Provider satisfaction: an analysis based on expectation

As medical managers, we have been given the charge to lead our specialty across the abyss of the |90s. If we are to make the journey successfully, we need to set the objectives, organize the necessary activities and resources, develop our medical team by communication and motivation, and measure our results. Clarification of our needs to our team members is important, but we need to fully understand the needs of our medical providers as well.

One of the most important steps in our trek is to understand what our medical providers expect (what is important to them) and if they are satisfied with their present situation. What are their expectations? What is their level of satisfaction? Without their "buy in" to what we offer, we cannot expect a smooth journey. As has been stated elsewhere, "Take care of your doctors."[1]

The Study

CIGNA Healthplan, Phoenix, Ariz., is a 162,000 member staff-model HMO, staffed by 280 medical providers. It has 15 health care centers located in Metropolitan Phoenix, which covers a geographic area of 422 square miles. The plan is divided into two regions - Northern and Southern.

In late 1990, the plan instituted a quality improvement program, with a pilot study in four of its health care centers. One of these was the C.J. Harris multispecialty referral center in Tempe, where the quality team was made up of myself as chief of staff, the center administrator, and the department heads of family practice, internal medicine, Ob/Gyn, radiology, surgery, and subspecialties. We undertook the task to explore provider satisfaction. The concept, based on the method of "Gap Analysis" reported by Jackson,[2] was to measure provider satisfaction based on their expectations. In previous surveys, we had measured only their satisfaction responses but did not know if the topics surveyed were important to them. Using a survey that included their expectations as well, we felt we could more realistically address important issues while screening out topics that were of less importance.

Subsequent comparison of satisfaction scores to expectation scores would give a measure of how we were doing in addressing their requirements. In our study, applying statistical analysis to our results was found to correlate well to our common-sense analysis.

Our quality team "brainstormed" ideas for the survey that we felt would be important to physicians. In order to encourage successful completion of the survey instrument, we limited the number of questions to 12, with one open-ended question for possible later investigation. The final questions could best be characterized as being similar to "motherhood and apple pie." We did this intentionally in order to have questions with high expectation scores.

The survey was initially done at the C.J. Harris Center. After we looked at our results, we decided to extend the study to the Southern Region and then to the Northern Region. We found no significant differences between our center's results and those of the Southern Region and none between the Southern and Northern Regions. One hundred ninety of the 280 providers surveyed returned the completed study, representing a 68 percent response.

The survey questions are shown in figure 1, left. The questions first addressed the expectations of the provider with HMOs in general and then the satisfaction of the provider with CIGNA. The responses are reported on a scale from 5 to 1, with 5 being the highest score. The results for each segment of the survey are presented in figures 2 and 3, page 49.

Mean expectation scores between 4 and 5 signify that almost all people responding would agree with the question's importance. It was felt that expectation scores of 4.5 and higher would designate questions important to providers. Expectation scores below 4.0 would not be considered as important and pursuit of improvement in this area would be less prudent.

A satisfaction score that varied by more than 3 standard deviations from the expectation response would be considered significant. A satisfaction score of less than 70 percent would suggest an area of concern. It would seen advisable to pursue this topic for improved satisfaction. This could be described as our "common-sense analysis."

The Results

In comparing the importance of the expectation questions with one another, we find that "social bonding," Question 11, was not statistically important in the providers' expectation. Although we often hear providers talk about "getting together," social bonding in this survey was not considered to be a significant expectation. Thus, future efforts in this area would not have to be as heavily emphasized. All other questions proved to be important in the providers' expectation.

Our providers were not satisfied on questions 7, 8, 9, 10, and 12. These questions, dealing with retirement, well-trained support staff, fair pay, communication, and home office awareness, had some of the highest expectation scores. It would, therefore, pay great dividends in the long run to investigate these issues in order to improve satisfaction.

In the area of "recognition for a job well done," Question 6, even though by statistical analysis our providers appear satisfied, it is an area that common sense suggests we need to do some work in. Stated in the framework of Covey, "We need to attend to the little things."[3] Physicians are a strange lot. Their individuality can at times be their worst enemy. We no longer exist in a society where our individuality can be taken as a strength. We are moving further into an environment where physicians are being challenged at every turn; challenged at their very root of existence. Historically, this is a new dimension for them. They are resentful. They are suspicious. They at times feel helpless and fearful of what will come next. Like anyone, they build a shield of protection around themselves that is designed to guarantee their safety. At times this shield takes on the appearance of disinterest.

Summary

We no longer can assume we know physicians' expectations. It is imperative that we know and can satisfy those expectations. At CIGNA Phoenix, we have heard providers' responses and action has been taken. The problems referred to in Questions 8, 9, 10, and 12 have already been addressed. Regarding question 8, many nursing positions have been upgraded to LPN or RN status, Regarding question 9, physician salary scales have been increased in certain departments, and plans are under way to increase them in others. In response to question 10, our medical director has initiated more ways for providers to be heard, primarily in open communication meetings. Under question 12, our corporate office has been made aware of the low satisfaction scores, and we have increased communication from that source. Finally, a follow-up survey is now in the process of being completed. Knowing what is important to physicians before committing huge resources for change seems to us to be a reasonable approach to a very difficult issue. Pursuit of improvement in areas of low satisfaction is critical for a continuing team effort between providers and administration.

References

[1.] Rock, W. "Prescription for Physician Executives: Take Care of your Doctors." Physician Executive 17(2):10-15, March-April 1991.

[2.] Jackson, P. "Gap Analysis." Presented at Group Health Association of America meeting entitled Evaluating Case Mix and Severity of Illness, Los Angeles, Calif., Dec. 2-3, 1990.

[3.] Covey, S. The Seven Habits of Highly Effective People: Restoring the Character Ethic. New York, N.Y.: Simon and Schuster, 1989.

Mel T. Moore, MD, is Chief of Staff, CIGNA Healthplan of Arizona, Tempe.

COPYRIGHT 1993 American College of Physician Executives
COPYRIGHT 2004 Gale Group