Improving Press-Ganey Scores Using Qualitick.


Bassett Healthcare Network – Cobleskill Regional Hospital.

This case study outlines how Cobleskill Regional Hospital ED successfully employed the Qualitick program to dramatically, and consistently, improve their Press-Ganey scores and national ranking.


Cobleskill Regional Hospital, affiliated with Bassett Healthcare Network, is a 40-bed not-for-profit hospital founded by the people of Schoharie County in 1956. Cobleskill Regional Hospital is Schoharie County's only provider of acute inpatient medical care, emergency care, short-stay inpatient rehabilitation, and many other diagnostic and therapeutic healthcare services. Cobleskill Regional Hospital has been affiliated with Bassett Healthcare Network since 1994. Cobleskill ED wanted to improve their ED patient satisfaction scores but found that low ‘n’ numbers from their regular Press-Ganey mail surveys, and protracted reporting time, they needed a program which could generate higher ‘n’ numbers for deeper performance analysis, and real-time reporting for rapid-cycle improvement.

To help achieve these objectives Bassett Healthcare Network commenced their Qualitick program in Q1 2015. The ED team initially focused on patient wait times, staff interactions by readily making performance data available, recognizing ED staff, and sharing all comments, good or bad. This approach made for transparency and accountability, and patient comments were communicated in real-time. The process was executed with a personal touch through staff member recognition emails for a job well done. No matter how many times an individual was recognized this process was adhered to. If the ED had a dissatisfied client it was the Joan Goodrich (ED Director), or Deborah Funk-Valois (ED Medical Director), reaching out personally to address their concerns within 24 to 48 hours. The real-time nature of the Qualitick program allowed for immediate service recovery.


The Qualitick program’s innovative process of engaging patients prior to discharge helped Cobleskill ED to garner higher ‘n’ numbers, and the state-of-the-art reporting provided real-time knowledge. This deeper understanding allowed the leaders to strategically and tactically make adjustments and improvements in the delivery of care. Ultimately, this improvement was reflected in their Press-Ganey scores.


With HCAHPS already in place, it’s very likely that EDCAHPS will be similar in structure. CMS has been very vocal about the use of their mandated surveying being for their own use and urges hospitals to employ their own data-collection methods as the CMS mandated methods do not necessarily garner large sample sizes. CMS is very clear on this:

“CMS does not review or endorse the use of HCAHPS scores for comparisons within hospitals, such as comparison of HCAHPS scores associated with a particular ward, floor, individual staff member, to others. Such comparisons are unreliable unless large sample sizes are collected at the ward, floor, or individual staff member level.”

Furthermore, during AHRQ/CMS webinars on ‘How to Improve CAHPS Scores,’ hospitals have been encouraged to:

  1. 1. Do their own ‘Proxy Surveys’
  2. 2. Which provide greater insights of ‘whys’ and ‘drivers’.
  3. 3. To use this data to operationalize improvement.



Candie Miller (Quality Process and Data Analyst) commented, “with the Qualitick trending data it became apparent that wait times were an issue, so a policy was put in place where patients were notified about wait times more frequently. This in turn had a huge positive impact on patient perception about wait times, as opposed to not knowing and having to wait.”

Candie continued, “Qualitick data, was reviewed regularly across all ED teams, discussions would take place and plans were implemented for improvement. Our Qualitick account manager was always in close contact with the Quality Process and Data Analysis team, and this was the catalyst in effectively implementing strategies for success. Once upward trends in our Press-Ganey score became apparent, the results were presented to C-Suite, who now intend to use the same methodology in the clinic setting and the inpatient side.”

Tracie Kobel (Qualitick Operations Manager) added, “it took dedication from the team at Cobleskill to turn perception into real knowledge about performance execution. For many years they simply depended on a handful of mail surveys each month in the vain hope of understanding team performance. Now they have an effective tool and process in place from Qualitick to get a more in-depth understanding of performance execution, where they can marry common sense strategies for superior results. And with EDCAHPS around the corner, Cobleskill are well positioned to ascertain great scores."

Real-time patient satisfaction tool provides better training and support to the E.D.



Feedback plays a critical role for the emergency department's quality improvement process. Yet the services of many patient satisfaction survey companies are expensive, and the results are so delayed that there is little value in helping identify or correct issues. The lack of timely patient satisfaction data can make it very difficult for the Medical Director and physicians to know where to focus improvement efforts.


An effective on-site, real-time patient satisfaction program can provide the information needed to make meaningful improvements. At many of its contracted facilities, Envision® uses cutting edge technology, including portable tablet computers for bedside use and touchscreen kiosks in the patient discharge area in the emergency department (E.D.) to allow patients and families to easily provide feedback regarding their E.D. experience. Alerts are sent to the E.D. nursing and physician staff, the Medical Director and the administrator on duty so they know within moments if a patient was either extremely satisfied or dissatisfied. The immediate feedback affords the opportunity to recognize and reward as well as quickly perform service recovery. This not only enhances patient satisfaction, but may also reduce risk by improving patient safety and compliance with discharge instructions.


Envision's implementation of real-time patient surveys has positively impacted patient, physician, nursing and administration satisfaction, and enhanced the focus on patient experience awareness and training. The completion percentage of ‘surveys to E.D. visits' averages over 20 percent, which far exceeds the return rate of many well-known survey tools. The large sample size provides relevant feedback that helps the department focus on improvements that matter.

Quality Benchmarking

Real-time surveys identify problematic patterns early and allow hospitals to take immediate corrective actions that can result in positive future outcomes and performance metrics. Because of those corrective actions, results like the following become a reality.


Wait Time Average


Explanations & Instructions


Recommend Staff member for Exceptionally Good Service


Patient satisfaction increases with implementation of studer principles

Major Hospital Shelbyville, Indiana Annual ED Visits: 24,000



With the never-ending list of challenges facing emergency departments today, increasing patient satisfaction is more challenging than ever before. But because EDs are the front door to the hospital for many patients, high patient satisfaction is critical to a hospital's reputation and success.


Envision® has an established partnership with the Studer Group, and utilizes its principles to improve patient satisfaction at hospitals throughout the country.

Studer concepts create great places for patients to receive care by first creating great places for employees to work and physicians to practice medicine. Studer Group health care organizations experience rapid and remarkable improvement across the board, setting them apart from the average hospital. The Studer Group's approach is different:rekindling the passion of employees and physicians by refocusing them on why they chose health care as their profession — to engage in work that is purposeful, worthwhile and makes a difference in the lives of others.

The following case study highlights the impact Envision's implementation of Studer principles made at Major Hospital, a 73-bed general medical and surgical hospital in Shelbyville, IN, with approximately 24,000 emergency department visits per year.


Envision's implementation of real-time patient surveys has positively impacted patient, physician, nursing and administration satisfaction, and enhanced the focus on patient experience awareness and training. The completion percentage of ‘surveys to E.D. visits' averages over 20 percent, which far exceeds the return rate of many well-known survey tools. The large sample size provides relevant feedback that helps the department focus on improvements that matter.

Implementing Studer Principles

When Valerie Miller, RN, MSN, began her position as manager of the emergency department at Major Hospital in 2005, improving ED patient satisfaction scores was a key objective. "My mission was to encourage staff to treat every patient like family," says Ms. Miller. “So that's how we started in the nursing division." But the ED needed more — a common cause around which to unite that would provide all employees with specific methods and tools to increase patient satisfaction.

Major Hospital turned to Envision for innovative solutions. Envision's first order of business was to recruit Chris Loman, MD, an experienced emergency department medical director known for his leadership and management expertise. Dr. Loman shared Ms. Miller's belief in treating patients as family, bringing the evidence-based approach of the Studer Group to make that philosophy a reality.

Improving Patient Satisfaction

With Dr. Loman's guidance, the ED began implementing various Studer principles, including tactics such as rounding for outcomes, which positively impacts patients and staff. "My assistant managers round on patients, and I round on staff, physicians, and other departments within the hospital," says Ms. Miller. "We found that to be very enlightening, and it gave us a great opportunity to improve our patient handoffs in other areas."

Dr. Loman also put Studer's Five Fundamentals of Service to work, ensuring that all patients receive consistent, quality care. The Studer Group uses the acronym “AIDET" to help users remember to: Acknowledge the patient by name; Introduce yourself; Give an accurate time expectation of the patient's Duration of stay; Provide a step-by-step Explanation of what will happen and answer questions; Thank the patient and family members.

“AIDET is working so well for us that we're now taking it throughout the organization and even to the physician practices," says Ms. Miller.

Immediate Patient Feedback

Envision also brought in Client IQ™ patient survey kiosks by Qualitick™ to gather immediate feedback on patients' experiences. As they exit the ED, patients have the opportunity to stop at a kiosk and respond to both standardized and customized questions. Envision then uses the standardized responses to benchmark participating hospitals and harness best practices.

“It's very hard to modify behavior in individuals based on Press Ganey surveys because there are so many loopholes in the way people think about Press Ganey, but with Qualitick, we can get very personal," says Dr. Loman. “How was your nurse? How was your doctor? Were you communicated with properly? Were you happy with your visit?

“And we can ask them all of these questions before the double doors even close on them because the questions are all there for the asking," Dr. Loman said. “I believe that such direct and instant feedback is the best way to modify individual behavior."

The Results

Major Hospital's 2010 patient satisfaction goal was to achieve a Client IQ raw score of 85 percent across the board for nurses, physicians and the ED as a whole. “Each quarter we met that goal and surpassed it, and comparing our year-end raw scores with the November 2010 Press Ganey report, we would be at the 99th percentile," says Ms. Miller. “We've made so many gains."

According to Client IQ data, 99 percent of Major Hospital's ED patients are happy with their care and would recommend the ED to family or friends. “The positive feedback that our staff received from the Qualitick data was phenomenal," says Ms. Miller. “It doesn't mean as much coming from myself or Dr. Loman, but when the patients themselves express how happy they are, that really means something to our employees."

Contact Us

For more information, call (888) 513-6044 or visit us online at www.envisionphysicianservices.com.

The Results January 1, 2010 - January 28, 2011:

Would you recommend the emergency department?


Were you satisfied with explanations and instructions?


Were you kept well informed of wait times?


Were you satisfied with how your pain was addressed?


Improving Relationships

"We have better interpersonal working relationships that have brought a much higher level of camaraderie – a sense that we're all in the same boat. And while we may have different functions, we're all here to propel that boat forward. Sometimes it's hard to get people to gel, but the Studer principles have helped us do that here." Chris Loman, MD
Major Hospital
Shelbyville, Indiana

Qualitick and Metcare

About Metcare:

Metropolitan Health Networks, Inc. (“MetCare") is a leading provider of health care services to people with Medicare in Florida. They care for approximately 35,000 customers in 16 counties in south and central Florida. Founded in 1996, their team of physicians, health care professionals, and associates are dedicated to serving their customers with the highest standards of medical treatment and personal service. MetCare is recognized by the National Committee for Quality Assurance (NCQA) as a level 3 National Physician Practice Connections®. MetCare's mission is “to provide the very best medical care and service to every customer, every time."

The Challenge:

MetCare is committed to providing its customers the best care and service at each and every one of its locations in south and central Florida. To ensure that they are striving towards this mission, they listen to their customers in a meaningful, accurate, and timely manner. MetCare had already experienced other feedback/measurement methods prior to reviewing their methodology. Their primary challenge was that of the long time lags between measurement. MetCare was looking for a real-time system that augmented their current data gathering process and one that would dovetail with their quality improvement methodology.

Solutions and Results:

At the beginning of 2010 MetCare implemented Client IQ across 10 of its sites in south and central Florida. They immediately formed a new centralized evaluation and response processes to compliment the greatly increased response rates and the real-time customer feedback it was receiving from the 10 sites. This centralized approach allowed the company to keep an eye on all of the sites as customers funneled through and gave their feedback immediately upon the completion of their office experience. Because the control on performance, recovery, and recognition was in their hands, all MetCare needed to do was execute their quality improvement process. As a result, they saw an immediate positive impact in each of these following areas:

  • Reduced wait times to see physician
  • Real-time employee recognition
  • Immediate service recovery
  • Overall improvement in customer satisfaction

Improving Relationships

"By having instant notification we have immediate and substantial control over service recovery issues as well as positive employee recognition. This helps improve current and future performance in areas of quality of care, customer satisfaction, and employee satisfaction. Working with Client IQ has vastly improved our visibility in many areas of process improvement and has provided us with a clearer pathway to implementable quality control measures." Lauryn Burton,
Customer Care Lead,

Major Hospital
Shelbyville, Indiana

Tripp Wingate – Qualitick Review

The delivery of healthcare services, formerly known in old school parlance as the "practice of medicine," has entered into a new era--the age of outcome metrics driving reimbursement. Value-based CMS incentives, which are based on quality metrics (70% clinical and 30% patient satisfaction), are incrementally year-over-year increasing for those who can make the top 50% performance grade. For those in the bottom 50%, they will see a corresponding reduction in their Medicare annual reimbursements.

These amounts now are substantial enough to push organizations from the black to the red. It is no wonder that for hospital-based providers, job and contract security hang in the balance based on the quality metrics score.

Despite much debate and concern over the relevance and reliability of these metrics, they are here to stay. Providers who value clinical excellence and job security must focus on making the measurement process better, not undermining or trying to roll back the unstoppable.

Yes, Press Ganey, Healthstream and a host of other traditional patient satisfaction survey vendors are successfully hawking to hospitals a survey methodology that we know is seriously flawed - low ‘N’ numbers, lagging data, and a lack of provider specificity. CMS has for now locked these vendors into an exclusive position through regulations which create barriers, preventing more advanced vendors from becoming certified for use in CAHPS reporting.

As technology advances I hope these regulatory barriers will be torn down to be more inclusive. In the meantime, all physicians agree and understand that effective communication improves adherence to treatment plans, reduces complaints and law suits, improves patient loyalty, and thus improves practice bottom line numbers and positive patient outcomes.

The Holy Grail which we all search for is how to objectively and quickly improve our communication skills. The traditional method of complaint investigation/feedback and quarterly reporting of group satisfaction reports, with admonition to "do better, be nicer," seem to have very limited ability to provide the frequent specific feedback needed to effect real advancement.

Imagine if a professional athlete only received feedback every 10th game in the form of team statistics, and the infrequent feedback from failed plays he/she may have been involved in. Conversely, imagine if a physician got inaccurate and delayed information from a heart rate or blood pressure monitor hooked up to a patient. How would that affect the physician’s treatment plan or the eventual outcome? Such feedback systems would have huge gaps of missed improvement opportunity or even being able to save a patient’s life.

It is obvious that in order to really advance, we need to have better systems. Systems which function like high level, real-time, personal coaches who reviews "game film" to improve approach to patient communication. A system that can give us reliable information for a high volume of our patients on what we are doing well as well as what areas that need new tactics, new approaches to achieve a high level of satisfaction, and consistency. Such a system exists - Qualitick360!