With an eye toward equity in healthcare, leaders at a Midwest children’s hospital wanted to improve the care experience for Spanish-speaking patients and their families. Because they lacked robust feedback data on this population, however, leaders had only limited visibility into Spanish speakers’ unique needs.

That all changed with the help of NRC Health’s patient experience feedback. Using NRC Health’s rapid response collection, hospital leaders…

• Saw a five-fold increase in response rates among Spanish-speaking families
• Were able to isolate the most effective survey modality for Spanish speakers
• Used the data to make meaningful changes to patient intake and documentation procedures
• And more!

Disparities in care quality are an unfortunate feature of the American healthcare system. Serving an equitable care experience to all populations has emerged as an urgent priority for health-organization leaders across the country. Attempts to pursue healthcare equity, however, frequently encounter a major hurdle: data disparity.

Due to language barriers, statistical underrepresentation, and other structural obstacles, many institutions simply do not have the data they need to make meaningful improvements to minority-group care. This was the case at one Midwest children’s hospital.

Because the hospital serves a sizeable cohort of Spanish-speaking patients, leaders there wanted to ensure that these patients experienced a quality of experience that was on par with their organizational standards. However, when they consulted family-feedback surveys, leaders found themselves hemmed-in by low response rates among Spanish speakers. Without robust feedback data, they were unsure where to focus their efforts.

To improve the experience for Spanish speakers, leaders needed to drive these response rates up. To do that, they turned to NRC Health.

NRC Health’s patient-survey strategy reaches 100% of patients within 48 hours of their care episodes. Compared with mailed-in paper surveys, which can take weeks to reach a patient’s mailbox, this immediacy gives leaders rapid insight into their consumers’ experiences.

Perhaps more importantly, the strategy also embraces a variety of modalities to better meet patients where they are. NRC Health’s solution can reach patients using SMS, email, or interactive voice recognition (IVR) technology, giving leaders a suite of options to reach their customers.

Leaders at this children’s hospital created visibility for their feedback data with internal data dashboards. Leaders and analysts stratified their results overall by race/ethnicity and language, then used these measures to identify significant gaps in experience for their families with limited English proficiency.

THE IMPACT

Leaders saw rapid results after the implementation of the patient feedback function. Within one year of its deployment, NRC Health helped them lay the foundation for broader institutional change.

Hearing more voices

Perhaps the most pronounced effect was a dramatic uptick in response rates among Spanish-speaking patients. Across three different settings, the raw percentage of responses saw as much as a five-fold increase. The proportion of Spanish-speaking to English-speaking responses also increased, reflecting a more accurate representation of the hospital’s patient population. 

“Awareness and visibility are key to mobilizing resources and making real change.”

-Senior Director Patient Family Experience

Understanding the data

With this new glut of data, leaders were better able to assess the experience of Spanish-speaking patients and their families. One stand-out insight was about the feedback methodology itself. Spanish-speaking customers showed an overwhelming preference for IVR feedback surveys: 95% of their responses came via IVR, versus 72% in the general patient population.

Another important insight came from a granular look at patient responses. They showed that while Spanish-speaking customers tend to return very high global measures (e.g., Overall Rating and Likely to Recommend), they were less enthusiastic about the particulars (e.g., Nurse Courtesy/Respect and Time Spent with Care Provider)

From this breakdown of scores, leaders were able to reasonably conclude that, while Spanish speakers enjoyed a high quality of care at their organization, possible communication barriers were driving down interpersonal scores. 

“It dramatically increased our response rates, from groups that historically we had not been able to get a lot of feedback from.”

-Director Patient Family Experience

Institutional improvement

The natural next step, therefore, was to do as much as possible to break those barriers down. Leaders instituted a number of meaningful changes in their operations:

• They partnered with their registration and intake staff to improve the accuracy of language documentation
• They trained nursing staff on ways to access interpretation services, and on
  documenting language preferences in the EHR
• They added iPads and special-purpose interpreter phones to every ED and PICU room

“A pitfall for many organizations is, we’re all interested in improving, but we don’t always make sure we have the data we need. NRC Health makes that data available quickly.”

-Senior Director Patient Family Experience

These steps have already marked a profound difference for Spanish-speaking families who seek care at this hospital. But they’re just the beginning of the organization’s ambitions for equity.

Going forward, the system’s leaders will be commissioning a number of studies to better understand the needs of Spanish-speaking families, including a Latino/Latinx Advisory Council, interviews and focus groups and additional strategy and learning opportunities through the Office of Diversity and Inclusion.

Leaders freely admit that the work of healthcare equity is far from finished. It may always be a work in progress. But so long as they pursue it in good faith—and with an eye toward Human Understanding—they will continue to move closer to a care experience that’s equitable for all. And that is a worthy goal for any institution.

“The experience data we got was a huge catalyst for change. It started conversations and got us to plan and prepare our approach. For us, it’s been really great.”

-Director Patient Family Experience