{"id":{"repo_id":"utswmed","oai_identifier":"oai:utswmed-ir.tdl.org:2152.5/10844"},"canonical_url":"https://search.dev.ndltd.org/etd/utswmed/oai:utswmed-ir.tdl.org:2152.5/10844","repository":{"repo_id":"utswmed","name":"University of Texas Southwestern Medical Center","base_url":"https://utswmed-ir.tdl.org/server/oai/request"},"display":{"title":"Bump Up to Top Box: Predicting Intermediate Press Ganey Scores","abstract":"The general metadata -- e.g., title, author, abstract, subject headings, etc. -- is publicly available, but access to the submitted files is restricted to UT Southwestern campus access and/or authorized UT Southwestern users.","abstract_html":"The general metadata -- e.g., title, author, abstract, subject headings, etc. -- is publicly available, but access to the submitted files is restricted to UT Southwestern campus access and/or authorized UT Southwestern users.","abstract_has_math":false,"creators":["Diercks, Lauren Ann"],"institution":null,"degree_name":null,"degree_level":null,"degree_discipline":null,"degree_department":null,"school":null,"contributors":["Reed, W. Gary","McDonald, Samuel","Turer, Robert W."],"advisors":[],"committee_chairs":[],"committee_members":[],"year":2026,"date_issued":"2026-06-15T19:57:12Z","date_published":"2026-06-15T19:57:12Z","updated_at":"2026-07-24T05:52:15Z","subjects":["Consultants","Emergency Service, Hospital","Patient Satisfaction","Quality Improvement"],"languages":["en"],"rights":[],"rights_urls":[],"identifier_entries":[{"key":"dc:identifier","label":"Identifier","values":["1596185262"],"render_values":[{"text":"1596185262","href":null,"code":true}]}]},"links":{"outbound_url":"https://hdl.handle.net/2152.5/10844","outbound_label":"Handle","outbound_source":"dc:identifier"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:contributor","label":"Contributor","values":["Reed, W. Gary","McDonald, Samuel","Turer, Robert W."]},{"key":"dc:creator","label":"Author","values":["Diercks, Lauren Ann"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:date","label":"Dc Date","values":["2026-06-15T19:57:12Z","2024-05","May 2024"]},{"key":"dc:type","label":"Dc Type","values":["Thesis","text"]}]},{"id":"subjects_keywords","label":"Subjects and Keywords","entries":[{"key":"dc:subject","label":"Dc Subject","values":["Consultants","Emergency Service, Hospital","Patient Satisfaction","Quality Improvement"]}]},{"id":"language_rights","label":"Language and Rights","entries":[{"key":"dc:language","label":"Dc Language","values":["en"]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier","label":"Identifier","values":["https://hdl.handle.net/2152.5/10844","1596185262"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description","label":"Description","values":["The general metadata -- e.g., title, author, abstract, subject headings, etc. -- is publicly available, but access to the submitted files is restricted to UT Southwestern campus access and/or authorized UT Southwestern users.","BACKGROUND: Patient satisfaction scores are used in hospital rankings, contracts, and incentive plans and are our best indicator of the patient experience. Press Ganey (PG) is a commonly used patient satisfaction survey that uses a five-point Likert type scale to measure satisfaction with several metrics. Previously, models have been used to predict PG scores to increase overall proportion of people who select the highest rating for a given category, called the top box. The distribution of most PG scores largely favors the top box category and tappers off towards the lower scores. Therefore, there is reason to believe that patients who give intermediate scores are both a large enough sample for an intervention and have the potential to make an impact on the top box score. This project aims to identify which patients are likely to give an intermediate score and how to target those patients to increase the overall binary top box score. Through a logistic regression model, we will be able to identify key predictors of patients that are likely to give intermediate scores. LOCAL PROBLEM: The Clements University Hospital Emergency Department (CUH ED) overall ED PG top box score was 82% in second quarter of 2022 (Q2 2022) which can be improved to increase ED ranking. The goal for the overall ED PG score is 85% per hospital administration. METHODS: This quality improvement initiative was performed at an urban, academic medical center enrolling patients discharged from the ED. We used PG scores for overall ED experience from 2018-2022 to derive an ordinal model that predicted scores that were categorized into three clinical groups: low score (PG Likert scale score of either 1 or 2), intermediate score (3 or 4), and top box score (5). We reserved 8% of the test data for a validation cohort. Patients identified as most likely to provide an intermediate score for "overall ED experience" were the target population for the QI intervention. INTERVENTIONS: To sustain a 2% increase in top box scores for consecutive PG quarterly cycles we will prioritize the completion of NOBL leadership rounding on the target population described by our model as likely to provide an intermediate satisfaction score. This will improve the effectiveness of a current process and its effect on the overall emergency department PG score. NOBL rounding is an existing ED practice for nurse managers. NOBL is a scripted nurse leader rounding tool that evaluates patient satisfaction of waiting and expectations, staff listening, call light and bathroom responsiveness, and the nurse's evaluation of the ED room environment. This intervention seeks to improve patient selection during NOBL rounds to optimize its effect at increasing PG scores. The outcome measure of the intervention is overall ED top box score, with balancing measures of number of patients approved by the model and nurse leadership reported efficiency of the model. The process measure of ordinal scores was also calculated to show movement within the score segments. RESULTS: The model predicted intermediate scores using waiting room and room to provider time with an accuracy of 61%. The overall ED PG score was moderately correlated to the NOBL questions about listening (.43) and waiting (.53). We will also evaluate trends of the top box, intermediate, and low PG scores of patients during PDSA cycles. CONCLUSION: The next step for this project is to review the top box scores for the rest of the PG cycles in 2024. Ideally, we will show a sustained improvement in top box score overall. We will also report movement in intermediate and low scores and time used for NOBL rounding."]},{"key":"dc:format","label":"Dc Format","values":["application/pdf"]},{"key":"dc:title","label":"Title","values":["Bump Up to Top Box: Predicting Intermediate Press Ganey Scores"]}]}],"canonical_facts":{"dc:contributor":["Reed, W. Gary","McDonald, Samuel","Turer, Robert W."],"dc:creator":["Diercks, Lauren Ann"],"dc:date":["2026-06-15T19:57:12Z","2024-05","May 2024"],"dc:description":["The general metadata -- e.g., title, author, abstract, subject headings, etc. -- is publicly available, but access to the submitted files is restricted to UT Southwestern campus access and/or authorized UT Southwestern users.","BACKGROUND: Patient satisfaction scores are used in hospital rankings, contracts, and incentive plans and are our best indicator of the patient experience. Press Ganey (PG) is a commonly used patient satisfaction survey that uses a five-point Likert type scale to measure satisfaction with several metrics. Previously, models have been used to predict PG scores to increase overall proportion of people who select the highest rating for a given category, called the top box. The distribution of most PG scores largely favors the top box category and tappers off towards the lower scores. Therefore, there is reason to believe that patients who give intermediate scores are both a large enough sample for an intervention and have the potential to make an impact on the top box score. This project aims to identify which patients are likely to give an intermediate score and how to target those patients to increase the overall binary top box score. Through a logistic regression model, we will be able to identify key predictors of patients that are likely to give intermediate scores. LOCAL PROBLEM: The Clements University Hospital Emergency Department (CUH ED) overall ED PG top box score was 82% in second quarter of 2022 (Q2 2022) which can be improved to increase ED ranking. The goal for the overall ED PG score is 85% per hospital administration. METHODS: This quality improvement initiative was performed at an urban, academic medical center enrolling patients discharged from the ED. We used PG scores for overall ED experience from 2018-2022 to derive an ordinal model that predicted scores that were categorized into three clinical groups: low score (PG Likert scale score of either 1 or 2), intermediate score (3 or 4), and top box score (5). We reserved 8% of the test data for a validation cohort. Patients identified as most likely to provide an intermediate score for "overall ED experience" were the target population for the QI intervention. INTERVENTIONS: To sustain a 2% increase in top box scores for consecutive PG quarterly cycles we will prioritize the completion of NOBL leadership rounding on the target population described by our model as likely to provide an intermediate satisfaction score. This will improve the effectiveness of a current process and its effect on the overall emergency department PG score. NOBL rounding is an existing ED practice for nurse managers. NOBL is a scripted nurse leader rounding tool that evaluates patient satisfaction of waiting and expectations, staff listening, call light and bathroom responsiveness, and the nurse's evaluation of the ED room environment. This intervention seeks to improve patient selection during NOBL rounds to optimize its effect at increasing PG scores. The outcome measure of the intervention is overall ED top box score, with balancing measures of number of patients approved by the model and nurse leadership reported efficiency of the model. The process measure of ordinal scores was also calculated to show movement within the score segments. RESULTS: The model predicted intermediate scores using waiting room and room to provider time with an accuracy of 61%. The overall ED PG score was moderately correlated to the NOBL questions about listening (.43) and waiting (.53). We will also evaluate trends of the top box, intermediate, and low PG scores of patients during PDSA cycles. CONCLUSION: The next step for this project is to review the top box scores for the rest of the PG cycles in 2024. Ideally, we will show a sustained improvement in top box score overall. We will also report movement in intermediate and low scores and time used for NOBL rounding."],"dc:format":["application/pdf"],"dc:identifier":["https://hdl.handle.net/2152.5/10844","1596185262"],"dc:language":["en"],"dc:subject":["Consultants","Emergency Service, Hospital","Patient Satisfaction","Quality Improvement"],"dc:title":["Bump Up to Top Box: Predicting Intermediate Press Ganey Scores"],"dc:type":["Thesis","text"]},"updated_at":"2026-07-24T05:52:15Z"}