Paul Willging Says…


Customer satisfaction surveys are more than just paper

It doesn’t make sense that most age-qualified communities I’m aware of don’t have a system for continuously measuring resident satisfaction. Of those that do, only a few actually study the results and incorporate what they learn into their planning and budgeting processes. Could it be because the survey process isn’t structured properly to be of maximum use?

To be maximally useful, these surveys should be used not only to document quality, but to scrutinize for areas of discontent, or the beginnings of discontent. Survey results can be analyzed to determine which services or components correlate with an overall sense of satisfaction with the community’s residents, and which do not or work in the opposite direction. If the primary source of new admissions is the satisfied customer (and her family), knowing what diminishes satisfaction is critical for a community’s profitability.

Usefulness can be further enhanced by aggregating results for comparable communities and developing benchmarks for allowing comparisons between them, with communities that have high levels of satisfaction serving as best-practices models.

Equally important, satisfaction surveys need to be completed by all of the players in the community, not just the residents. True quality management recognizes that the customer base goes beyond residents and families. Staff are the facility’s internal customers.

The complete satisfaction survey will therefore assess overall satisfaction with the services and the quality of life they support, as viewed by all participants in the community.

Admittedly, “quality of life” is perhaps the most difficult of the topics addressed by customer satisfaction research. Perhaps it can be looked at this way: Assessing of quality of life evaluates perception of the four fundamental attributes of a quality existence: a sense of control over one’s destiny, a sense of belonging and self-worth, a sense of privacy, and a sense of safety and security.

Residents lose their sense of control when events occur that affect them adversely and they feel they have no recourse. Similarly, employees feel a loss of control when they know a resident needs help, but they are unable to assist the resident, either because of time constraints or because of lack of appropriate credentials.

As for “sense of belonging,” everyone wants to feel like a part of the community in which he/she lives and works. For both residents and employees, the more they believe they belong in the environment, the greater their sense of camaraderie, kinship, and being at “home.”

Access to privacy is crucial for residents. Even in the most institutional setting, people need to have the opportunity to be alone when they so desire. And the best employees know that “leaving someone alone” can at times express good customer focus.

Finally, residents without a sense of safety and security, both physically and psychologically, will not feel that their environment provides quality of life. For staff, this means not only pointing out the smoke alarms and the door locks, but conveying to residents that they are always available when needed and are as committed to residents’ well-being as their families are.

We need to know what is happening to the customer in such important areas-and we need to know how the customer perceives what is happening. Marketing guru Chuck Chakrapani, in his book How to Measure Service Quality & Customer Satisfaction: The Informal Field-Guide for Tools and Techniques, says it best when he refers to customer satisfaction as a “subset” of service quality measurement. To measure the effectiveness of a product or service absent customer satisfaction is “to measure something without context,” he writes.

Especially in seniors housing and care, measuring resident satisfaction is at least as important as measuring clinical outcomes, if not more so. It’s certainly more important than measuring process, the government’s favorite approach under OBRA.

Granted, one should probably give credit to the federal government for its recent attempt (through quality indicators) to elevate the status of outcomes as a critical benchmark in assessing nursing facilities. It is certainly an improvement over the traditional fixation on inputs and process. But it really doesn’t go far enough.

Appropriately structured customer surveys identify areas of strength, areas of weakness, and the role of each service in contributing to the overall sense of customer satisfaction. When used in a continuous program of quality improvement and ongoing communication with residents, satisfaction surveys serve as assurance that the facility is addressing customer concerns.

I’ve described the rationale and basic elements of a useful customer satisfaction survey process. Next month, I’ll discuss how to put it together.

To comment on Dr. Willging’s views, as expressed here, e-mail
Paul R. Willging, PhD, was involved in long-term care policy development at the highest levels for more than 20 years. For 16 years as president/CEO of the American Health Care Association, Dr. Willging went on to cofound the successful Johns Hopkins Seniors Housing and Care postgraduate program (cosponsored by the National Investment Center for the Seniors Housing & Care Industries), and later served as president/CEO of the Assisted Living Federation of America. He has enjoyed an equally long-lived reputation for offering outspoken, often provocative views on long-term care.

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