Patient satisfaction, sometimes dubbed the patient experience, has become an increasingly important metric for providers to track. Aside from reimbursements being aligned with these data, studies find that satisfied patients have lower hospital readmission rates, fewer surgical complications, and are more likely to comply with physician orders. Patients today are also more prone to compare physicians. Instead of telling a couple of friends about a bad experience, they can alert 100 people in a matter of minutes on social media.

“Service excellence isn’t a nice thing to do anymore, it is a business imperative,” said Kristin Baird, president and CEO of the Baird Group. “Reimbursement is at stake at some point, but more important than that is the patient relationship and lifetime value of customers as loyal advocates.”

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Cultural shift

Surveys like CG CAHPS are being used to track patient satisfaction and focus on 4 areas: access, provider communication, office staff, and provider rating. These are key measures to track, but Baird said groups may want to start elsewhere. Before practices even begin measuring, they have to know what their priorities are, she said. These priority should then be tweaked based on measurements set forth under CG CAHPS.

Practice managers need to decide what the culture will be for patients and employees. Will the focus be on teamwork? Putting patients’ needs first? Engaging in provider/patient partnerships? “You have to really think about what you want your patient experience to be; to craft the vision of the culture of your future,” Baird said. 

The survey

When it is time to start surveying, Baird recommends looking for a consultant for a couple of reasons. First, grumpy patients never receive survey questionnaires, skewing results. Second, writing good questions, analyzing data, and benchmarking results is a science.

For practices that cannot afford to work with a consultant, said Tom Jeffrey, president of SullivanLuallin Group, a few tips can help improve the process internally. Practices can improve “face validity” – ensuring patients are responding to the aspect of care being discussed – in 2 ways. First, questions should be categorized into sections such as provider visit, scheduling, or reception. Second, ask questions tailored to the way a patient would go through a visit. This will help separate the physician visit from the staff’s performance.

The industry standard for a sample size is a minimum of 30 patients per provider, Jeffrey said. Most organizations, however, should shoot for at least 50 responses per provider to “meaningfully gauge” how he or she is performing.

Providers can expect about a 20% response rate on surveys, depending upon the kind given. E-mail surveys, the most cost effective, tend to net about 18% returns; point-of-service are much higher, at about 60%, Jeffrey said.

Resolving problems

When survey results come back, it is good to focus on physician outliers: those who may be bringing down the whole group’s score. Practices should work with them to improve areas of deficiency. But it is important not to stop there.

“What we are really seeing is office staff makes such a huge difference,” Baird said.

Her group, for instance, has researched the link between patient retention and their experience when calling the office. After thousands of mystery shopping calls to physicians by individuals hired by Baird Group, she found that 35% of patients said they would not return to an office after a bad phone call. Factors that influenced respondents included how office staff greeted people on the phone, whether they introduced themselves, and how the call was ended.

The good news is, these are all trainable skills. People are amazed at organizations that offer great customer service, such as the Ritz Carlton, where all employees say, “It’s my pleasure,” to customers. This does not happen by accident, Baird said. Organizations like that create standards and expect staff to comply.

“Surveys are numbers, a measurement, like taking blood pressure is a measurement that indicates problems, but measuring won’t solve the problems,” Baird said.

More information on CG CAHPS can be found on the AHRQ website.

Areas measured on the CG CAHPS survey


  • Patients were able to get answers to medical questions the same day they call the office
  • Patients are able to see the provider within 15 minutes of their appointment time

Provider communication

  • He/she listened carefully to the patient
  • She/he explained things in a way the patient could understand
  • He/she knew important information about the patient’s health history
  • She/he spent enough time with the patient

Office staff

  • Clerks and receptionist were: courteous, respectful and helpful
  • Someone from the office followed up regarding results of any tests taken during the visit