Evaluating the use of a modified CAHPS survey to support improvements in patient-centred care: lessons from a quality improvement collaborative.

OBJECTIVES: To evaluate the use of a modified Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey to support quality improvement in a collaborative focused on patient-centred care, assess subsequent changes in patient experiences, and identify factors that promoted or impeded data use.

BACKGROUND: Healthcare systems are increasingly using surveys to assess patients' experiences of care but little is established about how to use these data in quality improvement.

DESIGN: Process evaluation of a quality improvement collaborative.

SETTING AND PARTICIPANTS: The CAHPS team from Harvard Medical School and the Institute for Clinical Systems Improvement organized a learning collaborative including eight medical groups in Minnesota.

INTERVENTION: Samples of patients recently visiting each group completed a modified CAHPS survey before, after and continuously over a 12-month project. Teams were encouraged to set goals for improvement using baseline data and supported as they made interventions with bi-monthly collaborative meetings, an online tool reporting the monthly data, a resource manual called The CAHPS Improvement Guide, and conference calls.

MAIN OUTCOME MEASURES: Changes in patient experiences. Interviews with team leaders assessed the usefulness of the collaborative resources, lessons and barriers to using data.

RESULTS: Seven teams set goals and six made interventions. Small improvements in patient experience were observed in some groups, but in others changes were mixed and not consistently related to the team actions. Two successful groups appeared to have strong quality improvement structures and had focussed on relatively simple interventions. Team leaders reported that frequent survey reports were a powerful stimulus to improvement, but that they needed more time and support to engage staff and clinicians in changing their behaviour.

CONCLUSIONS: Small measurable improvements in patient experience may be achieved over short projects. Sustaining more substantial change is likely to require organizational strategies, engaged leadership, cultural change, regular measurement and performance feedback and experience of interpreting and using survey data.