The use of patient satisfaction data to assess the impact of continuous quality improvement efforts

Objective: To quantitatively compare patient satisfaction with the visit to an academic otolaryngology office before and after quality improvement efforts. Design: Survey research of convenience sample of new patients. Setting: Outpatients offices of the Department of Otolaryngology at Washington University School of Medicine, St Louis, Mo. Patients: New patients seen between November 1993 and March 1994 (phase 1) and November 1995 and February 1996 (phase 2). Intervention: Numerous departmentwide quality improvements efforts were begun between phase 1 and phase 2. The Visit Rating Questionnaire, a 9-item patient-based questionnaire, was used to measure patient satisfaction. Main Outcome Measures: The percentage of patients who rated their visit overall as excellent. Results: Overall, 973 patients participated. The percentage of patients who rated their overall visit as excellent was 570 (58%) of 1067, while it was 200 (41%) of 491 for phase 1 and 370 (64%) of 576 for phase 2 (χ²=63.8; P<.001). Using a process control chart for the percentage of patients who rated the visit as excellent demonstrated special cause variation, indicating that the continuous quality improvement efforts had made an impact on patient satisfaction. Conclusions: The impact of continuous quality improvement efforts can be documented with patient satisfaction measures. The techniques of statistical process control, including the use of control charts, can transform the data from these measures into information that allows for the evaluation of the effectiveness of continuous quality improvement efforts.