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The Secrets of Satisfaction

Presented byDavid Rich and Sean Jordan

What satisfaction research can tell OPOs about building positive partnerships with doctors, nurses and administrators.

Who We Are

The Research & Planning Group is an independent marketing and opinion research firm that specializes in conducting a wide range of studies for the healthcare industry.

We have been conducting studies for OPOs since 1998, and over the last six years, we have conducted the hospital partners study we’ll be talking about today for 15 different OPOs across the country.

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The Hospital Partners Study

The purpose of the hospital partners study is to provide participating OPOs with an understanding of how they can improve the relationships they have with the physicians, nurses and administrators who work with them on organ and tissue cases.

The study is designed to provide both a quantitative and a qualitative assessment that can be compared:

• laterally (across the industry to other OPOs)• and longitudinally (comparing each repetition to the baseline and the trend to measure

each OPO’s individual performance over time).

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The Objectives We Address

The hospital partners study has four distinct areas of focus:

• Service Satisfaction• Communication (during and after cases)• Education• Overall Assessment (similar to a SWOT analysis)

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The Research Method We Employ

RPG conducts the hospital partners study using a in-depth telephone interviews.

They deliver a number of advantages over other methods, including:

• A pre-set response rate in the form of quotas• Human interviewers who can ensure responses are deep and meaningful• Conversational interviews that allow hospital partners to fully express themselves.• Flexibility for busy hospital partners who want to participate when it’s convenient for

them

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The Sampling Plan We Set

The population for the study is defined as all hospital partners who have worked with an OPO at least three times in the last two years on a donation case.

Each OPO provides RPG with a list of these partners and sets a quota for how many hospital partners will be included in the study.

To incent participation, physicians are offered an honorarium of between $150-200, depending upon the region, payable to themselves, the sponsoring OPO or a charity of their choice.

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The Results We Deliver

Our analysis is centered around the idea of splitting hospital partners into cohort groups and trying to understand how these groupings impact satisfaction and their perceptions of the sponsoring OPO.

We look at different “slices” of each sample to see where differences might exist, and because we have both qualitative and quantitative data, these “slices” aren’t restricted to traditional demographic breakouts.

For example, one slice we often compare is Highly Satisfied hospital partners versus those who indicate that the OPO Needs Improvement. Comparing the data collected from these two groups helps us to better understand what is really driving satisfaction.

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The Threshold for Excellence

OPOs who meet the following two criteria on a 10-point scaled question exceed what we refer to as the threshold for excellence:

A mean score of 9.00 or above80% or more partners expressing high satisfaction

When an OPO fails to meet the threshold for excellence for one or more variables, we prioritize which areas require the most attention and help the OPO to develop a strategy for improvement.

Once an OPO has reached this point, there is little that can be done to improve upon satisfaction for a variable and the strategy shifts to maintaining this high level of performance.

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Participating OPOs in 2012-2013

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Name of OPOShort Name

Level of Participation

Physicians Hospital Staff

Center for Organ Recovery and Education (Pittsburgh, PA)* CORE Yes YesCalifornia Transplant Donor Network (Oakland, CA) CTDN Yes YesDonor Alliance (Denver, CO) DA Yes Gift of Life (Ann Arbor, Michigan) GLMI Yes Iowa Donor Network (North Liberty, IA)* IDN Yes YesIndiana Organ Transplant Organization (Indianapolis, IN) IOPO YesLifeline of Ohio (Columbus, OH) LOH Yes YesLifeSource (St. Paul, MN) LSMN Yes Louisiana Organ Procurement Agency (Metairie, LA) LOPA Yes Mississippi Organ Recovery Agency (Flowood, MI) MORA Yes YesMid-America Transplant Services (St. Louis, MO) MTS Yes New York Organ Donor Network (New York, NY) NYODN Yes Unyts (Buffalo, NY) UNYTS Yes YesWashington Regional Transplant Community (Annandale, VA) WRTC Yes

*CORE and IDN participated in 2011 and shared their data for comparison.

The Variables We Measure

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Service Variables Communication Education Quality of Services Involvement Support Shown to Families Response Time Professionalism Respect Shown

Communication During Process

Communication Following Process

Follow-up Information Way Concerns Were Handled

Understanding of Donation Process Within Hospital

Effectiveness of Education

Overall Assessment Strengths of OPO Weaknesses of OPO Opportunities for OPO Perceived Problems for OPO Overall Satisfaction

The Variables We Measure (cont’d)

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Variable Mean Score %Highly Satisfied Above ThresholdQuality 8.78 69% 4

Involvement 8.63 70% 5Support Shown 8.97 76% 8Response Time 8.85 73% 6Professionalism 9.20 82% 10Respect Shown 9.39 90% 12

Service Variables (A Hospital Physicians)

The Variables We Measure (cont’d)

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Variable Mean Score %Highly Satisfied

Above Threshold

Communication During 8.39 63% 2Communication Following 8.11 55% 2Follow-up Information 7.96 58% 2Way Concerns Were Handled 7.57 56% 1

Communication Variables (A Hospital Physicians)

Education Variables (A Hospital Physicians)

Variable Mean Score %Highly Satisfied

Above Threshold

Understanding of the Donation Process Within Hospital

8.17 50% 2

Effectiveness of Education 7.70 41% 1

Overall Satisfaction

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Placement Mean Score %Highly SatisfiedHighest 9.25 75%Average 8.21 54%Lowest 7.32 26%

A Hospital Physicians

Placement Mean Score %Highly SatisfiedHighest 9.45 86%Average 8.88 76%Lowest 7.95 69%

Hospital Staff (Nurses and Administrators)

No OPOs exceeded the threshold for excellence for Overall Satisfaction for physicians; two exceeded it for hospital staff.

Overall Satisfaction (cont’d)

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A Hospital Physicians Hospital Staff (Nurses / Administrators) Gift of Life MI Iowa Donor Network Lifeline of Ohio Mid-America Transplant Services Mississippi Organ Recovery Agency Unyts

Indiana Organ Procurement Organization

Mississippi Organ Recovery Agency

Top Performers for Overall Satisfaction (in alphabetical order):

Satisfaction Champion



Collaboration Champion

Donation Follow-Up Champion


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Highly-satisfied hospital partners tend to feel very strongly-aligned with the life-saving mission of their OPO and also tend to be highly satisfied with most of the service satisfaction touch points this study measures.

They tend to be more positive about their partner OPOs in most areas, but tend to have many of the same concerns as their less satisfied counterparts when it comes to the need for consistent, collaborative communication and protocols and a greater amount of in-hospital education to help prepare them for the donation process.

Few physicians question the manner of front-line OPO representatives even if they might question the medical expertise, communication capability or service quality provided by these representatives.


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Hospital staff tend to express higher levels of satisfaction overall than physician partners, but this is not always the case. In some organizations, these groups are well-aligned, while in others, they express two very different types of experience in dealing with the OPO.

Whereas physicians tend to speak about organ donation case experience, hospital staff are more likely to be tissue-centric in their thinking.

Having both of these dimensions helps the research team to determine if concerns are systemic or due to consistency, also helps the research team to explain to each OPO how to feel about the data as a whole.

As one of the participating organizations said during a research presentation covering both types of hospital partners, “if we were only talking about hospital staff, we’d be celebrating right now; if we were only talking about physicians, we’d be embarrassed.”


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The most common suggestions for improving overall satisfaction include:

Improving communication both during and after the donation process, particularly with regards to follow-up.

Building stronger relationships with hospital partners and more collaborative communication during cases.

Focusing on improving the consistency and speed of response times for cases, or being better at communicating when to expect OPOs arriving onsite to respond to cases.

Being less aggressive about the donation process with the donor families or more sensitive to the families (and, by extension, the hospital partners themselves).

Helping hospital partners to do a better job of understanding donation criteria and protocols through good in-hospital education.

A Different Perspective

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A Different Perspective (cont’d)

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The Shape of the Data

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The data distributions suggest quite clearly that there is a need for OPOs to place their focus on improving communication and education if they want to improve overall satisfaction.

But it’s also important that we understand the relative importance of each variable. For that, we can turn to a process called multiple regression analysis.

Modeling Satisfaction

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Service Variables Model(A Hospital Physicians)Variable Importance

Involvement(Collaboration) High

Response Time High

Professionalism/Respect Medium

Support Shown to Families Low

Goodness of Fit 58%

Communication Variables Model(A Hospital Physicians)Variable Importance

Communication during donation

processHigh

Effectiveness of education

Low

Goodness of Fit 35%

Combined Model(A Hospital Physicians)Variable Importance

Involvement(Collaboration) High

Response Time High

Professionalism/Respect Medium

Communication during donation process Medium

Goodness of Fit 63%

The Secrets to Improving Overall Satisfaction

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We can see from the data that while every variable we measured is important, some have a greater impact on overall satisfaction than other.

The data suggest that an approach to improving overall satisfaction should follow a progression. Once a level is sufficiently mastered, the OPO can move on to the next level.

The research team strongly advises against attempting to address all four levels at once.

Each level requires an in-depth look at organizational protocols and behavior.

The Secrets to Improving Overall Satisfaction – Level 1

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Collaboration – Ensure that hospital partners are being included in all aspects of the donation process and not marginalized in any way.

Suggested actions• Huddling with hospital partners to help them understand their role in the process.• “Morning report” emails to affected hospital partners when a case is going on.• Sending Hospital Coordinators in pairs to split logistics and communication into two

tasks. Put the best communicators in charge of roping in hospital partners.

Move on when: Collaborative tools are in place, have been pilot tested effectively and appear to be meeting the needs of hospital partners.


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Consistency of Communication– Develop accountability indicators to ensure that communication protocols are being applied consistently during cases.

Suggested actions• Track use of tools like huddling to ensure consistency of use.• Measure both internally (OPO staff) and externally (follow-up spot check with hospital

partners).• Use measurements to improve training and development, not for punitive action.

Move on when: Accountability measures show that communication during the donation process is being handled consistently to specified standards.


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Feedback and Follow-Up– Develop stronger systems for providing feedback (immediately after cases) and follow-up information (long-term outcomes) to hospital partners.

Suggested actions• Automate systems as much as possible.• Create opportunities for information to be available on demand.• Conduct debriefing with hospital partners following cases or email a case report to

those involved.• When information is available on case outcome, however scant it is, share it.• When information cannot be provided on case outcome, have a system for ensuring

follow-up occurs once the information becomes available.

Move on when: Accountability measures show that communication during the donation process is being handled consistently to specified standards.


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Educational Offerings– Develop new opportunities and systems to provide education to hospital partners about donation criteria and the donation process.

Suggested actions• Think 21st century – replace old styles of education with new ones. Use on demand

education instead of traditional events.• Use both high-tech (apps, streaming videos, websites) and low-tech (info cards, one

sheets) methods to provide information.• Focus on the stories, not the statistics.• Work more closely with medical schools to ensure med school students learn about the

donation side of cases (rather than merely transplantation).

Education requires constant refinement. What works today may not work five years from today, and partners will not benefit if you are providing the same training over and over. Keep your methods fresh and you information current and you’ll keep your partners engaged.

Three More Thoughts

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We don’t need to drill down very far in the data to understand that collaborative communication is the key to improving satisfaction. The OPOs who are the best collaborative communicators also tend to be the best at providing services that meet with a high level of overall satisfaction.

You will be most effective if you reach for the low-hanging fruit first. The structure we have presented will help you to do that, but if you see an opportunity that’s within reach, don’t be afraid to pursue it.

Remember that satisfaction is a moving target. The purpose of opinion research is to help you move from a reactive position to a proactive position.

When you are reactive, you will be limited in your focus and your capabilities. But when you are proactive, you have time to plan, to develop, to refine and to experiment – all of which will provide you with huge advantages down the road.

Roadmap to Success

Presented byDavid Rich and Sean Jordan

What we have learned from hearing 15 OPOs respond to the hospital partners study

Things Have Changed Since We Started

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1. Physicians see you as a benefit now rather than a threat. They used to look at OPOs as stealing their patient and they felt a great loss and sense of failure as a doctor if they couldn’t save their patient.

2. Physicians are on your side. Even though they may not always act like it, they are on your side. That wasn’t always the case, but for the past six years, that is the case and the trend is growing stronger.

3. Physicians need to be included as key players in the entire donation process. We’ve had ICU doctors tell us that after a positive interaction with an OPO staff person, they are able to spot cases that they would have otherwise overlooked. Without the active involvement of the physician, there is no donation.

4. Physicians need to be communicated with constantly throughout the process of the donation. Regardless of how they are behaving, you can trust that the bottom line is that they want to know what is going on and how they helped to make the case a success.

First Turn

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Make communication with physicians a top priority throughout the process.

It begins with the Huddle at the beginning. Make the Huddle a mandatory, never to be forgotten part of the routine, regular protocol for each donation case.

Even if the physician doesn’t appear to be interested or doesn’t have the time, it is essential that your team make every effort to invite and let the Physician know who is involved, what is expected of the Physician, and that he/she will be constantly informed.

Set up the expectation for communication.

Second Turn

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Provide a daily report via email or in person to the physician on the status of the donor and email whenever there is a change in the donor’s condition.

Remember, deep down most every physician really cares and wants to be in the know. Even if they push you away, they still want to know.

Daily reports will be greatly appreciated by all your hospital partners. It shows that you care about THEM and that they have an important part in the process.

Third Turn

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After a case, follow up immediately with a full report on what occurred during the case.

Do everything you can to brief everyone involved, and especially every physician involved—be transparent about conveying the news, whether it is positive or not.

Fourth Turn

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After transplant surgery, follow up as soon as there is information about the outcome, regardless of the success of the outcome.

Give them as much information as you are allowed about the recipients and organs.

This information is of vital interest to all hospital partners and especially physicians.

Fifth Turn

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Conduct a full debriefing session analyzing and discussing what occurred from start to finish.

This should include the physician or be reported to the Physician if she or he cannot be present.

Include the physician in this process and she or he will feel a part of your team. It’s a great opportunity to bond and educate.

Sixth Turn

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Read and re-read carefully and do not dismiss what the Physicians have had to tell us in the research.

Embrace it, act on it, and benefit from it. The statistical information is valuable as a measurement, the heartfelt words of the physicians will give your staff the focus and direction to be successful.

Seventh Turn

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Executive OPO leadership must develop relationships with Attending Physicians, all active Physician partners, and key Residents.

Physicians need to know that someone in leadership knows them and is accessible to them.

Senior management does not need to micro-manage the donation process, just meet and let the physicians know that they have a connection with top brass at the OPO.

Physicians may never make a call, but knowing they can and knowing whom to call is important to them.

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OPO InsightsAlso, please be sure to check out our free blog, OPO Insights, which contains all sorts of information on the research we have conducted and read over the years!

Find out more at http://opo.researchplan.com!

http://opo.researchplan.com/

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