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The Impact of Satisfaction Surveys on Quality Improvement

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Title: The Impact of Satisfaction Surveys on Quality Improvement


1
The Impact of Satisfaction Surveys on Quality
Improvement
  • OCTOBER 23, 2008

2
Mary Tellis-Nayak RN, MSN, MPH Vice President of
Quality Initiatives
mary_at_myinnerview.com
715-848-2713
3
Objectives
  • The participant will be able to
  • Describe how satisfaction surveys fit into a
    quality improvement framework
  • List three things most important to nursing home
    residents and families in Wisconsin
  • Identify two areas where employees satisfaction
    with their workplace relates to residents
  • Describe how to use satisfaction data to improve
    the quality of life for their residents

4
Outline
  • Overview
  • Satisfaction surveys as framework for QI
  • Why is resident satisfaction important for
    quality of care?
  • Listening to the voices of Wisconsin families
    and residents
  • The relationship between resident and employee
    satisfaction
  • Integrating satisfaction data into your QI program

5
  • To provide long-term care leaders evidence-based
    management tools to better achieve their
    organizations goals

6
Sources of data
  • Largest private dataset of resident and family
    satisfaction in nation
  • From mailed resident and family surveys returned
    to third-party
  • Respondents rate communities using four-point
    scale (excellent, good, fair or poor)

7
My InnerView will support you to advance
excellence
8
Satisfaction Surveys A Framework for Quality
Improvement
9
Quality control
  • Quality control is the ongoing effort to
    maintain the integrity of a process to maintain
    the reliability of achieving an outcome

10
Quality assurance
  • Retrospective review or inspection of services
    or processes that is intended to identify problems

11
Quality improvement
  • Quality improvement is the purposeful change of a
    process to improve the reliability of achieving
    an outcome
  • The continuous study and improvement of a
    process, system or organization

12
Collect data ensure validity, organize
Evaluate outcomes measure variation
Turn plan into action improve process
Turn data into information benchmark,
study variation
Turn knowledge into plan apply new wisdom to
process
Turn information into knowledge study
current process
13
5 complain to management
45 complain to frontline staff
50 have problem, yet dont complain
Good quality is good business (TARP studies)
14
Quality pyramid
15
When you dont remember anything, youre
satisfied!
16
Loyalty is generated by memorable things that
happen that we didnt expect.
These cause person to give score of Excellent,
not Good
17
The relationship between satisfaction and
occupancy
18
Research shows that, in most industries, there
is a strong correlation between a companys
growth rate and the percentage of its customers
who are raving fans that is, those who say
they are extremely likely to recommend the
company to a friend or colleague.
19
The importance of Recommendation
Recommendation is touchstone to determine
significance of your scores on all other items
20
The importance of Recommendation
  • Provides crucial information
  • Tells you loyalty of respondents
  • Correlates to other quality outcomes
  • All items in survey
  • Occupancy
  • Quality indicators
  • Employee satisfaction
  • That is why this question is used for Priority
    Action Agenda

21
If you want to grow your business
exponentially, you must get serious about
building and maintaining loyal relationships
with your customers Loyal customers are
easiest customers to serve Long-term customers
tend to spend more with you than new customers
Happy, loyal customers purchase other products
or services in companys line Satisfied,
loyal customers recommend companys products or
services
FREDERICK RIECHHELD THE LOYALTY EFFECT
22
Why is willingness to promote your company such a
strong indicator of loyalty and growth?
FREDERICK RIECHHELD THE ONE NUMBER YOU NEED
TO GROW
23
Because when customers recommend you, theyre
putting their reputation on the line. They will
take that risk only when they are loyal.
24
In most of the industries studied, the
percentage of customers who were enthusiastic
enough to refer a friend or colleague perhaps
the strongest sign of customer loyalty
correlated directly with differences in growth
rates among competitors.
25
We do not know what process(es) to improve (QI)
unless we know what is important to our
internal and external customers and how they
evaluate our performance in these areas
26
AN EXERCISE What Matters Most
27
QUADRANT ANALYSIS TWO KEY CONCEPTS
1. How residents, families and staff rate your
care and services
Your average score on each item 1 4 Poor
Fair Good Excellent
Rank order all items by average score 1 100
Lowest to highest ranking score
2. How much each item influences
residents, families and staff to recommend to
others
Correlate each item with Recommendation 0 1
No correlation to strongest correlation
Rank order all items by correlational strength 1
100 Lowest to highest ranking correlation
28
QUADRANT AND ACTION PRIORITIES
Successes
B. Primary strengths
A. Secondary strengths
1 - Lowest to highest ranking score ? 100
You can meet customer expectations
Challenges
C. Secondary opportunities
D. Primary opportunities
1 ----- Lowest to highest ranking correlation
------? 100
You have little control over customer expectations
29
WISCONSIN
Voice of Residents and Family Members
30
(No Transcript)
31
SKILLED NURSING RESIDENT AND FAMILY
Survey items
  1. Choices/preferences
  2. Respectfulness of staff
  3. Respect for privacy
  4. Resident-to-resident friendships
  5. Resident-to-staff friendships
  6. Meaningfulness of activities
  7. Religious/spiritual opportunities
  8. Quality of RN/LVN/LPN care
  9. Quality of CNA/NA care
  10. Quality of rehabilitation therapy
  11. Adequate staff to meet needs
  12. Attention to resident grooming
  1. Commitment to family updates
  2. Competency of staff
  3. Care (concern) of staff
  4. Responsiveness of management
  5. Safety of facility
  6. Security of personal belongings
  7. Cleanliness of premises
  8. Quality of meals
  9. Quality of dining experience
  10. Quality of laundry services

32
WISCONSIN RESIDENTS
What matters most
1 - Choices/preferences 14 - Competency of
staff 15 - Care (concern) of staff 9 - Quality of
CNA/NA care 8 - Quality of RN/LVN/LPN care 2 -
Respectfulness of staff 16 - Responsiveness of
management 12 - Attention to resident grooming 17
- Safety of facility 11 - Adequate staff to meet
needs
33
WISCONSIN FAMILIES
What matters most
15 - Care (concern) of staff 14 - Competency of
staff 1 - Choices/preferences 8 - Quality of
RN/LVN/LPN care 16 - Responsiveness of
management 9 - Quality of CNA/NA care 2 -
Respectfulness of staff 17 - Safety of
facility 11 - Adequate staff to meet needs 5 -
Resident-to-staff friendships
34
RESIDENT
35
FAMILY
36
FAMILY
RESIDENT
A
B
8
2
8
10
2
13
17
15
19
17
SECONDARY STRENGTHS
PRIMARY STRENGTHS
15
5
7
14
13
10
7
5
14
4
9
9
3
3
6
6
4
1
1
19
16
12
20
18
SECONDARY OPPORTUNITIES
PRIMARY OPPORTUNITIES
16
21
22
22
12
21
18
20
11
C
D
11
37
FAMILY
RESIDENT
B
A
8
2
8
10
2
13
17
15
19
17
SECONDARY STRENGTHS
PRIMARY STRENGTHS
15
5
7
14
13
10
7
5
14
4
9
9
38
FAMILY
RESIDENT
B
A
10
13
17
19
17
SECONDARY STRENGTHS
PRIMARY STRENGTHS
5
7
13
10
7
5
4
39
FAMILY
RESIDENT
3
3
6
6
4
1
1
19
16
12
20
18
PRIMARY OPPORTUNITIES
SECONDARY OPPORTUNITIES
16
21
22
22
12
21
18
20
11
C
D
11
40
Re-enter quality improvement
  • In the aggregated report from Wisconsin, the
    question that addresses Choices and preferences
    (Q1) is in Quadrant D for both families and
    residents
  • How does an organization use QI to address this
    issue?
  • Remember definition The continuous study and
    improvement of a process, system or organization

41
How do you improve the process of CHOICE?
  • What, today, are the areas in our home where
    residents have the opportunity to choose?
  • What are the areas where they want the
    opportunity to choose and they dont have it
    today?
  • Within those areas, what are the options they
    want to choose from?

42
Why do you feel that this facility is not meeting
your choices and preferences?
43
Look at the possibilities
  • Bathing times shower, bath
  • Meal times
  • Food choices
  • Dining choices (with whom, types of service,
    etc.)
  • Activities
  • In the facility in the community religious
  • Choices around ethical and end of life issues
  • Pureed foods vs. normal consistency
  • Antibiotics vs. not taking any
  • Hospitalizations

44
How do I get answers to the why questions?
  • Hold focus groups with residents and/or families
  • Create a follow up questionnaire and distribute
    it to residents/families
  • Hold discussions about choice at resident
    council and family council meetings
  • LISTEN to the interactions between residents,
    families and staff
  • Let your residents and families know you listened
    to what they said on the surveys and you want to
    take action to improve

45
What next?
  • Gather answers to why?
  • Organize them and identify trends and patterns
  • Do they focus on dining or bathing or end of
    life?
  • Did you hear any specific ways you could meet
    residents needs for choices and preferences?
  • What processes impact resident choices?
  • What can we do to change and improve these
    processes to allow for resident choice?

46
Collect data ensure validity, organize
Evaluate outcomes measure variation
Turn plan into action improve process
Turn data into information benchmark,
study variation
Turn knowledge into plan apply new wisdom to
process
Turn information into knowledge study
current process
47
What about employees?
  • Most of the most highly correlated items from
    What matters wost in Wisconsin have to do with
    the relationship between the resident and the
    staff
  • Care and concern
  • Competency
  • Quality of CNA/RN/LPN
  • To try to improve resident and family
    satisfaction without addressing the needs of
    employees is impossible

48
SKILLED NURSING
Voice of Employees
49
(No Transcript)
50
AN EXERCISE What Matters Most
51
SKILLED NURSING EMPLOYEE
Survey items
  1. Quality of orientation
  2. Quality of in-service education
  3. Quality of resident-related training
  4. Quality of family-related training
  5. Comparison of pay
  6. Care (concern) of supervisor
  7. Appreciation of supervisor
  8. Communication by supervisor
  9. Attentiveness of management
  10. Care (concern) of management
  1. Safety of workplace
  2. Adequacy of equipment/supplies
  3. Sense of accomplishment
  4. Quality of teamwork
  5. Fairness of evaluations
  6. Respectfulness of staff
  7. Assistance with job stress
  8. Staff-to-staff communication

52
WISCONSIN EMPLOYEES
What matters most
10 - Care (concern) of management 9 -
Attentiveness of management 17 - Assistance with
job stress 6 - Care (concern) of supervisor 7 -
Appreciation of supervisor 8 - Communication by
supervisor 5 - Comparison of pay 11 - Safety of
workplace 3 - Quality of resident-related
training 15 - Fairness of evaluations
53
EMPLOYEES
54
EMPLOYEE
55
DATABYTE
56
Quality pyramid
57
What does research have to tell us about the
workplace?
58
SUMMARY OF RELATIONSHIPS
Staff Satisfaction
59
KEY PERFORMANCE DRIVERS
higher family satisfaction
lower nursing assistant turnover
higher employee satisfaction
higher family satisfaction
60
KEY PERFORMANCE DRIVERS
higher satisfaction among families and employees
better clinical outcomes related to
falls, pressure ulcers and catheters
61
DATABYTE
62
Quality of leadership and quality of the workplace
THE INTERFACE
CNAs speak up!
  • November 2004 study
  • 156 nursing facilities in the Southeast
  • 3,579 CNAs, 6,502 families surveyed

63
Indicators of quality of workplace
  1. Pay compared to other nursing homes
  2. Safety of workplace
  3. Adequate equipment and supplies to do your job
    well
  4. Work allows you to make a difference in people's
    lives
  5. Co-workers work as a team
  6. Fair performance evaluations
  7. Staff are respectful of residents
  8. Helps you get to deal with job stress
  9. Communication between shifts

64
Quality of leaders produce a quality workplace
Rating by
6,305 CNAs in 156 Nursing Facilities
4 percentile
ranked groups, 2004
65
A quality workplace earns staff recommendation
66
A quality workplace earns family recommendation
67
A quality workplace creates QoL for resident
68
As staff are treated,
so will the elders be treated
69
A quality workplace creates QoCare for resident
70
A quality workplace creates QoService for resident
71
A quality workplace results in better state
surveys
72
A quality workplace makes business sense
73
Workforce Research and experience has shown that
a higher level of satisfaction among assisted
living staff directly correlates with higher
levels of satisfaction among residents and their
family members
74
We did the best we could, with what we knew, And
when we knew better, we did better.
MAYA ANGELOU
75
Now you know better so
what do you do?
76
Using satisfaction data
  • One member of the leadership team must be
    responsible and held accountable for managing
    this initiative
  • Human resources
  • Department manager(s)
  • Administrator/Assistant administrator
  • Staff development

77
Using satisfaction data
  • Use current structures or create new ones
  • QAA committee
  • Staff meetings
  • Neighborhood/unit meetings
  • Interdepartmental teams
  • Focus groups

78
A residents satisfaction with his/her
relationship to nursing staff was found to be
significantly related to the proportion of CNAs
on the residents unit who said they intended to
stay in the job, and to the proportion of CNAs
who had positive relationships with their
supervisors.
BISHOP, OCTOBER 2006
79
Using employee satisfaction surveys will help
leaders improve the tenure of staff by
addressing those issues most important to them
80
Dont miss this valuable opportunity to
improve quality of life for your residents by
improving quality of life for your employees
81
Thank you!
  • Questions? 715-848-2713
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