Table 2 Summary of promoters and barriers to the use of survey data found in case studies of two VA facilities

Organizational promoters

Nursing leaders had developed a patient-centered culture following external inspection in the middle of study period that was critical of care. This led to new quality improvement structures meeting JCAHO accreditation.

In the last few years the Director has set up a Patient Satisfaction Committee and Customer Service Council to consider survey and other patient feedback to decide on improvement approaches and assess progress.

Facility scores are regularly compared to others.

Clinical and nursing leaders had identified that patient-centered care needed to improve after comparing scores to other facilities at the beginning of the study period. This was in the context of developing many data-driven improvements in clinical care and raising the profile of quality improvement.

Performance Improvement Facilitator reports comparative facility survey results to each management group. Clinicians and nurses present results to their teams and discuss them. Magnet Status (for nursing practice) has been obtained and reaccreditation requires review of all survey data.

Organizational barriers

Too few quality improvement staff to exploit the data fully.

Lack of interest among some senior staff.

Large facility size and rapid turnover of patients and junior staff.

Professional promoters

Clinicians are beginning to ask for provider specific feedback.

All facility staff have recently received interpersonal skills training.

Survey results emailed to staff and presented around the facility.

Clinicians are involved in interpreting results, developing improvement plans and new surveys.

Nursing leadership is focusing on bedside patient care tasks and encouraging leadership skills in nurses.

Professional barriers

Clinicians and other staff can be skeptical about results.

Some staff do not have the skills for patient-centered care.

Nurses are less familiar with survey results.

Some staff need to be reminded of patient-centered behaviors.

Data-related promoters

Quality improvement staff disseminate the OPQ survey data and teach other staff about it.

There is an additional short local survey of all discharged patients.

OPQ survey data is triangulated with qualitative feedback from all contacts with the patient advocacy service.

Administrative staff disseminate and present the OPQ survey data. Senior nursing staff teach others about them.

There is an additional short local survey of all discharged patients.

OPQ survey data is triangulated with feedback with "active conversations" with patients and "speak to the director slips".

Data-related barriers

OPQ quarterly data not seen as a large enough sample or representative enough.