Using Patient Experience Surveys to Assess Longitudinal Care Journey

September 18, 2023 - Patient experience surveys have been transformative in capturing patient sentiment and guiding quality improvement initiatives, but at Community Health Network, the traditional CAHPS survey still falls short in improving the patient journey of care.

To be sure, CAHPS surveys (Consumer Assessment of Healthcare Systems and Providers surveys) are essential. CAHPS surveys help inform some value-based payments, help populate the CMS Care Compare websites, and they can provide a standard benchmark for assessing the quality of patient care.

But CAHPS surveys aren’t perfect for everything, according to Patrick McGill, MD, the chief transformation officer at the non-profit Community Health Network, which has more than 200 clinics and hospitals nationwide. They can be limited in scope because they only reach people who have had a complete episode of care: they got an appointment, visited the clinic, and received treatment.

“When you think about it from just a post-transactional survey standpoint, that really doesn't tell you anything about the journey,” McGill said in an interview with PatientEngagementHIT. “First off, it just tells you the winners, right? It tells you the experience that people who kind of ‘won’ because they were able to get an appointment, they had the appointment, they were able to get to their appointment.”

As Community began work to improve the total, longitudinal patient experience, it knew it had to expand how it surveys patients about care experience.

“But what about all the other people?” he posited. “And what about all the steps that it took them to get to that experience?”

Indeed, it’s not uncommon for patients to go without care. According to February 2023 figures from the National Association of Community Health Centers (NACHC), some 100 million people in the US don’t have a usual source of primary care due to a myriad of issues.

Community doesn't know specifically how many folks try to book an appointment but can't, but it's on its way to understanding more. For one thing, the organization is "intercepting" patients who don't end up booking a slot, asking them why and under what conditions they'd be able to book one.

The organization also wants to know the specific care access barriers faced by the populations it serves, among other elements along the patient care journey.

“The value for us when it comes to patient experience data is that longitudinal journey, in understanding all the points along the patient experience, not just the post-transactional and not just the care that they had,” McGill explained. “That stuff is very important to us, obviously. We want patients to have excellent care, but we want their entire experience, all of their interactions with us, to be excellent.”

In 2020, Community Health Network partnered with survey firm Qualtrics to revamp its patient experience surveying strategy. The organization would no longer solely be focused on post-transactional surveys—like the CAHPS surveys—but also surveys that look at elements along the healthcare journey.

Take patient care access, for example. Community has been looking at access for a while using the typical metrics many other health systems use: third-next available appointment, schedule capacity, or length of time to care.

“What we found was that really wasn't getting the voice of the customer involved,” McGill noted.

A patient calling on Tuesday for an appointment on the following Monday might not be the best data source, he said. The length of time to care for a patient would be six days, which McGill said is on the higher end of the spectrum.

But that’s not a super reliable data point. In that example, Community would have been fulfilling patient needs, even if the numbers don’t reflect that. So, McGill and his team reconsidered how it can survey patients to better understand access.

“We've launched an access survey where we ask questions like, ‘did the appointment you were given meet your needs?’” he said. “‘And if it didn't, was it because of your schedule or the provider's schedule? What can we do?’ We start to look at that data to adjust either schedule capacity or how many providers we have, or really operational changes that might, again, help the improvement.”

The healthcare organization has also designed patient experience surveying in the emergency department, a site of care notorious for poor patient experience scores driven by exceptionally long wait times. In 2023, researchers reported that ED wait times could reach up to nearly 6.5 hours.

“We have a platform where we can understand the drivers of what's leading to a poor experience,” McGill said. “Most of the time in the ER, it's communication. So how do we communicate better to set expectations of wait times?”

As Community looks closer at patient experience surveys illustrating different points of the healthcare journey, the organization said it can retool its operations. Insights into the barriers to care access can help in redesigning schedules, while the ED data could spark an initiative in communicating about wait times.

“We use that data to drive organizational changes,” McGill said. “We use it to give direct clinician feedback. So whether that's physician, APP, nursing staff, or office staff, whatever it might be, with real-time survey results, we're able to act on those directly.”

“And, we use it for patient segmentation, so we want to understand, from a health equity standpoint, are all patients experiencing the same type of care?” he added.

McGill said that segmentation capability is novel with its survey tools. As part of the health system’s overall efforts toward promoting health equity, the survey tool allows system staff to look at patient responses segmented by race and ethnicity, plus other key sociodemographics.

Such segmentation may highlight where Community needs to put more resources. For example, if the surveys show that Black women, in particular, are having trouble accessing care because there aren’t optimal appointment times available, the organization might reconsider how it serves this population.

Community supports this effort through stringent sociodemographic data collection. The organization has taken a look at its Epic EHR to assess data fields, as well as trained admin staff on how to discuss the collection of race and ethnicity data with patients upon intake.

Moving forward, Community plans to understand non-response bias. The organization does have some preliminary data looking into whether patients who did or did not receive care are more likely to respond to surveys.

“We're trying to understand where there are friction points,” McGill concluded. “Our response rate is actually pretty good, but that is something that we do track and monitor, to understand where there are gaps with the response rate.”