Why You Can’t Trust Your Customer Satisfaction Data

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By Heather Chavin, MA*

Most practices are proud of their customer or patient satisfaction numbers.

Based on outcomes numbers gathered by my company, which provides outcomes and patient progress reporting services, most clinics also have an issue with self-discharge. Our clinics average a 57% rate of completed plans of care across states and practice sizes. This means we’re losing almost half of our patients before their plan of care is complete.

In looking at customer experience, self-discharge translates to an unsatisfactory or, at best, a mixed customer experience. Because most practices collect patient satisfaction data at the end of care, they are fooled by positive reports that don’t take into account their least satisfied customers. In statistics, this is called a sampling bias. Savvy practices consider self-discharge rates as their primary satisfaction measure before delving into the specifics of any survey.

Why Patients Self-Discharge

According to our data, about half of self-discharging patients leave at or before the fourth visit. Clients report the most common reasons for self-discharge early in care are financial or lack of patient engagement. Those that leave later in care often do so in response to the common practice of the soft-discharge.

In a soft-discharge, a clinician encourages a patient to cancel an appointment if they are feeling better or to only make an appointment if they don’t feel better. This sends a muddled message to the patient about their success (and your clinicians’ efficacy), wreaks havoc on scheduling, and drives the administrative staff crazy.

In a recent presentation to a seven-clinic practice, I got the chance to dig a little on the reasons behind the soft-discharge. I gathered informal survey information on the question, “What are some reasons PTs soft-discharge?” Top reasons were provider confidence in determining end of care and patient self-efficacy in maintaining gains.

When tackling an issue like self-discharge, there is a tendency to focus exclusively on clinicians. Just as regions of the body are interdependent, so are the components of your practice. When tackling big issues like self-discharge, you can often find an outsized return on your investment by making administrative changes.

Reframe the Cost Discussion as a Value Discussion

There are two types of patients who struggle with cost. Those who simply cannot afford it, and those who choose not to allocate their resources to it because they don’t see the value. Ideally, once you have verified benefits, you’re having a candid discussion with the patient about their out-of-pocket expenses. In this world of high-deductibles, sometimes that discussion is a difficult one. Nothing, however, creates a more negative customer experience than a surprise bill for services.

Administrative staff can be empowered with a scripted outline to follow for this delicate discussion. What physical therapy is and its value should be addressed early when connecting with the patient. The way you present this will be specific to your clinic and culture. Physical therapy’s position as a conservative, cost-effective treatment should be emphasized in jargon-free language. Patients concerned about cost can be encouraged to have a discussion with their therapist as to how to best stretch their healthcare dollars.

Use your EMR or another aspect of your workflow to flag patients with these concerns to ensure they engage in the discussion with the clinician. If you offer payment plans or other assistance, the therapist can send the patient back to the administrative staff.

We know that patients value not only competence but also empathy and it has an impact on their satisfaction.1, 2 Connect with the patient by listening to all of their concerns, and you’ll start off on the right foot.

Provide Outcomes Status Reports to Inform Clinical Decision-Making

The experienced clinician is skilled at determining when a patient has maximized their physical gains. Newer clinicians may struggle in this area.

The two best tools for this scenario are 1) using shared decision-making to set specific goals and 2) monitoring your functional outcomes. If the practitioner and patient are on the same page as to what success means, then the point of discharge becomes crystal clear.

If you use tools to track patient-centered goals and functional outcomes, regular status reports can act as a clinical decision-making aid. Most clinics track outcomes, but not all do regular status reports and even when they do, many therapists don’t regularly incorporate the results into their clinical decision-making.

Cue your administrative staff to not only administer assessments regularly, but also to notate the results in the patient’s records in a way that is easily accessible to the therapist. Keep in mind that the leadership may need to do some education and expectation setting with clinicians before expending time and energy on the tracking process.

Collaborate on Guidelines for Discharge

Many therapists report feeling good about a patient’s progress, but are unsure about how they will fare without the support of the therapist. Often this presents itself as a gut feeling of the patient “not being ready.”

Helping a patient build self-efficacy is a much larger discussion. From an administrative perspective, the best impact a clinic can have is to agree on a set of guidelines for discharge. When a therapist wants to hold on to a patient despite the guidelines, it’s a cue to take a fresh look at the case.

Have an exploratory discussion with the front and back office both represented. Focus on creating clear guidelines as to when cases can be left open and when they will be closed. The therapists’ gut feelings should not be ignored and exceptions can always be made. It’s just important that the therapist delve into that gut feeling so they can articulate their reservations and tackle them directly with the patient.

Customer Satisfaction is a Team Sport

A clear value discussion, effective communication of outcomes data and guidelines for discharge are all straightforward ways your administrative staff can have an impact on the customer experience.

These, however, are not the only answers. Every practice is unique. Benchmark your self-discharge numbers and engage the collective wisdom of your entire team to find the strategies that will have the best return.


1Kim SS, Kaplowitz S, Johnston MV. The effects of physician empathy on patient satisfaction and compliance. Eval Health Prof. 2004;27(3):237–51.

2Steinhausen S, Ommen O, Thüm S, et al. Physician empathy and subjective evaluation of medical treatment outcome in trauma surgery patients. Patient Educ Couns. 2014;95(1):53–60. pmid:24411659

Heather Chavin

Heather Chavin, MA, is a member of the PPS Administrator’s Alliance and the business partnerships manager at CareConnections Outcomes Platform. She can be reached at heather@careconnections.com.

*The author has a professional affiliation with this subject.

Copyright © 2018, Private Practice Section of the American Physical Therapy Association. All Rights Reserved.

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