It Was Hard to Get an Answer
Anyone who has answered the phones at a medical group or health plan knows a version of the same sentence, usually from someone whose care has stalled: it was hard to get an answer.
The same sentence turns up in patient survey comments, and it tells the people reading the report very little. On the phone, staff can ask what happened. In a survey summary, the comment is coded under communication and becomes one bar on a chart. The chart tells leadership that something needs attention, but it gives no indication of what to change.
The comment could describe at least five different situations. The person may have waited on hold and given up. They may have reached the wrong department. Two staff members may have given them conflicting answers. They may have left a message that was never assigned to anyone. Or they may have received a correct answer that still did not tell them what to do next. Each of these has a different owner and needs a different fix.
Keep the comment attached to the step
The most useful habit is keeping each story connected to the step where it happened. What was the person trying to accomplish? Which step failed? What did the organization intend to happen at that point? Looked at this way, a comment about poor communication may turn out to be a missing rule about returning calls. A comment about access may turn out to be an appointment that was offered only at a time the person could not take. Without that detail, an organization is left with themes. With it, the organization has specific items it can assign.
The same approach works with survey data. AHRQ’s CAHPS improvement guide recommends pairing survey scores with other sources, such as complaints, direct observation, and staff accounts, in order to narrow down to a problem that can be changed. It also helps to read the written comments in full and review them by site and by language. A stable overall score can sit on top of one location or one language group where the same problem keeps recurring. A few comments do not establish a trend, but they are a good reason to look more closely.
Change one thing the next caller will notice
Once the step has been identified, I recommend changing that step and setting a date to check the result. If callers are not reaching the right person, the organization might simplify the phone menu, assign every unanswered message to a named staff member, and then test whether calls are being returned within the promised timeframe. The measure that counts is whether the next caller received an answer. Whether staff completed a training is a much weaker indicator. It is also worth confirming that the change did not simply move the backlog to a different desk.
One more lesson applies here. The person who raised the concern should receive a direct reply before their comment is folded into a report for a committee. After that, the staff involved should hear what was learned, and where an organization has patient advisors, they should hear it as well. People who take the time to speak up ought to be able to see that it made a difference.
After any survey, the natural question is how the organization scored. I find it more productive to ask what will be different for the next person who calls. It is also the question the staff picking up the phone most want leadership to ask.
Sources
- AHRQ: CAHPS Ambulatory Care Improvement Guide
- AHRQ: Determining Where To Focus Efforts To Improve Patient Experience
About the author
Sherry Sayari, MPH, is an Operational Standards Evaluator who has led population health, community outreach, and social services programs. More on the About page.
