Case Study: Tickit to Timely Patient Feedback

Low Completion

The completion rate of CG-CAHPS paper-based survey was 22 to 23 percent. The length of survey was a barrier — patients were receiving thick envelopes in the mail enclosed with six to eight pages of survey questions, front and back.

Data Delays

Data collected from the CG-CAHPS were delayed two to three months, which made it difficult to assess impact of quality improvement or innovation efforts. Adopting LEAN management tools to improve quality relies on having more timely data, ideally daily or weekly.

Limited Reach

CG-CAHPS survey responses were not representative of the SFHN patient population; responses from youth and adults (ages 18-44) were absent. Low health literacy was also a barrier for completing this paper-based survey.

Exit Hallway

Since the CG-CAHPS is formatted as an after-visit survey, Silver Avenue started testing a kiosk in the exit hallway. At this early stage of the pilot, the team was still using the full CG-CAHPS survey, which took patients up to 15 minutes to complete. The team learned that patients were reluctant to stop after their visit to complete the questionnaire. Even when a Silver Avenue patient advisor volunteered to invite patients to complete the survey, they did not generate a significant number of responses.

Waiting Room

Since patients did not want to spend extra time in the clinic to complete the survey, patient advisors at Silver Avenue suggested moving the iPad into the waiting room. Here, patients were already spending “non-value added time” in clinic. However, given the size and setup of the waiting room at Silver Avenue, the iPad kiosk felt awkward — somewhat “on display,” as some patients said. This workflow also relied heavily on staff’s invitations to patients: when checking in at registration, the flow coordinator invited the patient to complete the survey. This proved to be an unsustainable workflow because of competing priorities for the registration process (i.e. patient portal sign-up).

Exam Room

After evaluating patient advisor feedback and testing other workflows, Silver Avenue placed iPads in exam rooms to make patients feel more comfortable filling out the survey while not having to spend additional time in the health center. Patients were able to fill out the survey in privacy while they wait for their providers. The staff experience also improved, as medical assistants who invited the patients to complete the survey did not add more than 30 seconds to their normal workflow. Moreover, compared to registration staff who often have a line of patients waiting, this one-on-one intake process makes it easier for staff to remind patients about the survey.