Dear Crucial Skills,
How can I use the Six Sources of Influence to improve patient satisfaction scores at our hospital? Our scores average in the 70s, but when I talk to patients they tell us we are wonderful. I’d like patients to put that on the survey. We often see scores of 8 but get comments that suggest they think we deserve a 10. Any ideas?
Seeking a Source
Dear Seeking a Source,
If it’s alright with you, I’d like to think through this together, and I invite our readers to think through it with us in the comments.
First, let’s consider the survey. I’m going to assume that the purpose of your survey is to gather reliable data. Reliable data is uncorrupted, which means it’s free of errors and bias.
Second, let’s consider the Six Sources of Influence. They are personal, social, and structural levers that can be used to affect motivation and ability.
So, there’s a bit of irony in your question. In essence you’re asking how you can influence people in a situation where, if you want reliable data, they shouldn’t be influenced at all—unless it is to tell the truth as they see it.
And that is what I hear you asking—how can I get patients to report their feedback honestly? But you also said you want to “improve patient satisfaction scores” using influence, if possible.
Do you see the difference? I’m not accusing you of wrongdoing. I’m simply trying to think through this with you.
And here’s what I’m thinking.
Check Your Assumptions
There’s nothing wrong with having an assumption—that’s your hypothesis. But remember it’s a hypothesis only.
You hypothesize that patients are more satisfied with treatment than they’re reporting. You have two data sources: the verbal feedback, and the numerical feedback.
Given that they don’t match, it’s natural to conclude one source doesn’t accurately reflect patient perspectives. You assume the faulty data is the numerical feedback, and it may be. But I encourage you to consider the possibility that the faulty data is the verbal feedback.
Do you see how that’s possible? Why might a patient tell a nice healthcare professional his or her staff is wonderful and then mark up an anonymous survey with 7s?
Seek Better Data, Not Better Scores
Given the wording of your question, it sounds like you want both reliable data and better scores—who doesn’t! But when it comes to your survey, make only reliable data your goal.
The cardinal sin of any survey is bias. And while that’s obvious on paper, it’s not always clear in practice. Surveys should be used to gather data that allow us to make a reasonable inference about a population, but frequently they are used to gather data to support a belief or proposition, which results in bias.
So, commit to improving the survey, not the survey results. Truth in the data makes it possible to do the work of improving results.
Define Your Terms (Source 6: Structural Ability)
One of the first things I learned as a philosophy undergraduate was “define your terms.” The point of all communication is to convey meaning. We only confirm whether or not meaning is accurately conveyed through feedback. And, when it isn’t, that feedback can be anything from a scrunched eyebrow to a survey anomaly.
The fact that you’re encountering discrepancies between verbal and numerical feedback could mean your survey questions are unclear. For you, a 10 may mean “medical care provided without error by qualified healthcare professionals.” For some of your patients, a 10 may mean “attractive nurses, plenty of morphine, and 200 cable channels on a big-screen TV.”
So, define your terms. This is particularly important with ratings. Make it clear what you mean by an 8 or a 10 or a 5 by providing examples of the care those ratings represent. In your definitions, avoid interpretations like “timely care” and provide factual examples like “nurses responded to calls within 10 minutes on average.”
In short, your respondents should never feel confused. You might add a question to your survey: “Did you find any questions in this survey confusing or difficult to answer? If so, please explain.” Use that feedback to continually improve the clarity of your survey and your respondents’ ability to answer accurately.
Remind Respondents of the Impact (Sources 1 and 3)
While I’m inclined to think that the discrepancies you cite have to do with ability and not motivation, here’s an idea just in case.
Remind patients of the personal and social value of complete and reliable data. You might do so on the survey itself and verbally when administering it.
“While this survey is optional, your honest and anonymous feedback help us provide quality care for the community. When you take the time to answer objectively, you help us provide better care for you and other patients.”
Hire An Agency (Source 6: Structural Ability)
Finally, consider hiring an agency. We sometimes do so with our own surveys. Professionals in survey design and analysis understand how various factors can contribute to discrepancies or bias, from wording to question types to the order of the questions themselves.
I hope this has sparked a few ideas. Certainly there are other ways you could apply the Influencer Model to your situation, and I invite readers to share their ideas.