survey.
Surveying took place in the waiting rooms of both Primary Care and Specialty Care Practicesat various locations throughout Lehigh Valley Physicians Group.
Stationed in the waiting room of each practice, patients were approached by the surveyor after they entered the practice after checking in, but before they were taken back to an exam room. If the patient was new to the practice, they were asked to take the survey after the completion of the visit. The surveyor identified himself as an LVPG employee, and explained the purpose of the survey. The surveyor reminded the patient that the survey was only 5 questions in length, and would only take a moment of his/her time to complete. Patients were informed that their answers were anonymous, and would be used to help improve patientexperiences at the practice. Patients who declined participation were thanked for their time. When asked, the surveyor clarified that this survey does not replace the Press Ganey satisfaction survey or any other survey (via email or mail) the patient may receive in the future. All questions on the iPad were in English; however we did have paper versions in Spanish. Spanish surveys were used at locations where a language barrier impaired response capture. The paper surveys were then entered into the web-based survey collection tool upon completion. Once the patient agreed to take the survey, the surveyor identified what type of practice the patient was in (Primary Care or Specialty), and if the respondent was the patient or not (parent of a child in a pediatric practice, adult child of elderly patient, etc.). After that information was entered, the iPad was handed to the patient for selecting their responses to the 5 survey questions using the touch-screen feature of the iPad. The surveyor then stepped back to allow the patient privacy to answer the questions honestly. When the patient was unable to use the iPad (not tech savvy, elderly, poor vision, etc.), the surveyor asked the patient each question and their rating, and entered the response on his or her behalf. Patients were also given the option to skip questions they did not want to answer. For example, if the patient was roomed right away, no answer was given for question 4/Keeping You Informed About Any Delays, since no delay was perceived. Skipped questions did not impact the data; it simply was given a null value.
Measurements and Calculations
Responses were captured using an Apple iPad computer equipped with the web-based survey collection tool, SurveyMonkey. The survey consisted of 5 questions similar to those created by Press Ganey, which asked the respondent to rate their satisfaction of the Medical Practice on a Likert Scale ranging from very poor to very good (very poor, poor, fair, good, or very good). The five questions included:
Making it easy to contact our office
Showing concern for you
Treating you in a friendly and courteous way
Keeping you informed of any delays
Explaining things in terms you understand
Once all data had been collected the number of each response was counted, and put into a formula sheet to determine the Mean score of each question (Table 1). Results generated would be compared to the previous study done in 2012, as well as data generated from Press Ganey for both 2012 and 2014.
Data from the Beryl Grant Survey will be presented as mean scores for each question as well as an overall mean score. These scores will be compared to the mean scores from the previous study and to mean score data pulled from current Press Ganey reports with the same time period, practice sites, and survey questions as the Beryl Grant Survey.
During the data collection period, we gathered responses from 500 individuals. Out of that total number, 454 were the patient, and the remaining 46 responses were not (i.e. spouse, parent, or friend). The breakdown of responses included:
Patient – 454 of 500 = 90.80%
Non-patient – 46 of 500 = 9.2%
When 2014 Beryl Grant mean scores were compared to the 2012 mean scores (Figure 6), the recent scores were an average of 2.4 points lower than that of 2012. When 2014 Press Ganey mean scores were compared to the 2012 mean scores (Figure 5), the recent scores were an average of 1.6 points higher than that of 2012.When we compared the 2012 Beryl Grant mean scores to the 2012 Press Ganey mean scores (Figure 4A), Beryl Grant scores tended to be an average of 1.85 points higher than the mean scores of Press Ganey. When we compared 2014 Beryl Grant mean scores to the 2014 Press Ganey mean scores (Figure 4B), Beryl Grant scores tended to be an average of 1.93 points lower than the mean scores of Press Ganey. Finally, we compared the 2012 Press Ganey mean scores to that of the 2014 Press Ganey mean scores (Figure 5). The recent scores were an average of 1.6 points higher than that of 2012.
In summary, 2014 Beryl Grant scores were lower than the previous study done in 2012, but the 2014 Press Ganey scores were higher than those from 2012. These incidental findings cause us to believe some other factors are affecting the data. When we looked back at the practices where surveys were conducted we noticed that 6 out of the 22 sites, (27%), were Community Practices. In the 2012 study, only 3 of the 65 sites, 5%, were Community Practices. Community Practices due to high patient volume, limited budget, and diverse patient population tend to have lower mean scores like those seen in Figure 8. Another factor that could have influenced the lower Beryl Grant scores is the mode of survey. Are patients who complete digital surveys less critical? Some limitations exist in the study. If to be redesigned, we thought that the survey should be more comprehensive. Carr-Hill RA (1992) reveals, patient satisfaction surveys provide meaningful information about the quality of health care, but they deliver little variation with a majority of responses expressing positive opinions without reason why. Coulter (2006) states, “Current research trends in assessing the quality of care have shifted toward obtaining detailed responses from patients about their experiences, rather than simply evaluating ‘satisfaction’ by using categorical responses such as very good, good, average, bad, very bad.” Though these reports give us insight, they do not give a clear suggestion to improve.
The results of our study reinforced the fact that patient satisfaction is now a key factor in the success of a clinic or hospital. In the near future it is patient utility that will determine the reimbursement a practice receives. Patients do not only want the highest quality of care, but the sincerity of care that comes with it. As competing networks grow and develop, it is the data gathered from surveys like the Beryl Grant Survey and Press Ganey CG CAHPS/HCAHPS that will allow the Lehigh Valley Health Network to not only better itself, but remain on top in relation to other competitors.
The Beryl Institute.(2012). Engaging patients with effective communication. Allentown,
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Carr-Hill R.A (1992). The measurement of patient satisfaction. J Public Health Medicine,
Centers for Medicare & Medicaid Services.(2014). HCAHPS fact sheet. Retrieved from
Coulter A (2006). Can patients assess the quality of healthcare? BMJ, 333, 1-2
Press Ganey. (2014). Frequently asked questions about CGCAHPS. Retrieved from
Tables and Figures
Highlighted Press Ganey questions on Lehigh Valley Health Network CG CAHPS Survey
Survey used for Patient Interviews 2014
*Note Questions similarities to Press Ganey section of CG CAHPS
Comparison of Mean Scores Patient Interviews vs. Press Ganey 2014
Comparison of Mean ScoresBeryl Grant vs. Press Ganey 2012
Comparison of Press Ganey Mean Scores 2012 and 2014
Comparison of Beryl Grant Mean Scores 2012 and Patient Interviews 2014
Formula Sheet Used to Convert Patient Interview Data to Mean Scores
List of LVPG Medical Practices with highlighted survey sites with Press Ganey Overall Mean Scores
List of Community Practices with highlighted survey sites with Press Ganey Overall Mean Scores
Published In/Presented At
Kemmerer, J., (2014, July, 25) Lehigh Valley Physician Group Patient Satisfaction Surveying: Quality Control of Primary Care and Specialty Practices. Poster presented at LVHN Research Scholar Program Poster Session, Lehigh Valley Health Network, Allentown, PA.
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