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Better outcomes through consumer feedback: A spotlight on China

By Brad Contento, corporate communications, CARF International

Brad ContentoAt a hospital in the city of Guangzhou in southern China, a 70-year-old woman is an hour from being discharged following a 5-day inpatient stay due to a stroke. Her experience has gone smoothly and she is in high spirits. Her husband is helping gather her things, complete the final paperwork, and call their daughter with the good news that they will be coming home.

As her husband and doctors zip in and out of the room, the woman sits in her bed and reviews a packet given to her by a hospital representative the previous day. The packet includes a questionnaire asking her to rate on a 4-point scale various aspects of care she received. With pen in hand, and thinking of the supportive therapists and doctors she’s encountered over the past week, she has so far given high marks on each question.

But when she gets to a section asking her to rate the statement “staff respected my privacy,” she pauses. She remembers an incident that happened during her first day in the hospital, when a nurse entered the room unannounced while she and her husband were having a personal conversation.

Because the survey is anonymous, the woman decides to answer truthfully. She marks the statement a 2 out of 4. When she finishes the survey, she seals it in an envelope and hands it to a hospital representative, who will drop it in the mail to be analyzed by a neutral third-party.

What the woman has just provided to the hospital is invaluable feedback. What she doesn’t know is that several other patients have also given a low response to the “staff respected my privacy” statement. Their responses will soon be aggregated, analyzed against industry benchmarks, and presented to hospital administration to be used in data-driven quality improvement efforts.

Just two years ago, the hospital had no feedback tool in place and would have missed this opportunity.

Across the world in pursuit of feedback

The questionnaire that the woman filled out was created by a growing branch of CARF called uSPEQ®. Within the hour, the woman will be at home with her family, but the data she provided has just begun its global journey.

After being handed to the representative, the envelope is first mailed more than 600 miles to Hangzhou on China’s easternmost coast. There, the consulting firm Okeway will scan the survey answers and comments into an electronic form. Okeway is CARF’s key consulting partner in Asia and Europe, and specializes in rehabilitation management.

After converting the feedback, Okeway sends the survey data digitally across the Pacific Ocean to the uSPEQ analysts at CARF’s headquarters in Tucson, Arizona; 7,600 miles and 15 time zones away from Guangzhou where the feedback was first collected.

The reasons why a growing number of hospitals in China are sending their data halfway around the world become clear when the uSPEQ analysts begin their work.

In Tucson, the feedback from the woman and the hospital’s other patients collected over a period of time is combined and converted into statistical and graphical reports. This is a process that has been honed over more than a decade of field testing in North America. The data is compared against historical data from the same hospital as well as benchmark information collected from similar programs around the world.

The resulting report (delivered quarterly) and supportive consultation from uSPEQ analysts will become integral sources of data for the hospital. The longer a program uses the uSPEQ tools—and the more facilities that participate—the stronger the data become.

This is why Okeway and CARF have been working hard in China to expand on the foundation of data already established in North America. It’s also why many Chinese hospitals are jumping at the opportunity to plug in to the international benchmarks.

Quality improvement in China

The boom in the use of uSPEQ survey tools is part of a larger quality improvement groundswell in China. In just two years, 12 hospitals have implemented uSPEQ surveys to collect feedback from more than 4,000 patients in medical rehab settings. As many as 100 more hospitals in China may adopt these tools over the next 12 months. Even more are looking to implement CARF’s quality standards.

This is good news for persons served in China. Traditionally, patients in the Chinese healthcare system have had a relatively passive role in their treatment. Until very recently, it would have been rare for a doctor or therapist to inquire about a patient’s preferences or future plans. This was due in part to the high ratio of patients compared with the number of service personal in the Chinese medical rehabilitation system. It was also due to simply not yet having applied international quality guidelines.

The region was primed for third-party tools to be introduced to help bridge the gap.

Similar to funders in North America, Chinese funders look more favorably on feedback collected by a third party than that done directly by providers. Financial incentives in the region are heavily tied to survey results, so using a neutral source is a significant step toward impartiality. Being able to provide this neutral source is what uSPEQ’s Chief Research Officer, Di Shen, is most happy about. Originally from Jiangsu province, it is serendipitous that Shen is in a position to lead this movement to improve outcomes in China.

Better outcomes

According to Zhang Wen, a CARF surveyor and service provider at a CARF-accredited hospital in Shanghai, the implementation of quality improvement efforts has quickly had a positive effect in China and on her own organization.

“It is obvious that patients are now achieving better experiences from our hospital. Many would refer their friends or family members to our hospital. They would tell others they received excellent care and services at the hospital. They were able to meet their expectations. These serve as excellent testimonials for our facility. From the patient’s satisfaction and the analysis of their outcomes, we can more effectively and quickly improve our services.” (Translated from this video)

Collecting feedback from persons served is an important step in the process that Wen describes. Feedback helps guide practices so that patients are at the center of services. Asking for and acting on their input is a direct signal that they are part of the team, they are valued, and their preferences are taken into account.

In short, it is a keystone practice.

Within a year of being discharged from the hospital in Guangzhou, the woman will be back to living her life, having likely forgotten the little mark she made on a piece of paper. But that mark meant a lot to the hospital, which will be deep into the process of implementing an action plan for improvement. Patient feedback will have prompted a series of meetings, customizations, and updates to how services are delivered. Future patients will receive better care.

The industry will have gotten a little bit better.

(Note: This article focuses on uSPEQ’s Consumer Experience Survey. uSPEQ also offers an Employee Climate Survey. Contact for more information on either survey tool.)

(Medical Rehabilitation,Performance Management and Improvement)

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Thank you, Rosalind. Great to hear!

Posted by: Brad Contento at 6/15/2017 9:41:05 AM

Comments from customers are extremely valuable. We the consumer, no matter the service, should always strive to give the best service possible. I try to stress to our staff that as a patient in any setting a patient wants to know that their health and well being is of importance to all who enters their space. I thoroughly enjoyed the information and in our business customer service is key. I will share this at our next up-coming in-service. The main key being you'll never know who will stop and share their experience at our facility in person or on the phone. Thank you! Rosalind

Posted by: Rosalind Sibley at 6/7/2017 1:42:02 PM

Hi Deborah,

Yes, please send a note to There are some variables that affect the pricing, so they should be able to answer that for you.

Posted by: Brad Contento at 6/7/2017 1:19:02 PM

Do I need to contact uSPEQ to get the costs?

Posted by: Deborah Roberts at 6/7/2017 1:13:36 PM

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