Here’s why and how you should take patient-satisfaction surveys

In an increasingly competitive environment, aesthetic plastic surgery patients want and expect better services than they received in the past, and surgeons are becoming more concerned about maintaining their overall reputations. Every practice, large and small, is facing competitors who want their patients. If you don’t know what your strengths and weaknesses are, you can’t compete effectively in the market.

Feedback from customers and patients can be the key to your practice’s continued success. To obtain this feedback, satisfaction surveys have long been popular with managers of health plans and hospitals. Private practices are also increasingly conducting surveys to stay in touch with their patient base.

A review data provided by patients in a satisfaction survey can produce invaluable information regarding their overall experience at the facility. In this way, patient-satisfaction-survey material can become a critical component to future business operations and decisions, and it can have a huge impact on your practice’s bottom line.

By analyzing specific tasks or areas within your practice or surgery center, you can identify areas of high satisfaction, and—perhaps more importantly—areas that need improvement. Perhaps the largest context in which patient satisfaction is currently measured involves customer-service functions.

The key advantage of implementing surveys is it gives you the ability to determine what your patients are thinking. In today’s competitive environment, satisfied patients are less likely to file malpractice lawsuits and are more likely to refer their friends and family members.

Designing the Survey
Measuring patient satisfaction isn’t as easy as writing a few questions and handing them to patients, however. The entire process—from the way you ask the questions to the way you analyze the results—should be carefully mapped out.

The patient-satisfaction survey you develop for your practice should have an easily understood format, and it must be simple for your patients to complete and for your staff to analyze. Too many questions can make the task a burden for your patients, which will ultimately defeat its purpose.

First, decide who you are targeting and what you expect to gain. Some practices use a satisfaction survey only for patients who have undergone a procedure in their surgery center. Other practices send a survey to people who come in for a first consultation but do not book surgery within a certain period of time.

Second, decide how often and in what manner you will conduct your survey. A survey may be implemented weekly, monthly, quarterly, semiannually, or annually. Quarterly is considered to be a reasonable interval; more frequent surveys can be too intrusive.

Several methods are currently used to solicit feedback from patients: telephone surveys, written surveys, focus groups, and personal interviews. Most practices use written surveys, which constitute the most cost-efficient and reliable approach. Phone surveys may yield good results, and they have the added value of allowing you to probe for more specific information. However, not all patients will be willing to speak on the phone.

Third, choose your questions carefully. Doing so will allow your survey to deliver the kind of information you really need to put into practical use. Basing business decisions on the results of a poorly written or executed survey is hazardous at best.

Survey questions typically cover the following areas:
• scheduling (phone etiquette, ease of getting an appointment or scheduling a surgery date, and waiting times);
• communication between patient and office staff (quality of patient-education materials and the ability to get a call returned quickly);
• staff interaction (receptionist courtesy, a caring nursing staff, and helpfulness of the business office); and
• interaction with the physicians (how well they listen, thoroughness of instructions, whether they take time to answer questions, and how much time they spend with patients).

With telephone or written surveys, you have the flexibility to create a questionnaire from scratch or adapt a template developed by an outside vendor. Doing so can be time-consuming and taxing on your busy staff, however. Therefore, it is best to customize your survey to match the specific services offered by your practice or surgery center and change the questions frequently to stay current with your practice’s evolution.

It is widely accepted that patients are more likely to answer survey questions honestly if they believe their identities will not be revealed. Therefore, make every effort to keep the entire survey process anonymous.

Patients should be able to complete their surveys at home and return them without fear of being identified. Some practices have chosen to assign a unique patient-identification number to each survey, which enables them to track which surveys have been returned.

In some cases, however, patients may want to provide their names. Some practices give patients this option so that respondents could ask to have a staff member contact them about their comments or concerns. But generally, patients are less likely to be honest and make criticisms if they are compelled to use their name or to speak with a “live” person.

Consider asking your patients for ideas when designing your survey. Create two or three focus groups composed of six to 10 patients each, and turn some of the issues they raise into questions for your survey.

You may consider pretesting the survey with a focus group. Ask a handful of patients you know well to take it, then talk them through the survey to see whether they understand the questions, and revise the questions accordingly. Patients will often appreciate being part of the process and will be eager to participate.

Distributing the Survey
By using the best distribution methods to reach patients, you can streamline data collection and help encourage responses. When you distribute your questionnaire, try to survey the largest group possible to improve your chances of getting an adequate number of responses. Some practice managers try to survey nearly every patient after each encounter. However, this may become time-consuming for your staff and overwhelming for your patients.

If you opt to hand out surveys to patients in the office, do it consistently. In some practices, surveys are given to every patient who comes in over the course of a few weeks or indefinitely. The danger is that some patients will slip by without receiving a survey, or your front desk staff might avoid giving a form to patients who are particularly unhappy. To avoid this and instead obtain a random sample, give a survey to every fourth or fifth patient who comes in during a particular week.

Many physicians have found that distributing patient surveys in the exam room is effective. Instead of leafing through magazines or product brochures while they are waiting, patients can complete survey questionnaires. Once they have seen the physician, patients can complete the remaining questions about the physician and their overall satisfaction.

A Sample Patient-Satisfaction Survey
We would like to continue to improve our services and quality of care that we offer to our patients in the future. Please complete and return the unsigned form in the stamped, self-addressed envelope provided. We thank you for helping us improve our services to you. All of your responses will be kept confidential.
   Please answer each question using the following scale:

             1 Excellent
             2 Very good
             3 Good
             4 Fair
             5 Poor

  • Was the person who answered your phone calls friendly, helpful, and interested in your needs?
  • Was the office easy to find and inviting from the exterior, and was there adequate parking?
  • Was the front desk staff friendly and helpful?
  • Were you seen at your scheduled appointment time?
  • Was your surgery or treatment adequately explained to you?
  • Was the physician accessible and attentive?
  • Were all of your questions answered?
  • Was the nursing staff understanding, patient, and caring?
  • Were the financial transactions conducted in a satisfactory manner?
  • Were the following areas clean and comfortable?

             Reception area
             Examining room
             Recovery room

  • Were the instructions you received for your aftercare satisfactory?
  • Would you recommend our services to a friend?
  • Do you have any additional comments?

  Thank you for taking the time to fill out this survey. Your responses are greatly appreciated!

Responses to written surveys can be mailed or faxed back your office. The typical response rate you can expect from a mailed survey is 30%. To bring your response rate to that level, you should include a postage-paid reply envelope and a cover letter from you explaining the importance of patient feedback to the practice.

If the survey is e-mailed to respondents, their answers can be e-mailed back to you. If your practice has a sophisticated Web presence, you can give patients the option of completing the survey online, and this can increase your response rate.

Follow up on the survey 5 to 7 days later with a thank-you or reminder card—or a second mailed survey—to greatly increase your response rate. The more responses you can tally, the more valid and reliable your results will likely be. Of course, mailing will increase your costs, but the increased response rate will be worth the added expense.

Analyzing the Responses
Analyzing the data may prove to be the most complex part of the survey process. The primary challenge emerges when the completed surveys are returned. If you don’t have a dedicated person on staff with analytical and database-management skills, you may end up with a stack of surveys that are never analyzed adequately. Reviewing each response and implementing changes based on these responses is what provides the value to the process.

With most surveys, a five-point scale of numerical responses to each question that represent a range from “excellent” to “poor” is used. Space is then provided for free-form written comments. Your average score on a given question may be 4.2 out of 5, but the written responses will help you understand what is behind that score.

When you analyze your results, avoid lumping responses together into broad categories. Instead, calculate a score that takes all the individual responses into account.

For example, do not combine scores for “good” to “excellent” into one category called “satisfied.” It is better to calculate a weighted score based on 5 points for each person who said “excellent,” 4 points for “very good,” 3 points for “good,” and so on. Then, total the responses for each question and average them to get the actual score.

The data can be used to monitor quality and to improve clinical practice, as well as to evaluate surgical or treatment outcomes. Your medical staff should work with the staff to address service-related issues that are identified through the surveys, while your practice administrator should deal with the front desk and scheduling issues.

Whereas satisfaction measurement is still being used primarily to monitor and improve service excellence, some practices are beginning to ask patients more clinically oriented satisfaction questions, such as whether they were happy with the results of a procedure or treatment. Patient-perception data about clinical outcomes may lack certain statistical validity. However, when it comes to aesthetic patients, perception is reality.

One of the main criticisms of patient-satisfaction surveys is that their results are unreliable. But if you stick to some simple guidelines, it can be very powerful to see exactly what some of your patients are saying about you and the procedures you are offering.

Additional Considerations
You need to ask the right questions, get enough responses, and then put the information to good use to make surveys worthwhile.

One important consideration is exactly how many surveys you will need to distribute to get reliable results. In general, 50 responses will provide enough data to measure patient perceptions. However, to get 50 responses back, you may have to send out as many as 170 surveys, based on an estimated response rate of 30%.

Remember that each individual response can have valuable information, so it should be carefully reviewed by one dedicated staff member and the physician or physicians in the practice.

If the process sounds too complicated and time-consuming, you may consider hiring a consultant or enlisting a dedicated vendor that conducts surveys. Fees will vary by the size of the practice, by the number or frequency of surveys, and by how finely you want the results broken down.

Another option is to purchase a satisfaction survey. Several organizations offer surveys and, in some cases, allow you to compare your results with average results from other practices that have used them. Patients complete the survey, and the practice sends the surveys to the organization from which they bought the survey to tabulate the results. Your patient-satisfaction scores are reported to you over time as you repeat the survey.

Your ability to compare your results with those of similar practices can help identify areas you need to work on most. The comparisons, however, are relevant only if your results are being compared with other aesthetic practices or physicians who cater to a similar patient base.

Patient-satisfaction-survey results can be used as benchmarks for best practices. To get the most out of a patient-satisfaction survey, develop a process in which key staff members participate and discuss the results.

Prioritize the issues, design a specific plan of action for issues you want to address, assign responsibilities, and draft a time line for implementing improvements. Using the data to make adjustments in areas such as efficiency of the consultation process and managing aftercare for surgery patients is an excellent tool for maintaining sensitivity to the needs of patients and for delivering a quality experience to everyone who walks in your door.

Many health care organizations base physician compensation on patient-survey results. Aesthetic practices also use patient surveys to reward staff members for excellent customer service and to single out employees who are not living up to the expectations of the practice.

Aesthetic surgery practices have become far more sophisticated in their methods of attracting and keeping patients. “We want to make sure we’re giving the best possible care, and we want our patients to be happy. We also want to know what we are doing right, and especially what we might not be doing so well,” says Laurence Kirwan, MD, a plastic surgeon in Norwalk, Conn. “The best way to measure your success is through the eyes of your patients.”

Wendy Lewis is a contributing writer for Plastic Surgery Products; author of America’s Top Cosmetic Doctors (Castle Connolly); and the editorial director for, a medical marketing and publishing group. She can be reached via her Web site,