If You Don`t Ask, You`ll Never Know
Unquestionably, one of the most difficult endeavors in all of medicine is attempting to measure quality. If you ask your everyday street provider how his agency assesses and measures quality, almost without fail, the discussion quickly turns to the topic of response times. Sadly, for some agencies, that is one of the only, if not the only, assessment of quality they even bother to look at.
Yes, having a timely response to a call for help is one aspect of quality in the field of prehospital medicine. However, it is but one of a number of key elements of quality that also include communications, personnel, equipment, protocols, training/education and employee-assistance programs.
In my opinion, one of the most consistently overlooked and neglected areas of quality assessment in prehospital medicine is the routine acquisition and evaluation of customer feedback. Audience responses at six or seven conferences where I was teaching played a big part in forming my opinion on this subject. Of the nearly 3,000+ folks whom I polled, only 40 to 50 indicated that their service routinely followed up, either by phone or mail, with a significant number of patients to obtain their feedback about the patient care and customer service provided during the call.
In my mind, it comes down to a pretty simple question: How can we know what our customers think about the care and service we provide if we don’t ask them, especially since they are the recipients of same?
Just being out of the chute in less than 60 seconds during daytime emergency responses isn’t going to cut it as a sole measure of quality. Nor is arriving on emergency scenes in less than 8 to 10 minutes on 80% of your calls. Don’t get me wrong—I’m not saying those areas of performance aren’t important, because I truly believe they are. I’m just saying that one of the most data-rich gold mines of information relative to quality improvement in our profession lies virtually untapped, mostly due to our unwillingness to tap into it.
In the past, I’ve worked with various individuals and provider agencies in this particular area, and for those who are interested, I recommend taking a simple approach when first venturing into this type of endeavor. That equates with a short letter and a one-page survey that contains the following questions and adequate room for a response:
- Were you or your loved one treated with courtesy and professionalism during the call?
- In your opinion, was there anything that our personnel could have done to make you or your loved one feel better or to make the call less stressful?
- Do you have any questions about the call and/or care provided that we can answer for you?
Some of the common reasons the non-progressive naysayers often toss on the table for why this won’t work include cost and time. Let’s look at each individually.
For the sake of discussion, let’s say your agency runs 4,000 calls per year with two cars, or six or seven calls a day per car with a total of 24 medics. You decide that you will mail out a survey to 25% of your patients, making each medic responsible for addressing and stuffing envelopes with a cover letter and questionnaire for one of every four patients he transports. Paper and printing costs should be less than $200 and postage (first-class both ways) less than $750, bringing your cash outlay to under $1,000.
Let’s estimate the total time to do the initial mailing, read the return responses from patients or family members and enter the data at 15 minutes each. Taking a total of 1,000 mailings per year, divided between each of the 24 medics, makes each medic responsible for a mere three to four mailings and data entries per month.
That represents a total time outlay of about 60 minutes spread over 10 shifts, or roughly six minutes per shift.
For those who say their agency can’t afford the $1,000, my answer would be: “That $1,000 will pay the first two or three hours of attorney fees for your first lawsuit.”
For those who say they just couldn’t spare six minutes out of a 24-hour shift on what I would consider an incredibly worthwhile effort, I’d just have to laugh out loud.
Given the relative low cost and minimal time, please consider the incredible amount of information you can glean from your customers about their perception of the care and service they received from your agency. Then, consider the problems you may be able to identify and solve when they are still small (i.e., don’t require an attorney). And, think of your improved relationship with your customers as a result of taking time to solicit their feedback.
The bottom line: If you don’t ask your customers for their opinion, you will never know what they truly think.
Until next month...
