Evaluating quality of care is a core issue for residents, their families, care providers, and policy makers at both state and federal levels. The earliest approaches to measuring resident satisfaction with care in senior living and long-term care settings were based on tools developed for hospital and acute care settings. Over the past decade, the focus has moved towards a "person-centered" approach to care across the health care continuum. To that end, there has been growing recognition of the importance of consumer satisfaction.

For aging service providers, understanding and addressing resident, family, and employee views are key to providing resident-directed services and quality care as a means to enhance quality of life. Most importantly, measures of resident satisfaction have been linked to health care outcomes, budgetary outcomes, employee satisfaction, work effectiveness, and retention.

In the aging services industry, national initiatives are highlighting the importance of measuring performance and outcomes as central to quality improvement management systems.

Quality First is the first-ever voluntary, nationwide quality initiative embraced by the leading long-term care organizations. Life Services Network, AAHSA's Illinois affiliate association, believes the best way for organizations to implement Quality First is to commit to building and reporting on their efforts to achieve excellence in care quality and quality of life for elders in their communities.

Organizations that pledge under the Quality First Covenant can demonstrate their commitment by adhering to the following two core values:

• Quality performance and excellence systems are key drivers of customer satisfaction, and
• "Managing by facts" is a means to utilize data, measurement methods, and benchmarking efforts towards quality improvement.

Consistent with Quality First, a new national quality improvement initiative, "Advancing Excellence in America's Nursing Homes," focuses on resident and family satisfaction and employee retention as keys to quality efforts.

Why should aging services providers evaluate satisfaction?

Understanding the needs and perspectives of your customers — residents, families, staff, and managers — guides your community to provide the best possible services. More importantly, satisfaction surveys evaluate your services and programs from the viewpoint of the customer, rather than from the viewpoint of the community.

For example, a senior living community may consider drivers of satisfaction as hospitality services, programs, and operations. In reality, customers view services, programs, and operations from the benefits they offer and issues they resolve.

The bottom line to evaluating customer satisfaction is this — what your customers think and feel about your organization's performance helps your managers and staff make improvements in programs and services that your customers will become aware of and value.

How are satisfaction, quality, and outcomes such as customer loyalty and retention linked?

The linkages between quality of services and care, customer satisfaction, customer retention and loyalty, and fiscal performance are well-established. An community may have excellent services and programs provided by dedicated staff and management, but they need a means to measure and document the impact of these processes in order to demonstrate benefits in relation to residents/customers, staff, and ultimately, fiscal performance.

What resources do aging service providers need to build customer loyalty, retention, and quality outcomes?

Life Services Network's Confidence Satisfaction Survey Program provides senior living and long-term care communities with measures, tools, and applications that lead to positive outcomes. Here are some key points, derived from marketing research, that provide the necessary steps towards meeting needs and expectations of residents, families, and employees.

Confidence Point 1: Learn from your most loyal customers.

The "satisfied" customers only tell part of the story — what drives your "most loyal" customers is key towards improving quality of care and services. To measure "loyalty" satisfaction surveys may include items addressing "how willing are you to recommend this community to others" or "do you feel your community has a great reputation compared to others."

Some organizations also hold "customer focusing sessions" or "learning circles" to best determine what is important to various groups. One of the common criticisms heard about satisfaction surveys for residential aging service providers is that there is a bias towards positive responses by residents due to a number of factors. Group discussion formats often lend themselves to more open discussions of issues as residents see "they are not the only ones" with particular concerns.

Confidence Point 2: Benchmark your results.

Not only is it important to understand how satisfied are your customers, but it is also important to recognize how satisfied are your customers compared to others living in similar communities. Benchmarking should include two forms — benchmark against similar organizations for the current year and benchmarking against yourself, comparing changes year by year within your organization.

Confidence Point 3: Develop an action plan based on survey results.

A turn-of-the century Italian economist, Vilfredo Pareto, studied the distribution of land wealth across various countries and found a rather consistent pattern — about 20% of people owned about 80% of the land. Pareto discovered that this 80/20 distribution occurred in other things in life. These principles have been applied to quality management over the past century.

Although the percents may not be so exact, what this tells us is concentrating quality improvement plans on the top issues will have a greater impact and be more cost-effective that trying to attack every possible problem.

The Confidence Satisfaction Survey Program uses this same premise to target what factors influence the most loyal residents, families, and employees — those who "highly recommend" their communities to potential residents and employees. Developing an action plan based on the top issues helps your managers and staff target what is most important to your residents and families.

Confidence Point 4: Identify tools and mechanisms to share survey results and action plans with key audiences.

Executive summary reports are an excellent means to share survey results with various key stakeholders — from board members to resident and family councils. Key results may also be developed into PowerPoint presentations to share in group meetings. Some organizations have also shared results via large display boards in lobbies of their buildings to share successes with all visitors.

Reporting results also provides opportunities for involving residents, families, and employees in action planning processes. Involving these various groups in goal setting are ways to assure action plans are addressed from the "customer" perspective.

Confidence Point 5: Make evaluation and feedback part of everyday life.

Evaluation is not a once-a-year event. Opportunities for residents, families, and employees to provide regular feedback regarding service quality via such mechanisms as comment cards, 800-numbers, or advisory groups are examples of how to make evaluation part of a continuous quality improvement program.

Keeping the focus on the customer's viewpoint communicates your organization's commitment to quality performance and how you value "person-directed" approaches to care and service!

To learn more about LSN's Confidence Satisfaction Survey Program, contact Jen Frink, Manager of Sales & Member Services, at jfrink@lsni.org or 630-325-6170.

Written by Linda Hollinger-Smith, RN, PhD, FAAN, Senior Vice President for Research, Life Services Network. Life Services Network is the state of Illinois affiliate association of the American Association of Homes and Services for the Aging and the Assisted Living Federation of America.