Page 139 - The Handbook for Quality Management a Complete Guide to Operational Excellence

126 I n t e g r a t e d P l a n n i n g U n d e r s t a n d i n g C u s t o m e r E x p e c t a t i o n s a n d N e e d s 127

survey items for each of the dimensions determined by the critical inci-
dent study. The teams were given brief instruction by the author in the
characteristics of good survey items. Teams were required to develop
items that, in the opinion of the core team, met five criteria: (1) relevance
to the dimension being measured, (2) concise, (3) unambiguous, (4) one
thought per item, and (5) no double negatives. Teams were also shown the
specific patient comments that were used as the basis for the categories and
informed that these comments could be used as the basis for developing
survey items.
Writing items for the questionnaire can be difficult. The process of
developing the survey items involved an average of three meetings per
dimension, with each meeting lasting approximately 2 hours. Ad hoc
teams ranged in size from 4 to 11 members. The process was often quite
tedious, with considerable debate over the precise wording of each item.
The core team discussed the scale to be used with each ad hoc team. The
core team’s recommended response format was a five point Likert-type
scale. The consensus was to use a five point agree-disagree continuum as the
response format. Item wording was done in such a way that agreement rep-
resented better performance from the hospital’s perspective.
In addition to the response items, it was felt that patients should have
an opportunity to respond to open-ended questions. Thus, the survey also
included general questions that invited patients to comment in their own
words. The benefits of having such questions is well known. In addition,
it was felt that these questions might generate additional critical incidents
that would be useful in expanding the scope of the survey.
The resulting survey instrument contained 50 items and three open-
ended questions.

Survey Administration and Pilot Study The survey was to be tested on a
small sample. It was decided to use the total design method (TDM) to
administer the survey (Dillman, 1983). Although the total design
method is exacting and tedious, Dillman indicated that its use would
ensure a high rate of response. Survey administration would be han-
dled by the Nursing Department.
TDM involves rather onerous administrative processing. Each survey
form is accompanied by a cover letter, which must be hand-signed in blue
ink. Follow up mailings are done one, three, and seven weeks after the
initial mailing. The three- and seven-week follow-ups are accompanied
by another survey and another cover letter. No “bulk processing” is
allowed, such as the use of computer-generated letters or mailing labels.
Dillman’s research emphasizes the importance of viewing the TDM as a
completely integrated approach (Dillman, 1983, p. 361).
Because the hospital in the study is small, the author was interested
in obtaining maximum response rates. In addition to following the TDM
guidelines, he recommended that a $1 incentive be included with each

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