Despite longer wait times, satisfaction still improves
Communication is critical for patients to be happy
In findings that at first glance may seem puzzling, the 2007 ED Pulse Report patient satisfaction survey by Press Ganey Associates indicated that while ED wait times continue to increase, so does patient satisfaction.
The survey shows that the average time a patient spent in the ED in 2006 was four hours, compared with 3.7 hours the previous year. However, overall satisfaction peaked at 83.1% during that same year, compared with a high of 82.9% in 2005. Even more striking, it was only 81.4% in 2003 and has steadily risen since then.
The answer lies in communication, says Matt Mulherin, a spokesman for Press Ganey. "EDs can compensate for wait times going up by providing better service quality in terms of communication," he says. He offers the analogy of an airline that has discontinued meal service. "That may tend to make customers less satisfied, but if at the same time you roll out a new rewards program or offer better communication from attendants, there will not be a drop in overall satisfaction," he says.
In the same way, EDs can compensate for long wait times by improving communications, Mulherin says. The patient typically is a well-informed health care consumer, he says. "They read about rising numbers of uninsured [in EDs], understaffing, and overcrowding," Mulerhin says. "They will have a higher tolerance as long as you are respectful of their time and keep them informed."
Improved communications may not be the only reason for increasingly high patient satisfaction scores, argues Michael Carius, MD, chairman of the ED at Norwalk (CT) Hospital. There also is an increased expectation regarding patient satisfaction on the part of hospital senior management, he says. "This has been impressed on those of us who are middle managers — ED chairs and nurse managers — or else perhaps we might enjoy employment elsewhere," Carius says. "There is also a general sense among all caregivers that patient satisfaction is important by itself, although this has a long way to go."
ED managers agree that beyond one hour, or possibly two, the effect they can have on patient satisfaction drastically decreases, and that is borne out by the survey results that show satisfaction dropped as wait times increased.
If you see the patient after an hour, the key is to apologize for the wait, advises Gregory Henry, MD, FACEP, risk management consultant with Emergency Physicians Medical Group in Ann Arbor, MI. "You never, ever get into a fight with a patient over the wait time," he says.
At Wake Forest University Health Sciences in Winston-Salem, NC, "when our waiting times go beyond one hour, our faculty, residents, and nursing staff know to greet the patient with a simple apology for their wait, and then begin addressing their care needs," says Bret A. Nicks, MD, assistant professor and assistant medical director in the department of emergency medicine. "In addition, when our wait times are several hours, we routinely have someone make an announcement in the waiting area explaining that it is very busy in the ED and we appreciate their patience and will take care of their medical needs as quickly as possible."
The critical time appears to be two hours or less, Carius says. "Less than two hours and you have an opportunity to intervene," he says. During that time, Carius adds, his staff use handouts to explain the triage process and occasional long waits.
Norwalk has signs in the patient rooms explaining the long waits. They also have volunteers that carry the messages to the patients and families about the waiting times. "We apologize endlessly for delays that are beyond our control," Carius says. "But, in the end, if the wait is more than two hours, it is a losing battle."
How the patient perceives the wait also is a key factor, notes Henry. "If I say I think a blood test will be back in 40 minutes even though I know it's almost always 20 minutes, I'll be a hero if it comes back in 35 minutes," he explains. No patients complain if you say, "'We're done now, you can go early,'" Henry points out.
It's important for the ED physician to give all patients "anticipatory guidance," Henry says. "We lay out for them a realistic time frame and, when pushed, always overestimate the time," he says. "After all, you get to set the expectations."
Finally, says Henry, it's at least as important to concern yourself with family satisfaction as it is to focus on patient satisfaction. "More [complaint] letters are written to administration by, or prompted by, the family than the patient," he says.