title: Factors affecting the use of patient survey data for quality improvement in the Veterans Health Administration.
abstract: BACKGROUND
  Little is known about how to use patient feedback to improve experiences of health care. The Veterans Health Administration (VA) conducts regular patient surveys that have indicated improved care experiences over the past decade. The goal of this study was to assess factors that were barriers to, or promoters of, efforts to improve care experiences in VA facilities.
  
  
  METHODS
  We conducted case studies at two VA facilities, one with stable high scores on inpatient reports of emotional support between 2002 and 2006, and one with stable low scores over the same period. A semi-structured interview was used to gather information from staff who worked with patient survey data at the study facilities. Data were analyzed using a previously developed qualitative framework describing organizational, professional and data-related barriers and promoters to data use.
  
  
  RESULTS
  Respondents reported more promoters than barriers to using survey data, and particularly support for improvement efforts. Themes included developing patient-centered cultures, quality improvement structures such as regular data review, and training staff in patient-centered behaviors. The influence of incentives, the role of nursing leadership, and triangulating survey data with other data on patients' views also emerged as important. It was easier to collect data on current organization and practice than those in the past and this made it difficult to deduce which factors might influence differing facility performance.
  
  
  CONCLUSIONS
  Interviews with VA staff provided promising examples of how systematic processes for using survey data can be implemented as part of wider quality improvement efforts. However, prospective studies are needed to identify the most effective strategies for using patient feedback to improve specific aspects of patient-centered care.
authors.affiliation: Thames Cancer Registry, King's College London, 42 Weston Street, London SE1 3QD, UK. Elizabeth.Davies@kcl.ac.uk
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Davies
authors.forename: Mark M
authors.initials: MM
authors.lastname: Meterko
authors.forename: Martin P
authors.initials: MP
authors.lastname: Charns
authors.forename: Marjorie E Nealon
authors.initials: ME
authors.lastname: Seibert
authors.forename: Paul D
authors.initials: PD
authors.lastname: Cleary
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence; D019538:Health Care Surveys / Q000706:statistics & numerical data*; D006787:Hospitals, Veterans / Q000145:classification / Q000592:standards*; D006801:Humans; D007407:Interviews as Topic; D008505:Medical Staff, Hospital / Q000523:psychology; D019982:Organizational Case Studies; D015279:Organizational Culture; D017060:Patient Satisfaction; D018802:Patient-Centered Care; D058996:Quality Improvement / Q000592:standards*; D012944:Social Support; D013531:Surgicenters / Q000592:standards; D011795:Surveys and Questionnaires; D013597:Systems Analysis; D014481:United States; D014493:United States Department of Veterans Affairs / Q000592:standards*