EMS Insider, Healthcare Reform

Patient Satisfaction, Part Two

EMS providers have a narrow opportunity to earn patient confidence. When a patient or family member dials 9-1-1 for help, every step in the response is a chance to win or lose respect. From the moment you arrive on the scene, to the ride to the hospital and turnover at the ED, how you treat the patient, their family and/or friends during each phase could spell success or disaster for your agency’s reputation.

Municipal-based services are under fire to prove their worth and avoid privatization. Private ambulance services are under fire from the community, elected officials and other EMS services. Every time a contract comes up for bid someone wants to take your lunch money, and a poor reputation based on patient satisfaction makes staying in business a difficult feat.

Response times and Utstein survival rates are important. The general public, however, may not understand those metrics. If you have what is perceived as poor customer service, word will travel fast. And if you are seeking to expand your service, you certainly do not want a poor reputation to precede you. Keep in mind that the people who have already purchased your services—city administrators, healthcare systems—will hear any complaint loud and clear. So will the media.

A tale of two communities

When I first took the helm of a large service, I walked into a maelstrom. The healthcare system wanted to scuttle the operations of the service, which had already lost millions of dollars and had not made its own payroll in eight years. In this particular community, the median yearly income was $17,000. A high percentage of the population was socially and economically disadvantaged. The county was in the top 10% for crime and had poor performance on standardized testing in public schools.

We undertook patient satisfaction surveys to better understand our patients and what they expected from us. We then incorporated what we learned into our employee screening, our training and our competencies. In a very short period of time we corrected the sinking of the financial ship and, more importantly, improved patient satisfaction through adjustments that were made based on feedback from the surveys.

Fast forward a couple of years to when I moved to California and became the EMS coordinator for a fire department. In this community, median yearly income was $85,000. A high percentage of the population could be termed “well-off.” The county was in the bottom 2% for crime and was one of the highest performers on standardized testing in the state.

I again instituted patient satisfaction surveys to determine how we were doing and what we could do better from the patient’s point of view. In this community, like many others in Northern California, the population is politically active and they want value for their tax dollar. When I discussed with the frontline members and local union what I wanted to do, I received tremendous buy-in and support for the patient satisfaction surveys.

We collected data from the survey results and I decided to compare it to the city back east where I had previously performed the patient satisfaction surveys. The two communities were polar opposites in terms of income equality, poverty level, demographics, education and overall health.

What did we find out?

Despite their vast differences, members of both communities wanted exactly the same things from their EMS providers. Both cities wanted:

  1. A timely/rapid response
  2. Courteous, pleasant and respectful staff
  3. Clean ambulances and equipment (BP cuffs, stretchers, monitor, etc.)
  4. A blanket or a sheet to cover them when they were being carried from their home on a stretcher or chair.

I was floored. These two different communities, who could not be more disparate, both had the same basic expectations of their service providers. I could have wound the clock back to the 1950s, sent two “ambulance whites” in a Cadillac to the scene, and as long as they responded with lights and sirens, arrived right away, used clean equipment, were respectful and nice to the patient and covered them with a blanket, then for the most part we’d be golden.

Now, let me say, I would not go back to the 1950s-era level of care. (Jimmy, I have the oxygen turned up to 15—drive faster!) But realistically, it was not a heavy lift to give the patients and their families what they wanted.

Survey design

Our challenge as an industry is to develop a useful tool, one that will provide useful information for our service and the patients we serve. Correctly designed patient satisfaction surveys will allow for lateral benchmarking with other providers regardless of service delivery model (hospital-based, fire department, third service, private for-profit and non-profit, career or volunteer).

There are a variety of customer service surveys already in use. We have all seen surveys for everything from motels, to fast food, electronic/computer sales and auto service repair stations. Hospitals have been well ahead of EMS in this regard and having been performing patient satisfaction analysis for years.

One company that has extensive experience in the field of patient satisfaction metrics is Press Ganey, which has been performing patient satisfaction analysis for healthcare systems and hospitals for years.

If your EMS service is part of a hospital, you are already familiar with the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPHPS). HCAPHPS was developed by the Centers for Medicare and Medicaid Services (CMS)1,2. It was the first national, standardized, publicly reported survey of patients’ perspectives of hospital care.

In part three of this series, I’ll break down the areas examined by HCAPHPS and opportunities to adapt the assessment to better serve EMS needs.

Read Part One, here.


1. Centers for Medicare and Medicaid Services. (n.d.) The HCAHPS survey: Frequently asked questions. Retrieved on Jan. 19, 2016, from https://www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/hospitalqualityinits/downloads/hospitalhcahpsfactsheet201007.pdf.

2. Centers for Medicare and Medicaid Services. (March 2011) Introduction to HCAHPS Survey Training. Retrieved on Feb. 1, 2016, from http://www.hcahpsonline.org/files/March%202011%20HCAHPS%20Introduction%20Training%20Slides%20Session%20I%202-28-2011.pdf.