Opportunities for Improving Patient Satisfaction

As surgeons, we often measure the success of a procedure based on the medical outcomes we achieve. However, for our patients, there are additional factors beyond visual results that determine what makes a successful treatment. To understand what influences patient satisfaction, it is important to consider each step of a patient’s overall experience, from the first phone call to the last follow-up visit. In each of these areas, there are simple, straightforward ways to increase patient comfort and, thus, improve the patient’s perception of his or her treatment.

managing your WEBSITE and PHONES

An informative yet organized website is key to having patients well primed for their visits to your practice. Many practices’ websites consist mostly of graphics; these sites may be visually attractive, but they typically offer little information. In contrast, there are websites that provide a lot of information but are disorganized and difficult to navigate. Invest adequate time and resources into building a user-friendly website, as this will improve your patients’ experiences.

Because patients typically call to schedule an appointment, it is also important to have a competent staff member managing the phones. This staff member should be able to answer a range of questions that patients may have at this point, including those that are medical in nature, such as, “What am I allowed to do after surgery?” or “What does this procedure encompass?” Having a staff member who is informed will increase the patient’s confidence in your practice.

IN-OFFICE EXPERIENCE

When patients come for an appointment, it is important to keep waiting times as short as possible. I work in both a private setting and a public hospital, and there is a big difference in terms of waiting times between these two sectors. Due to a lack of resources and the increased number of emergencies, waiting times are typically much longer in a public setting. In a private setting, greater resources allow processes to be optimized for the patient, as they would be in a high-quality restaurant or hotel. This is much more of a challenge in the public sector. We have done a few things to try to reduce waiting times, such as having a more structured appointment schedule.

In addition to having a short waiting time, it is also important for the patient to have a good waiting time. For this reason, we have installed a television in the waiting room that does not feature standard programming but, instead, features a slide show specifically for our patients. The slide show consists of photographs of nature and animals interspersed with information that we wish to convey to patients, such as descriptions of eye diseases. Our program also explains to patients why waiting times may differ from one person to the next. This 45-minute continuous loop is played without sound so as not to be too intrusive. We have found that patients watch this program and that it typically occupies most of their waiting time.

Most cataract patients are elderly, especially those in the public hospital, and they are actually not so unhappy to wait. Rather, it is usually the patient’s relatives and friends who stress about the waiting time. Additionally, there are relatives and friends who need to take patients home after their procedures but do not necessarily need to be there the entire time. We try to kindly send these accompanying individuals away from the practice. We give them a printout of shopping facilities located near the hospital and take down their cell phone numbers. Then, we send them a text message when we know that the patient will be ready soon so that they have ample time to return. Quite a few relatives and friends take advantage of this arrangement, and it typically relaxes the patients as well.

CatInfo

Prior to surgery, we send patients a 24-page booklet that gives them information about their procedure. However, many patients have trouble reading this material, and others simply do not get the opportunity to do so. Therefore, about a year ago, we launched a program called CatInfo, an interactive computer-based tool that we use to deliver cataract-related information to patients in the office. Once a patient’s preoperative assessment is completed, he or she sits down with a touchscreen tablet and headphones. The patient is shown a 15-minute audiovisual presentation about cataracts and cataract surgery while a professional voice reads the text aloud.

The presentation is divided into small chapters, and at the end of each section the patient must press on a traffic light: Red means “I would like to repeat the last module again”; yellow means “I have further questions that I would like to discuss with the physician”; and green means “continue—everything understood.” The patient’s feedback for each chapter is recorded in a log, which, at the end of the presentation, is printed out and given to the physician. Then, when the physician starts the informed consent discussion with the patient, he or she can say, “You have seen this presentation, and I see that you had a question about the severe complications of cataract surgery. Let me go into more detail about that.”

Initially, we were looking for a presentation to buy but could not find one that we liked, so we decided to produce our own. Our presentation is quite different from other companies’, as the videos or animated presentations of surgery in many of these are too complex for patients, especially those that are elderly. Additionally, many of these video presentations attempt to sell a product, such as a premium IOL, but do not discuss the actual condition or surgical procedure. Our traffic light system, with the printout confirmation that the patient has interactively responded to the information, gives us extra documentation as well.

In the beginning, we were told it would be difficult for 70-year-olds who had never used a computer to use CatInfo; however, we have been using this system for more than 9 months for all patients, and there is rarely a patient who has difficulty maneuvering the touchscreen. Patients receive a brief tutorial on the tablet before using the device.

We conducted a study to determine if informing patients with CatInfo in addition to the face-to-face discussion with their physician was more effective than the traditional informed consent procedure.¹ Patients with bilateral cataract who were scheduled for cataract surgery were randomized to a study group (n=60) or a control group (n=30). Those in the study group watched CatInfo, while those in the control group watched a short sham computer presentation without cataract-related information. All patients had a faceto- face informed consent discussion with a physician. Then patients in both groups received the same validated questionnaire with cataract-related questions.

We found that patients in the study group answered statistically significantly more of the 19 questions correctly than patients in the control group (15 vs 12). There was an age effect in the study group, with CatInfo having a greater impact on elderly patients. The elderly patients likely benefitted more from CatInfo because they were not informed about their condition before coming to our office. Younger patients generally prepare beforehand by using the Internet or other means to research a condition and its treatment.

Patient satisfaction is much higher with the use of CatInfo, as patients have been guided through the entire treatment process and have had the opportunity to ask questions afterward. In a questionnaire we provided to patients, about 98% said that they would want to use this system again if they had any other kind of surgery in the future.

QUESTIONNAIRES

Like many practices, we ask patients to report their satisfaction by filling out a questionnaire. However, we found that it was tedious to have patients fill out paper forms and then have to enter their responses into our database. Instead of having patients complete the questionnaire by hand, we now use a SurveyMonkey (surveymonkey.com) survey on an iPad. Before patients leave the clinic after their last follow-up visit, we hand them an iPad and ask them to answer eight to 10 questions concerning patient satisfaction, including how happy were they with the experience in the operating theater and the preoperative assessment. Once the survey is completed, all of the data is automatically stored in the cloud, and it can be easily and instantly analyzed.

CONCLUSION

Patient satisfaction is not only about postoperative vision or refraction. In large part it is about the way patients perceive the whole treatment process, from the way they were addressed by the staff, to the way they were introduced to the information, to how they were treated during and after surgery. I always communicate with patients throughout the entire surgical procedure, as many patients have told me this relieves some of their stress.

All of the staff members play an important role in a patient’s experience. I tell my staff that we must make patients feel that the day of their surgery is special and show them as much empathy as possible. When you see 25 to 30 patients per day, it is not easy to remember to make each patient feel that he or she is being taken care of individually. However, individualized attention and care really is a key to success.

Patient satisfaction depends largely on how well the patient was treated. We may perform a procedure perfectly and give the patient great postoperative vision, but if the whole process was chaotic and stressful, or if the patient felt mistreated, he or she will not perceive us as having been professional and the procedure as having been beneficial. We cannot underestimate the importance of these aspects in how a patient perceives his or her treatment.

Oliver Findl, MD, MBA, is Director of Ophthalmology at the Hanusch Hospital, Vienna, Austria, and a Consultant Ophthalmic Surgeon at Moorfields Eye Hospital, London. He is also the Founder and Head of the Vienna Institute of Research in Ocular Surgery (VIROS), Hanusch Hospital, Department of Ophthalmology, Vienna, Austria. Dr. Findl states that he has no financial interest in the products or companies mentioned. He may be reached at e-mail: oliver@findl.at.

1. Wollinger C, Hirnschall N, Findl F. Computer-based tutorial to enhance the quality and efficiency of the informedconsent process for cataract surgery. J Cataract Refract Surg. 2012;38(4):655-659.