by Greg L. Drevenstedt, PhD

Why surveys are a “best practice” of the best practices

In business, a “best practice” is a method or activity that has a positive impact on customer satisfaction, employee satisfaction, or financial results. In orthodontics, a “best practice” is something that improves efficiency, patient satisfaction, and profitability. Surveys are a “best practice” of the best orthodontic practices. Many orthodontists provide great clinical care, but excellent customer service is what sets the best practices apart. The best practices actively listen to patients, parents, staff, and referring doctors, and respond to their needs and concerns. If you don’t provide a safe, confidential mechanism to give feedback, then you are leaving out a critical ingredient to practice success.

When developing your survey project, I recommend using a problem-solving technique you’re probably already familiar with: “who, what, where, when, how, and why.” The answers to these six questions are the building blocks for your survey. I’m going to address the last question first, since the reasons why to survey set the entire process in motion.

Why Survey?
First, you want to nip problems in the bud sooner rather than later. Regardless of whose concerns they are—those of patients, parents, staff, or referring doctors—if you don’t know what’s going on, you can’t fix it. Second, knowledge is power. Surveys help you learn more about your practice and how to make changes to benefit everyone. Surveys also allow you to gather more reliable feedback than you can get from piecemeal or anecdotal information. You may have a few outspoken parents, but how many have concerns that they don’t tell you about? Surveys also help boost patient/parent retention and referrals. Put simply, surveys are another way to show that you care. Patients, parents, staff, and referring doctors truly appreciate being asked their opinion. In almost every survey we conduct, at least one person writes, “Thanks for asking!”

Who Do You Want to Survey?
Answers to the other questions depend on your answer to this one. Reasons for surveying your patients and their parents are obvious: You want to find out what they like so you can do more of it and market those strengths, and you want to find out what they want changed or improved so you can take steps to do so.

Some orthodontists regard staff surveys as unnecessary. Downplaying the value of staff feedback can be a costly mistake. Good employees are hard to find, and staff turnover is very expensive. Actively soliciting the feedback of your staff is a great team-building exercise that increases the staff’s investment in the practice’s success.

Use surveys to reach out to the general dentists and other doctors who refer to you. It is impractical to take all of your referring doctors out to lunch to ask them how you’re doing. Although surveys are no substitute for in-person meetings, they will enable you to gather feedback more efficiently. And they underscore your commitment to satisfying their needs and those of their patients.

What Do You Want to Know?
Start by reviewing what you know about the group you plan to survey. The sidebar (page 92) includes a series of questions about patients/parents, staff, and referring doctors that should be answered as a team exercise at your next staff meeting. Your collective answers to these questions will help you identify key issues to cover in your survey.

When it comes to survey questions, be specific. In your patient/parent survey, invite respondents to evaluate specific aspects of their experience—from scheduling an appointment, to their arrival at your practice, to the ease of financial or insurance arrangements, to their levels of comfort during treatment.

For example, we ask parents and adult patients to rate their satisfaction in 20 service areas on a five-point scale, from “Not At All Satisfied” to “Completely Satisfied.” This scale allows us to easily compare answers across patients. I also recommend including open-ended questions, such as what parents and their children like best and like least, and what they would like changed or improved.

If you are making changes in your practice to better serve patients and parents, don’t assume that these changes are self-evident. Your survey will let you know where you need to focus your efforts. Also include basic demographic questions, such as age, gender, marital status, educational attainment, and occupation to give you a profile of who completed your survey.

Staff members are a tremendous resource in every practice. Collectively, they spend more time with patients and parents and have qualitatively different interactions with them than you do. Your staff survey should solicit feedback about positive aspects of your practice, as well as areas in need of improvement. For example, our staff surveys invite team members to evaluate the practice in five areas: communication, teamwork, leadership, customer service, and policies. We also include open-ended questions about what staff like best about the practice and changes that could be made to benefit patients, the orthodontist(s), and the staff.

For your referring-doctor surveys, questions should allow your referral sources to evaluate specific aspects of practice-to-practice service and communication, as well as the feedback they hear from patients. Open-ended questions can address ways to improve the referral process or other suggestions about how to better serve patients.

When developing your own survey questions—no matter what you’re asking of whom—keep these five guidelines in mind:

1) Questions should be polite and friendly.

2) Questions should be easy to understand and answer.

3) Surveys should be as brief as necessary—don’t cheat yourself, though; make sure you cover everything that’s important to you.

4) Don’t pry. Asking about household income is off-putting.

5) Protect respondent confidentiality. Don’t require names, and provide envelopes so patients or staff can seal their completed surveys.

If you want help developing your survey, I will gladly e-mail you examples of patient/parent, staff, and referring-doctor survey questions.

Survey Guide
To help you develop your surveys, answer these questions as a group in your next staff meeting.

Patient/Parent Survey
? What are the most common compliments we receive from patients/parents?
? What are the most common concerns we hear from patients/parents?
? What do we want to know about our patients/parents?
? What improvements/ changes have we made that benefit patients/parents?
? What new services or amenities do we offer to patients/parents?
? What benefits will our patient/parent survey provide to our practice?

Staff Survey
? What are the most common compliments we receive from staff/coworkers?
? What are the most common concerns we hear from staff/coworkers?
? What do we want to know from staff/co-workers?
?What improvements/ changes have we made to employee policies?
? What benefits do staff members receive?
? What benefits will our staff survey provide to our practice?

Referring Doctor Survey
? What are the most common compliments we receive from referring doctors?
? What are the most common concerns we hear from referring doctors?
? What do we want to know from referring doctors?
? What improvements/ changes have we made to our referral process?
? What benefits will our referring-doctor survey provide to our practice?

Guidelines for Survey Success
When developing your own survey, use this checklist as a final review:
? Is the tone of each question polite and friendly?
? Is each question easy to understand and answer?
? Are any questions inappropriate, or do they pry too much?
? Will the survey responses be easy to tabulate and summarize?
? If we repeat the survey, can we easily compare results over time?
? Do we assure respondents of confidentiality?
? Make your survey a win-win by getting everyone involved. Solicit input from the entire dental team, and reward their efforts.
? Protect respondent confidentiality:

Don’t require respondents to identify themselves.

For in-office surveys, provide envelopes so completed surveys can be sealed.

Use an independent third party to tabulate data and prepare a summary report.
? Conducting a survey creates the expectation that improvements will soon follow. Ignoring feedback is worse than not gathering it at all. Be prepared to make changes to achieve practice goals and meet the needs of your patients, parents, staff, and/or referring doctors.
? With your survey results in hand, create an action plan to implement improvements that includes clearly identifiable milestones for reaching goals and objectives. Seek expert assistance for additional training and the development of new systems.
? Use your first survey as a benchmark, and conduct follow-up surveys annually to monitor the progress of your practice.    —GLD

When To Survey?
 If you want a fresh look at your practice, any time is a good time to do a survey. For example, we recently conducted surveys for a group practice in which a senior orthodontist was retiring and a young orthodontist had started as an associate. The surveys were used to gauge parent and patient perceptions following the transition, and the  orthodontists were pleased to find few concerns about the change.

If you’re preparing to make changes—such as updates to your practice or a move—you may wish to conduct a survey in advance to gather additional suggestions, or solicit potential concern about the changes. You can also conduct follow-up surveys after the change to gauge reactions.

Where Will Respondents Complete the Survey?
There are advantages to having your patient/parent survey filled out in your office. First, you maintain control over the process; you’ll get back the same number of surveys you hand out. Second, you and your staff can personally invite adult patients and parents to provide feedback, which is great for internal marketing. On the other hand, allowing patients to fill out surveys at home provides them with more privacy, so they may feel more comfortable providing critical feedback. But whether you hand them out to take home or mail them directly to patients, you will get fewer surveys back than you distribute.

For your staff survey, I recommend giving employees time during the workday to complete the survey in the office, with the option to take it home. Space and distance from the office may help them to think about your practice more objectively and thoughtfully. Since referring-doctor surveys are mailed directly to each practice, doctors will fill them out either in their office or at home and mail or fax them back to you.

How Will You Do the Survey?
In other words, what survey format will you use? Paper surveys are most common because they are easy to prepare and reproduce, they’re portable, they’re cost-efficient, and they don’t break. With paper surveys for your patients/parents, you have a choice of mailing them or handing them out in your practice. Mailing has two disadvantages:

1) Increased expense due to postage. When calculating the costs for your survey project, be sure to factor in postage to the recipient and for the survey’s return. Always include a self-addressed stamped envelope with the survey; and

2) Unpredictable response rates. In my experience, response rates for patient/parent and referring-doctor surveys sent by mail vary from 15% to 50%. Not long ago we conducted a patient/parent survey for an orthodontist in California. We mailed out 1,300 surveys and received 230 responses—an 18% response rate.

With this in mind, there are two advantages to mailing surveys:

1) Mailing surveys offers the highest degree of confidentiality; and

2) You maximize the marketing value of your survey with the widest reach. This is especially important if you’re making changes and want to solicit the most feedback, or if you want to get the word out about special services. To save money, you can also mail surveys to a random sample of patients, such as every fourth or fifth patient in your database.

Another option is to distribute surveys in the office, which ensures that you maintain control over the project and get back all the surveys you give out. I recommend distributing surveys to every one of the next 100 parents/patients who visit your practice, which will provide a good snapshot of your patient base.

Distribute surveys to adult patients and parents of kids when they arrive for their appointment, and ask them to complete the survey during their visit. Although the front-office staff is primarily responsible for distributing and collecting the surveys, everyone—especially the clinical staff—should get involved. Be sure to thank the patients for taking the time to provide their opinion.

No matter what format you use, taking deliberate steps to protect confidentiality communicates trust and encourages honest, candid responses. Don’t require patients, staff, or referring doctors to identify themselves. With in-office paper surveys, provide envelopes so that patients or staff can seal their completed surveys.

Using Your Results
You’ve collected your surveys—now what? It’s time to tabulate and organize the data, and put it into a useful form. Otherwise, you’ll end up with a big stack of surveys that collect dust. Ask a staff member or an independent resource to tabulate the results and create a summary report that highlights key findings.

With your results in hand, the next step is to make a list of suggested changes or improvements. Pay attention to individual concerns voiced by survey respondents. Be prepared to make some of the changes they recommend. When they take the time to fill out a survey, patients, staff, or referring doctors expect improvements to follow.

Review the list of suggested improvements, and identify those that are consistent with the mission, values, and vision of your practice. Create an action plan to implement improvements that includes clearly identifiable milestones for reaching goals and objectives.

I recommend communicating your survey results to your staff to celebrate strengths and focus efforts on areas in need of improvement. Also, communicate to parents, patients, and referring doctors any changes or improvements that will be made based on their feedback.

If you’re like most orthodontists, you have competitors who want your patients. To be a best practice, you need to know the strengths and weaknesses of your practice from the perspective of your patients and their parents. If providing quality care is part of the mission of the practice you own or work in, then measuring how well you do this is vital.

Greg L. Drevenstedt, PhD, is principal of Valmont Research LLC, which provides Practice Enhancement Surveys™, demographic analysis, and custom market research for orthodontists, dentists, and industry clients nationwide. He is also a postdoctoral fellow at the Andrus Gerontology Center at the University of Southern California in Los Angeles. He can be reached at (888) 679-0991 or [email protected]