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Measuring to improve.

R Klein1, M Bobbitt

  • 1Market Strategies, Inc., USA.

Managed Care Quarterly
|March 3, 1996
PubMed
Summary
This summary is machine-generated.

Rush Prudential Health Plans enhanced member satisfaction by linking external customer needs to internal operations. A detailed diagnostic survey improved their managed care service quality.

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Area of Science:

  • Healthcare Management
  • Service Quality Improvement
  • Managed Care Organizations

Background:

  • Rush Prudential Health Plans, a Chicago-based managed care company, offers three distinct health plans: The Anchor Plan (HMO), The Affiliates Plan (HMO), and The Plus Plan (POS).
  • In 1994, the organization initiated an annual member satisfaction research study to align external customer requirements with internal operational processes.

Purpose of the Study:

  • To implement a comprehensive service quality improvement process across all marketed health plans.
  • To establish a robust link between member-defined requirements and the organization's internal operations.

Main Methods:

  • Conducted an annual member satisfaction research study across three health plans.
  • Employed a detailed diagnostic telephone survey to capture the entire clinical encounter experience.

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  • Utilized a three-stage research process: identifying external requirements, translating symptoms to root causes, and developing action plans.

    • Main Results:

    • Identified key areas for service quality enhancement through member feedback.
    • Translated member-reported issues into actionable operational improvements.
    • Developed a targeted service quality improvement plan based on diagnostic survey findings.

    Conclusions:

    • A detailed diagnostic telephone survey is more effective than traditional 'report card' surveys for measuring service quality in managed care.
    • Linking external customer requirements directly to internal operations is crucial for effective service quality improvement.
    • The implemented process provides a framework for continuous enhancement of member satisfaction in health plans.