Vital Stats
Administrator: Todd M. Fowler, MBA, CMVE
Center Manager: Carol Fairchild, RN
Assistant Manager: Todd Hilton, RN
Types of surgeries: endoscopy, orthopedic, GYN, ophthalmology, cosmetic/reconstructive, general, ENT, urology
Staff: 22 - 10 RNs, 6 OR techs, 2 office, 1 anesthesiologist, 1 CS tech, 1 housekeeping, 1 surgical equipment specialist
ORs: 3
Procedure rooms: 2
Operating surgeons: 25
Monthly case volume: 350
Years in operation: nearly 4
Ownership structure: physician-owned

Two years ago, patient satisfaction surveys were more trouble than they were worth for the Holzer Clinic Ambulatory Surgery Center in rural Ohio. "I was doing a paper-and-pencil survey that I wrote and handed out myself," says manager Carol Fairchild, RN. "The return rate was 15 percent."

Ms. Fairchild soon found a company to handle her patient surveys with a Web-based program (see "Your Patient Satisfaction Survey Options"). The service she selected isn't fully automated - patients fill out and mail a paper survey to the company, which enters the data and posts the results online - but the quantity and quality of the results have been remarkable. The ASC's managers have already used the results to modify patient check-in and pain-control drug policies.

How Web-based surveys work
Ms. Fairchild quickly discovered that using a company to help design, distribute and analyze patient satisfaction surveys has many inherent advantages over the homemade paper-and-pencil variety. Here's a short list of those advantages.

• Customized surveys. "I can ask whatever questions I want to," says Ms. Fairchild. "This is what attracted me to it. I could customize it to the types of surgeries we are doing and the services we are providing." For example, she says, an eye center's survey won't include a question about general anesthesia. "If you ask a lot of questions that are not applicable, patients lose interest and won't send [surveys] back."
• Reliable circulation. Each month, the company e-mails Ms. Fairchild a formatted survey to print and ships her about 350 envelopes (the number of cases Holzer averages per month). At discharge, each patient is handed a survey and a stamped envelope addressed to the survey company. The company charges the 37 cents per pre-printed envelope, regardless of whether the survey is returned. "They're good about helping me not over-order," says Ms. Fairchild. Total cost for each survey is 74 cents - 37 cents for the stamp, 37 cents for the survey company. That's about $130 a month.
• Automated results. The company updates Holzer's Web-based file and results as the surveys are received. "If they got four today, they'll be on there," says Ms. Fairchild. "They gather the data and create charts, pie graphs and databases for me. I can look at results by procedure and by physician. I can print just the comments sections for all surveys without having to open every survey." In addition, the company alerts the facility if patients rate any category on the survey lower than "good."

"I can address it immediately," says Ms. Fairchild. "As long as the patient provided some contact information, I call them to see where we can improve. A lot of times, they just need further information; some will initially score us low but by the time a few days have lapsed, and they're more recovered, they feel a whole lot better about their procedure."

The company also alerts her when Holzer gets an especially good review so she can share it with staff in a timely manner.

Making changes
Ms. Fairchild regularly analyzes the data for trends and areas of improvement. "The scores range from 0 to 5 in each category," she says. "If I see pain scores went from 4.8 to 4.3 in one month - what was different? A new nurse in PACU? More of one type of case?"

Since starting the system, Holzer Clinic ASC has improved in two major areas:

• Patient wait times. "Scores were low, and we realized we had patients coming in too soon," says Ms. Fairchild. Staff now instruct patients to come in 30 minutes before procedures instead of an hour. "The scores went up immediately," she says. "They're barely here long enough to get worried."
• Pain control. After several complaints that pain management after conscious sedation cases was inadequate, Ms. Fairchild set out to fix it with the anesthesia provider on such cases. "We were using Versed and Demerol, now we're using Versed and fentanyl, because it's faster acting," she says. "And we give the fentanyl first, because it precipitates the Versed's action, making it more effective." The result: Scores quickly jumped from 4.2 to 4.6.

Overall benefits
Thanks to this system, Ms. Fairchild's patient-satisfaction-survey return rate is 30 percent - even though case volume has increased by 25 percent.

"And best of all," says Ms. Fairchild. "I'm no longer spending time doing it by hand."

- Stephanie Wasek