Confronting Brutal Facts with Satisfaction Surveys

By: Joe Carlon, MBA, Tory McJunkin, MD, Paul Lynch, MD, & Ryan Tapscott, Ph.D.pmnlogo

An employee satisfaction survey can help uncover the brutal facts about your business. Such a survey assists in the finding of true motivations and passions of the people who make up the organization. By embarking on this bold journey of discovery, you can start to build a great company.

Dear Arizona Pain Specialists-

I understand that keeping my patients and staff happy is important, but I’m not sure how to gauge this. I am often running from the office to the surgery center to meetings, so I rarely have enough time to stop and ask, “How is the patient experience or does my staff enjoy working here?”. How can I be certain?

-Successful MD with a Busy Schedule


Now more than ever, patients have an abundance of choices in who provides their care. They can easily find ratings and opinions of you and your practice online. Do not despair! There are proactive steps you can take to engage your patients and your staff to address negative issues that exist. By doing so, you’ll create an environment of healing for patients, and a sense of purpose for your staff.

The answer to your question lies in the idea of confronting the brutal facts.  In his book Good to Great: Why Some Companies Make the Leap… and Others Don’t, Jim Collins explores this concept and argues it is a cornerstone of running a successful business. More specifically, it is a concept he refers to as “The Stockdale Paradox.” Collins defines the paradox as such: “You must maintain unwavering faith you can and will prevail in the end, regardless of the difficulties, and at the same time have the discipline to confront the most brutal facts of your current reality, whatever they might be.”

He argues that the idea of facing an ugly, unhappy reality plagues organizations and prevents transformation of businesses because leaders are simply too far removed from reality. In medical practices this can be exacerbated by two facts: 1) owners are kept extremely busy as practicing physicians and 2) owners are also strongly biased.  This can create an environment where staff does not want to speak up when an opportunity for progress is recognized, or worse, it can promote an environment where staff buries important feedback (either from staff or patients or both).

So how does the busy physician owner solicit such “brutal facts” from his or her patients or staff? How does a physician, who was never made to take an organizational behavior class in medical school, create a culture of openness?

Recognition. As a physician you were trained to save the day. When running a business, physicians must learn to accept you cannot do it all. You need someone you can trust to make decisions when busy doing procedures, providing care to patients in the office, or building relationships in the community. Identify someone who believes in your work; this trusted individual will help create an environment conducive both to quality patient care and to meaningful work for employees.

You must establish mechanisms to allow your practice to identify and confront these brutal facts. Two simple ways to achieve this are through patient and employee satisfaction surveys.

Patient Satisfaction:

When it comes to patient satisfaction, a practice must be prepared to be both proactive and reactive. Physician rating sites like and are constant, permanent reminders of how easy it is for a patient to leave your clinic and complain.  Such negativity can broadcast that the wait time was excruciatingly long, or that your bedside manner leaves something to be desired. These rating sites are only growing in popularity. The most you can hope to do is participate in the conversation and focus on listening to the message, even if the details aren’t exactly as you remember them. By actively engaging your patients’ feedback online, you will not only mitigate the likelihood of lashing out, but it will force you to “confront the brutal facts.” Physician responses should not be specific, lest you violate HIPAA regulation. Rather, take comments as an opportunity to state your philosophy on patient care, and acknowledge you are listening and taking steps to improve the patient experience.  Logistically, we recommend that you make it the responsibility of one person in the practice to monitor all online posts about your practice. This should take no more than 15-30 minutes per day, including a reporting of what was published about the practice online.

But why wait for patients to leave your office before you tell them how much you appreciate them and want their feedback?

Take proactive steps to engage your patients the moment they walk through your doors. We recommend two simple things: 1) a 5-7 item questionnaire on a 5 x 7 card and 2) having a medical assistant ask one additional question, “Is there anything else we can do to make your visit better?” Our patient feedback survey can be found here:

Assign the task of collecting this information to your office manager and have him/her put data into a spreadsheet. This will allow you to generate satisfaction scores for each item and help identify areas for improvement. Additionally, have the same manager take any specific feedback and share both the positive and negative results with the entire staff during your weekly meeting. Publicly recognize staff when they exhibit behaviors that help deliver a better experience for your patients. This kind of behavioral reinforcement will, with time, have a dramatic effect on the way your practice responds to patient feedback, and will let your patients know you care about their well-being.

Employee Satisfaction:

Why an Employee Satisfaction Survey?

Feelings of pride and self-worth are critical to our happiness as human beings. Because we spend at least one-third of our lives working, being unsatisfied with our job or career can have a major influence on our overall happiness.  In a medical practice, it can too often be the case that we focus on a successful outcome (the end result) rather than the process. When you perform a procedure or diagnose a patient with a complicated condition, it can be easy to forget that there were a lot of pieces to the puzzle that put that patient in the same time and place as you. When we instituted our, “Anonymous Feedback Form,” I received disconcerting feedback that one of our employees did not feel that her work made a difference. Because I believe in the mission statement and vision of our company, I thought, “If this employee knew how vital her role is to the success of our business, she would be proud to work here.”

This began a journey diving to the core of what our employees think, feel and believe about our organization, and their individual contribution to the greater whole. I begin to ask myself: “Is everyone on the same page?” “Does every person — from the physician to the person answering the phones, know and understand the vision of the company?” “Do employees understand their unique role in the whole picture?”

As the CEO, I would have to face the brutal facts in discovering the employees’ honest opinions. I knew that these answers would be essential in moving our organization to further success. I had a theory: if any employee who has contact with a patient is unhappy with his/her job, the patient will feel the effects. And thus, our patient satisfaction would decrease. Patient satisfaction is most likely directly related to employee satisfaction, so improving one would likely improve the other.

How we did it:

One of the things that make our organization unique is our physicians’ strong interest in research.  We have a PhD on our staff who spends most of his time doing business research and clinical trials for our company. He put together a survey asking pointed questions about employee satisfaction. This included: work environment, knowledge of the mission statement, whether or not the employee feels rewarded, and, most importantly, would the employee recommend our facility to their own mom or dad.

I sent an email to the organization expressing some of my goals which included: making our company a highly desired place to work, for each person to realize the purpose we serve in the community, and to understand the value we bring to patients.  The vision was clear: by completing the survey, it would help us improve. I emphasized the anonymity of the form (which I hoped would help ensure honest feedback) and provided the link to the survey, which can also be found here:

I committed to present the results to the company within two weeks.  Transparency is a key to maintaining a healthy approachability with the employees.

Our findings:

The results were in, and the feedback was indicative of a young organization experiencing a tremendous amount of growth in a short period of time. Some 54.1% of the employees viewed their employment as a job, while 45.9% viewed their employment as a career.  20.5% of respondents manage other employees, while 70% of employees agreed or strongly agreed our mission statement is clearly defined. This was good news to me. However, I want 100% of our employees to understand our mission. Also, some 87% of employees agreed or strongly agreed that their work makes a difference on a daily basis.

Further statistical analysis showed employees who see their work as a career vs. a job, are more likely to believe the organization is a good company to work for, feel that their work makes a difference, and believe in the organization’s mission. As well, it revealed the more the employee believes in the company’s mission statement, the more motivated he/she is to do the job, the more he/she believe hard work is rewarded, and the happier he/she is in the position.

What to do with the results:

Happy employees beget happy patients. A survey like this can be beneficial on multiple levels if the information is utilized by improving processes, communication and overall morale. However, realize it takes time to make significant changes. Even in a young organization like ours, people are creatures of habit and patience is needed to achieve true transformation.

My task was clear – I needed to make sure every employee understood the mission statement of our company. Together our executive staff and I toured each facility, presenting each employee with a card to carry with our mission and purpose statements. I gave a speech charging them to take pride in their work and reminding them that they are each an important part of the big picture. I was astounded that many of our employees had never heard our inspiring story. Each employee now carries the card behind their badge and understands what it means to work for our company.

It’s key to any organization’s success to have a realistic perspective of employee satisfaction. A leader must look at the product of such a survey with the intent to produce positive change and the perseverance to ensure results.  It takes courage to examine the brutal facts of an employee survey, but it is a necessary endeavor if you wish to maximize the potential success of your practice. Creating a happy, positive work environment for employees is an integral part to any successful practice, and sometimes in order to achieve this requires the leaders of the practice to be willing to look in the mirror and confront the brutal facts. It’s always easier to look through a window than it is to look in the mirror, but sometimes it is necessary to look in the mirror and realize that change, although difficult, is necessary to improve the culture and success of your business.  The results are well worth it!

Dr. McJunkin and Dr. Lynch founded Arizona Pain Specialists, a comprehensive pain management practice with three locations, seven pain physicians, ten midlevel providers, three chiropractors, on-site research, and behavioral therapy.  They teach nationally and are consultants for St. Jude Medical and Stryker Interventional Spine.   Through their partner company, Boost Medical, they provide practice management and consulting services to other pain doctors throughout the country. Joe Carlon is CEO of Boost Medical. For more information, visit and