By the start of 2026, a psychiatric patient survey – called PIX – created by Yale-New Haven Health and Yale School of Medicine will be required at all 1600 psychiatric hospitals receiving funds from the Centers for Medicare and Medicaid Services.
“Before PIX, providers did not have an evidence-based instrument to survey our psychiatric patients and collect practice-changing data that will fundamentally improve how we deliver care,” said David Klemanski, PsyD, MPH, co-director, Division of Quality and Innovation at YNHPH and assistant professor at Yale School of Medicine. “People thought [psychiatric patients] couldn’t reliably provide feedback.”
It was thought that due to the psychological conditions psychiatric patients are experiencing they could not give any useful or honest information about their hospital stays or the effectiveness of their treatments, Klemanski said.
After every medical hospitalization – whether it is for pneumonia, heart failure, an elective surgery or giving birth – patients complete a survey. Surveys typically ask patients to give feedback on their experience in the hospital by rating how friendly staff were, how clean the facilities were, how effective their care was and so on.
As a patient, it’s your one chance to express your concerns with the hospital without fear of retaliation. It’s also the one way the hospital gathers data on patient satisfaction.
In 2021, Yale New Haven Health piloted a feedback survey to all psychiatric patients. For the first time, the 3,000 psychiatric patients hospitalized annually across Yale’s five units had the ability to rate, review and comment on their experience.
“Before the survey this was a total missed opportunity,” Klemanski said. We had no way to know if patients thought they were being treated with respect or if treatment was even effective.
“Our team developed this comprehensive survey because we wanted to improve the way we delivered care,” Klemanski said. “We want to make [their stay] as pleasant as possible.”
Dr. Ebony Dix, an Assistant Professor at Yale School of Medicine and Director of the Geriatric Psychiatry unit at the St. Raphael’s campus in downtown New Haven was part of the team developing survey questions.
As a provider seeing patients daily, Dix said the most important questions to ask are “related to the treatment team relationships and how patients felt that their care providers worked with them. The therapeutic alliance with the patient is one of the most important things because from there everything happens.”
At Yale New Haven Health it is now routine for psychiatric patients to receive an ipad with the 25 question survey 24 hours ahead of discharge, giving them the chance to anonymously communicate with the hospital.
Delivering the survey while patients are still within the hospital makes a world of difference for response rate. The response rate for the voluntary survey is currently 60 percent compared with 10 percent when the survey was originally sent two weeks after hospitalization.
Not all units are created equal, however.
“I work with older adults, so we might have individuals who can’t complete it by themselves,” Dix said.
Dix suggested that perhaps an alternative method of completion for the geriatric population might be worth looking at down the line to get the most information possible.
“It’s only useful if patients can do it,” she said.
“The biggest message I try to tell patients is that this is giving them the voice they have not had,” Klemanski said.
The survey has already helped to make changes within the units. For example, there are efforts being made to provide more fresh air and natural light to patients that on average have the longest stays in the hospital – between 7 and 10 days.
So far survey results have not surprised Klemanski, Dix or the rest of the team. However, he said they plan to continue to monitor the data and read every written response in order to make changes in the future.
“When there wasn’t a way to collect information or ask questions it may make patients feel that we don’t care about their opinions,” Dix said. “I want patients to complete the survey as honestly and candidly as possible. If we keep seeing the same themes then we can implement a change.”
It was a massive gap not just for Yale New Haven, but for the 1600 hospitals nationwide that provide psychiatric care and receive federal funds.
The survey has been deemed so beneficial by the Centers for Medicaid and Medicare, that as of 2026 all 1600 hospitals providing psychiatric services nationwide and receiving federal funds will be required to send Yale’s survey to every hospitalized psychiatric patient. According to Klemanski, there is no additional funding to implement this new survey, but that the costs for Yale at least have been low.
“Whenever the government mandates something people get a little ‘eh how do we do this?’ but most hospitals are excited about it,” Klemanski said. “Only a few are worried about costs.”
Klemanski and his team did not stop with the patient survey. In 2022, they developed a survey for families of adolescents and geriatric patients.
“We are asking what it was like to have a loved one in the hospital,” Klemanski said.
In the psychiatric world families and outpatient providers play a critical role in treatment and the hospital wants to connect with them. Especially when it comes to intakes and discharge planning, connection with the outpatient team is essential for patient success and avoiding future hospitalizations.
Therefore, this year the focus is the outpatient treatment team.
“It’s the next groundbreaking thing we are doing…trying to include the outpatient treatment team instead of the historical model where hospitals operate independently,” Klemanski said.