New Solutions

Why CAHPS Surveys Matter

Posted by Melissa Herrett on Oct 13, 2014 9:43:46 AM


With the various Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys organizations have available for measuring their patients’ experiences, it’s easy to become overwhelmed with the myriad options.  When deciding on the correct CAHPS survey to use, two of the most important questions include why CAHPS surveys should matter to your organization, and what each type of CAHPS survey measures.  By understanding how and why CAHPS surveys are used, you will be better prepared to not only administer the survey, but also to explain to your employees why CAHPS surveys are important to them as well.     

The following table provides a brief overview to help you understand why CAHPS surveys matter, beyond simply providing a baseline measurement of patient satisfaction at your organization:

CAHPS Survey

Why it Matters/What it Measures


HCAHPS surveys measure how patients view the care they receive within a hospital. Survey scores on this particular instrument affect government reimbursement and are required for public reporting.

Clinician and Group CAHPS (CG-CAHPS)

CG-CAHPS measures experiences with providers and office staff. This tool helps providers better understand patients’ perceptions of the care they receive. CMS is expected to require public reporting of CG-CAHPS data within the coming years. For more information about this, download our free guide by clicking the icon at the end of this post.  

Patient-Centered Medical Home (PCMH-CAHPS)

PCMH-CAHPS measures experiences within a medical home. This instrument provides additional information doctors and clinicians can use to improve the patient experience.


Child-CAHPS measures parents’ or guardians’ opinions of care for patients younger than 18 years of age. This survey permits parents to offer their insight into the care their children received, identifying areas where providers could improve.

Accountable Care Organizations CAHPS (ACO-CAHPS)

ACO-CAHPS measures the interpersonal aspects of health care in Accountable Care Organizations. ACOs are required to administer this survey, which provides useful insight into improvement opportunities.

Home Health CAHPS (HH-CAHPS)

HH-CAHPS is used by home health agencies to collect feedback from patients receiving in-home care. Medicare-certified agencies are currently required to report HH-CAHPS scores to CMS in order to receive their 2% Annual Payment Update (APU).

Hospice CAHPS

CMS recently released a draft version of the Hospice CAHPS instrument. Approval of the final instrument is expected for late fall 2014. In 2015, non-exempt Medicare-certified hospice organizations must report their Hospice CAHPS scores in order to receive their full APU. Completed by family members or caregivers, the Hospice CAHPS survey will be used to rate hospice patients’ care experiences.

For more information about any of these surveys, visit

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Topics: Why CAHPS survey

Improving Patient Satisfaction through Employee Engagement

Posted by Greg Hyman on Oct 2, 2014 11:17:23 AM

More and more, healthcare organizations are focusing on the impact that engaged, passionate employees have on the patient experience. Anecdotally, the connection has long been clear, but only recently has data science begun quantifying the linkage in a meaningful way. Over time, these new metrics will allow leaders to better coordinate their patient experience and workforce management efforts, so as to accelerate improvement in both areas.

Avatar is at the forefront of research into these connections. For example, a study by the Avatar Research Team found that several factors contributing to employee engagement also strongly correlate with performance on important HCAHPS composites. By addressing opportunities in one area – say, by instituting a program to recognize employees who demonstrate desired responsiveness behaviors – leaders can predict improvement on specific HCAHPS measures.

Of course, even prior to these advancements, some preeminent organizations in the industry have developed powerful approaches to addressing patient satisfaction and employee engagement in tandem. For a case study on one such organization’s efforts, those of Baldrige-winning North Mississippi Health Services, click here.)

These metrics begin to address what has long been a challenge for many healthcare organizations. In general, patient experience and employee engagement programs have typically been managed separately, out of necessity. While this is usually the most efficient approach from a staffing and organizational standpoint, it introduces challenges in terms of communication, coordination, and linking tangible outcomes to investments. Silos have often represented a major barrier to improvement in what are two critical success factors for many healthcare organizations.

Today, metrics that incorporate both constructs provide patient experience and employee engagement stakeholders with structure around which to develop collaborative programs and measure results. HR executives can tie their employee survey to annual goals for employee and patient experience, and follow-up action plans can be developed with an eye to addressing both. Patient experience leaders can demonstrate the impact that improved experience has not only on patient loyalty and endorsement, but also on the organization’s ability to effectively attract and retain top talent.

The trend is clear: as the approaches to quantifying linkages between employee engagement and patient satisfaction increase in sophistication, healthcare leaders’ capacity to influence outcomes in both areas will continue to improve.

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Topics: patient satisfaction, employee engagement, patient experience

Defining Employee Engagement

Posted by Melissa Herrett on Sep 24, 2014 3:15:25 PM

What is employee engagement? This question served as the foundation for many discussions at Avatar’s event, “And Beyond,” last week in Chicago. While we often talk about methods for improving employee engagement, the first and most important step is to define the oft-heard buzzword.  

So what is employee engagement?  And what does an engaged employee actually look like?

Employee engagement is a strong desire to be part of the value an organization creates. It is more than simply being satisfied with one’s job. If you only have satisfied employees, you may have underperformers who are perfectly happy with their current situation and have no desire to perform at a higher level or advance in their careers.  Employee engagement means an individual is personally dedicated and committed to ensuring the organization excels.
Employees often fall into one of three buckets of engagement: Actively Engaged, Partially Engaged, and Actively Disengaged.



The following characteristics will help you classify individuals at your organization:

Engaged Employees are cheerleaders for your organization.  They:

  • Go above and beyond, frequently doing more than what is asked of them
  • Proudly represent and promote the company’s brand
  • Display a strong sense of loyalty to the organization
  • Derive purpose from their job content
  • Voluntarily take on tasks to create better outcomes
  • Act as role models, engaging and inspiring others
  • Are dedicated to the mission, vision, and values of the organization
  • Have awareness and personal commitment to their engagement levels
  • Display self-motivation and drive to perform at a high level
  • Contribute new ideas to better the organization
  • Adapt to and facilitate change

Partially Engaged Employees
  • Do only what is asked of them and are not inclined to do much more
  • Rarely, if ever, volunteer for extra assignments or take lead roles
  • Display lower energy and lackluster performance on assignments
  • Can often feel unappreciated or unimportant
  • Go to work primarily for the paycheck
  • Are not overly excited about their current work situation

Actively Disengaged employees can be considered vampires of your organization, sucking the life out of the company.  They:
  • Display a negative attitude about their employer and job duties
  • Focus on problems
  • Display behaviors and actions that can cause more harm than good
  • Are not personally invested in the success of the organization
  • Consistently “badmouth” supervisors behind the managers’ backs, either in the workplace or to friends and family
  • Actively seek to share their negative personal viewpoints with new and ambivalent employees

So how do you respond when asked “what is employee engagement?” Employee engagement is the employee who gets to work early because he/she is so excited about contributing to the organization’s success.  It is the employee who is constantly volunteering for new and varied assignments. It is the individual who regularly contributes new and innovative ideas to help the organization succeed. It’s the person who goes above and beyond because he/she cares.

Now that you can answer the question “what is employee engagement?”, you’re better prepared to identify partially engaged employees and help support their engagement.  Start by pairing them for projects with highly engaged employees.  Coach them.  Ask them what helps them get excited about their day.

Look around you, and you’ll see many individuals who are engaged and dedicated to ensuring success at your organization. By continuing to focus on best practices for maintaining and improving engagement, you can reduce the number of partially engaged and actively disengaged workers.

For more information on tips and techniques for improving engagement, download our free white paper, or consider joining us in Maine at our next event, scheduled for October 16, 2014.



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Topics: employee engagement, What is employee engagement

Why CAHPS Survey Selection is So Complicated – And What to Do About It

Posted by Greg Hyman on Sep 10, 2014 6:01:00 PM

At first glance, it might seem that the glory days of patient experience measurement occurred a decade ago, when surveying patients often meant sending them a page of home-spun questions, hoping for a handful of responses, and tackling the obvious service issues when time allowed. A laissez faire approach, maybe, but simple!

Today, simple is perhaps not the first word one would choose to qualify patient experience measurement, which, with the growing influence of value-based purchasing, often entails instrument selection from among an array of complex, overlapping surveys; compliance considerations; vendor relationship management; dedicated internal roles; and weighty financial implications.

But one need not condemn what is complicated or inconvenient. In fact, approached correctly, participation in CAHPS initiatives can have a meaningful impact on revenue and your mission – whether explicit or otherwise – to deliver outstanding care and a positive patient experience.  The process takes time, yes, but it begins with a single first step – selecting the right instrument(s).

To help you get started, the following presents an overview of the complications to selecting a CAHPS instrument, as well as how to address them. (For more ideas, click the link at the end of the article to download Avatar’s free CG-CAHPS Preparedness Guide, which presents an approach applying to CG-CAHPS and other CAHPS surveys.) 

Selection Consideration 1: Multiple Obligations

There are a number of reasons why CAHPS survey selection is complicated. First, many healthcare organizations are obligated not only to meet CMS’ requirements for value-based purchasing, but also the patient survey requirements of numerous other third parties, whether for accreditation, federal and local designations, or other drivers.

  • Step 1: Map out all measurement obligations and any competing or overlapping instrument specifications. Does it make sense to select the survey that meets the greatest number of high-priority demands? Yes, though a supplementary survey may be needed for competing requirements.

Selection Consideration 2: Multiple Instruments

In addition to the instrument requirements posed by CMS, PQRS, and others, some regulatory-driven surveys such as CG-CAHPS have multiple instrument versions addressing different timeframes or care settings. Based on the environment in which your patients are treated, your compliance requirements, and your plans for internal use of the survey data, you should be able to narrow down your version selection options to a manageable few.

  • Step 2: Identify the salient characteristics of each instrument, including appropriate settings, stage in survey lifecycle (is it likely to be used in future pay-for-performance?), and alignment with your internal measurement drivers. Narrow down your list!

Selection Consideration 3: Performance Improvement

For all their complexity, CAHPS Surveys have already had a powerful impact on healthcare, but used alone they are typically not adequate tools for guiding performance improvement efforts. Proprietary, driver-focused patient experience surveys are ideal as a foundation for performance improvement. It is important to keep in mind that different programs have different guidelines as to whether and how supplemental survey items can be utilized.

  • Step 3: Assess how the CAHPS instrument options you’ve identified will incorporate with your performance improvement efforts and supplemental surveying. If you’re already surveying patients, can the items be integrated with your CAHPS surveys? Do your existing surveys provide an adequate foundation for improving CAHPS scores over time? How will you establish and coordinate sampling and administration plans to meet your compliance and performance improvement needs?

These are just a few of the reasons why CAHPS survey selection can be challenging, as well as some steps for addressing the challenge. For many, the ultimate objective is to meet all compliance and performance improvement needs while minimizing redundancy and maximizing cost efficiency. While these recommended steps can serve as a starting point to achieving that objective, the path to an optimal, cost-effective program remains somewhat complex. When in doubt, grab your draft roadmap and pencil and call up a trusted expert. A good vendor will be happy to help you navigate your selection process.

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Topics: HCAHPS, Patient Surveys, CG-CAHPS, HH-CAHPS, ED-CAHPS, Choosing a CAHPS Survey

Why Improving Patient Satisfaction … Doesn’t

Posted by Greg Hyman on Aug 21, 2014 1:23:45 PM

Once upon a time, people talked about improving patient satisfaction as a way for health systems, hospitals, and independent practices to maintain and build their share of the market. A common analogy to the hospitality industry seemed fitting – if I’m a consumer with a choice of hotels for the annual family getaway, aren’t I going to select the hotel with the best amenities, the most wow factors, the familiar, reassuring brand name?

Of course I am, and the same often holds true for healthcare. After all, healthcare organizations are businesses. The growing preponderance of immediate care chains offering free coffee and snacks, bottled water, and flat screen televisions in every exam room is testimony to healthcare’s potential for overlap with hospitality, at least where customer service and marketing practices are concerned.

But healthcare is not the hospitality industry. Improving patient satisfaction as one would improve the satisfaction of hotel guests is a worthy goal, but it is not enough to truly do right by patients. In fact, studies have shown that focusing on patient satisfaction may have an ambiguous or even deleterious impact on patient health outcomes. 

Why? To boil down a very complex issue, look for example to the patient with borderline high cholesterol, who has researched the risk factors online and determined that intervention with statins is the answer. When his physician declines to write a prescription, instead recommending lifestyle changes as a first-line approach to lowering borderline high cholesterol, the patient may leave feeling ambivalent about the visit. Yet the doctor made a medical decision she felt was in the best interest of the patient.

In the admittedly simplistic example above, neither of the implied outcomes is truly “satisfactory.” Either the patient receives a prescription for a medication he may not yet need, or he leaves dissatisfied and less likely to adhere to the clinician’s recommendations. Whereas a focus on improving patient satisfaction does nothing to suggest a better scenario, seeking to improve the patient experience offers a multi-dimensional approach in which the patient, clinician, and staff are all active participants.

At the hospital or practice with a strong focus on patient experience, the scenario may look very different indeed. Utilizing a patient experience survey and sophisticated analytics, patient experience leaders may have previously uncovered a perceived need for better listening and communication between physicians and patients, as well as better post-visit follow up. Now, with the right coaching, training, and processes in place, the clinician and staff are prepared to work in collaboration with the patient to improve outcomes.

As a result of attending to the care experience, rather than focusing on improving patient satisfaction, the practice has done right by the patient. The physician demonstrates that she understands the patient’s concerns and responds with sensitivity. Post-visit follow-up further supports adherence to the physician’s advice. Now the patient is not only more likely to feel satisfied; he’s more likely to do his part to improve or maintain his health. 

So, in healthcare, we can place secondary importance on the amenities, wow factors, and satisfaction for satisfaction’s sake. At the end of the day, supporting patients’ engagement with their own health is the critical success factor here. Attending to the patient experience is how we can achieve this. 

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Topics: patient satisfaction, CAHPS, CAHPS Survey, CAHPS Surveys, patient experience, patient satisfaction survey, CG-CAHPS, patient experience surveys

Three Reasons Employee Engagement is a Challenge… and What to Do About It!

Posted by Melissa Herrett on Aug 14, 2014 9:51:20 AM

Research into employee engagement highlights the fact that engaging employees is often a challenging feat. Despite the increased attention many organizations are paying to engaging their workers, recent statistics show that almost 60 percent of employees are only partially engaged in their jobs, and 12 percent are actively disengaged. With the dedication and commitment toward engaging employees, why is it still so hard to achieve full employee engagement?
Here are 3 reasons why engaging employees can be difficult, as well as some techniques to address these challenges.
  1. Tough Economic Times – Often, an organization’s budget can lead to employees who are forced to do more with less. Whether it’s a matter of time or materials, when budget cuts are implemented, employees may simply not have the resources to do their jobs as effectively as they can. As a result, their engagements levels may experience a dip.

    To continue to engage employees despite a leaner approach to business, it’s important to ensure open and honest communication with each employee. Managers should be frank about why budgets and resources are slim. Following that conversation, managers and employees should work together to brainstorm ways to approach projects with limited time and resources. These conversations will also allow leaders to understand employees’ current workloads and help staff members re-prioritize projects as needed.

  2. Coworker Dynamics – Interacting with other people can at times be challenging. Every individual has a unique personality, mannerisms, and ways of approaching projects, and it can be hard to find common ground. In the workplace, this is especially true because you often don’t have the benefit of being able to select your coworkers. The fact of the matter is that people may simply not get along.

    In order to mitigate this issue, encourage employees to get to know coworkers outside of their projects and work. Sometimes, encouraging employees to connect on a more personal level will help them find common ground and understand where coworkers are coming from. These relationships may then positively impact the way individuals work together on projects and tasks. Managers should also discuss effective team building strategies and team dynamics, so that employees understand ways to cope when in a group that doesn’t necessarily see eye to eye.

  3. Work is, well… work – There’s no way around this one. Work is defined as “exertion or effort directed to produce or accomplish something,” according to The inherent nature of work can be exhausting and overwhelming. Add in the structure of today’s work environment, where employees are often accessible late into the evening hours through text messages, cell phones, and email, and the chances of mental exhaustion, extra stress, and overall burnout increase.

    To combat this issue, encourage employees to take time away from work to relax and reenergize. Get them to completely disconnect from work for a while, and they will likely come back feeling rejuvenated and ready to contribute. By showing employees that you realize their mental health is just as important as the work at hand, employees will likely become more engaged in their jobs.    

It’s no secret to anyone in the workplace that engaging employees can be a challenge. However, by recognizing the challenges, keeping them front of mind, and taking small steps in the right direction, the obstacles that seem momentous today can and will be overcome.

For more information about how work/life flexibility positively impacts engagement, download our Free White Paper. 

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Topics: employee engagement

3 Tips for Getting Employees Excited about an Employee Engagement Survey

Posted by Kelli Killian on Aug 6, 2014 10:22:00 AM

 Today organizations are treating employee engagement as much more than a trendy buzzword. Companies realize the very real impact engaged and disengaged employees have on their business, and they are looking for ways to keep employees engaged. Many of these organizations have found the value in administering an employee engagement survey and action planning around survey results to improve.

While surveys can be a powerful tool for increasing employee engagement, their benefits can really only be realized when the proper practices are set in place to support your survey initiative. An important step in survey administration is promoting the survey to employees to help them understand why you’re administering the survey in the first place. If employees do not understand, then they are less likely to participate in the survey or to respond thoughtfully, which could result in incomplete or inaccurate data. If you can’t help employees buy into the survey process, then the point of conducting the survey is lost. 

So how can you get your employees eager and enthused about the survey?  Read on for three tips to help build excitement about your employee engagement survey.



  1. Be an open book.  Let employees know why you’re conducting a survey and why it’s important. Share important dates. Let them know the steps you’re taking to ensure survey confidentiality. Tell them why the survey will be beneficial to them and the organization overall. Knowing the “how” and “why” will help to build enthusiasm among employees.
  2. Involve employees.  Including employees in the planning process can help increase their enthusiasm for the survey and show that this really is a team effort for the entire organization. Involving employees could be as simple as asking for volunteers to be survey captains, who champion the survey and encourage participation. 
  3. Consider an incentive.  A little extra reason to get excited about the employee survey can come in the form of an incentive. Prize examples could be a popular gift card, a catered department lunch or even an extra vacation day. Individuals should be entered to win only if they complete the survey. An incentive is an easy way to get employees’ attention.

Interested in learning more about building excitement for your employee engagement survey?  Check out our case study from AtlantiCare to learn how they boosted survey participation rates among their employees.


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Topics: employee engagement survey

Three Reasons Why CAHPS Survey Questions Aren’t Enough

Posted by Greg Hyman on Jul 29, 2014 9:41:56 AM

The Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys have done much over the last several years to encourage increased focus on the patient experience by tying patient survey scores to a portion of Medicare reimbursement.

Where many feel CAHPS has fallen short, however, is in potentially creating the impression that a static, standardized national survey is a sufficient tool for assessing the patient experience, let alone serving as a jumping point for improvement.  What more and more healthcare leaders are recognizing is that CAHPS surveys alone simply are not enough.

Scientific research bears this argument out.  A recent article in the journal Health Marketing Quarterly reviewed the validity and usefulness of HCAHPS. The authors concluded that the HCAHPS survey is an excellent beginning, with some problematic elements.

The results of the study closely mirror the findings of similar analyses conducted by Avatar.  In one such analysis, Avatar researchers compared the scores of clients who use an Avatar patient survey in conjunction with HCAHPS against the scores of those who use HCAHPS only.  The researchers found that clients who use an Avatar survey in conjunction with HCAHPS perform significantly better than clients who use HCAHPS only.

So why the discrepancy in scores among users of a robust, customized survey tool and users who limit themselves to the CAHPS survey?  HCAHPS measures only a small portion of the patient experience. Many other service and care factors are important or even central to the patient experience.  As a case in point, a regression analysis performed by Avatar researchers found that HCAHPS predicted only 38.6% of variance in Overall Hospital Rating and 35.8% of Recommend.  As such, HCAHPS is not providing complete information on the patient experience, potentially leaving organizations with missed opportunities to improve performance.

This is one of the reasons why surveys customized at the point of generation to reflect the individual patient experience are so powerful.  Adding items addressing services that an individual patient has received allows organizations to collect more accurate, more comprehensive data on the patient experience, extending the reach and specificity of their performance improvement initiatives.

While existing and emerging CAHPS programs have helped shift healthcare to a culture with increased focus on the patient experience, the demand this focus places on healthcare leaders to identify and improve service gaps underpins the reasons why CAHPS survey questions aren’t enough.  Customized, diagnostic surveys measuring each specific aspect of the individual patient’s experience have proven a powerful tool for driving significant gains in experience scores, and thus are the natural complement to any CAHPS program.

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Topics: HCAHPS, CAHPS Survey, patient satisfaction surveys, patient experience surveys

Three Ways to Ensure Confidentiality When Conducting Employee Engagement Surveys

Posted by Melissa Herrett on Jul 23, 2014 1:54:49 PM

Often, one of the biggest deterrents for employees when completing an engagement survey is their concern that the survey is not entirely confidential. If employees are worried they could be identified by their responses, they may be less apt to fill out the survey, and/or they may not be as truthful. The information gathered from the survey may therefore be inaccurate, and improvement plans will be less impactful.

In order to gather the most comprehensive data, organizations must be proactive about alleviating employees’ concerns regarding confidentiality.

Here are three tips to help ensure employees’ confidence in the confidentiality of your next employee survey.

  1. Contract with an outside party – Employees will likely feel more comfortable taking the survey if they are submitting their responses to a third party, rather than to management directly.
  2. Include information about confidentiality in the survey instructions – By clearly explaining what measures you are taking to keep responses confidential, employees will have a better understanding of these measures and will be more trusting of your commitment to maintaining confidentiality. Include detailed information in the survey instructions, clearly outlining your methods for keeping responses confidential, thus encouraging employees to state their honest opinions.
  3. Don’t report results under a certain threshold – If a manager only has one or two employees, it will be much easier to identify which employee is responding in a certain way. Therefore, to avoid this issue, report responses for small groups of employees as part of a larger group. At Avatar, for example, we maintain a five-person threshold, where responses from groups with less than five people are not reported directly to managers, but rather folded into a larger group.
By taking these steps to ensure confidentiality, you will show your employees you are dedicated to getting the most accurate responses and ensuring they are at ease answering the questions honestly. Alleviating confidentiality concerns will likely contribute to higher participation rates, thus allowing you to gather the most actionable data to engage your employees.
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Topics: employee engagement survey, employee engagement, Confidentiality,

Patient Satisfaction Survey Questions and Dimensions

Posted by Kelli Killian on Jul 8, 2014 6:09:30 PM


Patient satisfaction is a priority objective for many healthcare leaders today. With the implementation of Value-Based Purchasing (VBP) and the increased importance placed on patient loyalty, healthcare leaders are focused on finding ways to improve patient satisfaction. One influential way to implement this change is by administering a patient satisfaction survey to gather detailed information.  Patient satisfaction survey questions are posed based on broad dimensions of health care through which they can be measured.  Avatar Solutions utilizes the 5 point Likert scale to measure response to survey items instead of questions that make statements such as “Overall I was satisfied with the care I received.” Survey items that can be measured from “strongly agree” to “strongly disagree” dig deeper than questions alone. Read on to learn some of these dimensions and their common accompanying items that help to measure patient satisfaction.

Physician A high area of interest for healthcare leaders conducting a patient satisfaction survey is the physician dimension. This dimension measures the patients’ satisfaction with their doctor. There are many items of focus under the physician dimension. Common survey items include:

    • The doctor treated me with dignity and respect

    • I was given the opportunity to ask questions

Check-Out Process As an important part of the patient journey, the check-out process is frequently measured on patient satisfaction surveys. Common survey items include:

    • How promptly you were able to check-out

    • Explanation about the use of medications

The check-out process is one of the last points of contact during the patient journey and thus an area that healthcare leaders are concerned with measuring patient satisfaction.

Facility The organization’s overall facility is an important and often overlooked part that helps make up the patient experience. Common survey questions include the following:

    • Comfort and safety while waiting

    • Adequate parking was available

These are just a few of the dimensions and items that can be addressed on a patient satisfaction survey. To learn more about patient satisfaction, check back on our blog next week and join Avatar’s LinkedIn group The Patient Journey to continue the conversation.

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Topics: patient satisfaction survey

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