Using "good and bad surprises" to guide improvement efforts: insights from a memory assessment clinic

Continuous quality improvement requires an understanding of customer expectations, yet often little is known about what patients and their families expect from specialized diagnostic services. A project was conducted in 2000 at two memory assessment clinics affiliated with the University of Kentucky's Alzheimer's Disease Research Center (ADRC) to use open-ended "good and bad surprises" to learn what families expect from a memory assessment clinic and to demonstrate how "surprises" might be used to identify customer expectations.

A satisfaction survey was sent to persons who had had a role in the decision to seek a memory assessment for a family member within the previous 4 years. The responses to an open-ended question, which formed the basis for this study, were coded for process and outcome expectations.

Of the 528 (71.7% response rate) surveys returned, 390 (73.8%) included a response to the open-ended question designed to elicit good and bad surprises. Approximately one-half of the respondents had accompanied a parent and one-half of the respondents had accompanied a spouse to the memory assessment clinics. The diagnosis received and the provision of information caused the most surprises. Provision of information contributed to both good and bad surprises. Emotional support, provider attitudes, treatment availability, and the quality of the exam were additional causes of good surprises. The diagnosis received and family reactions caused bad surprises. The majority of the good surprises related to process expectations, and the majority of the bad surprises related to outcome expectations.

By eliciting information about good and bad surprises, organizations can identify their customers' expectations and identify areas for improvements. Assessment clinics should undertake improvement efforts designed to prepare customers for the diagnosis received and provide their customers with tailored information.