Staff involvement key to satisfaction gains

Frontline staff get input on selection, implementation

As a small (10,000 visits a year) department, the ED at Boone (IA) County Hospital is fortunate it doesn't have to deal with the long waiting times that face many other EDs. But that fact alone does not necessarily guarantee high patient satisfaction levels.

In fact, the department has done more than that; it has earned a Summit Award from the South Bend, IN-based patient satisfaction firm Press Ganey for maintaining levels of 95% or higher for three consecutive years. To be precise, its overall rating was in the 98th percentile for 2006 and the 99th for 2007. In addition, the likelihood of a patient recommending Boone County Hospital to a friend is 97%, and the overall ranking for physicians is at 99%.

One of the keys to those high scores, agree staff and management, is the proactive role that the ED staff takes in continuing a culture that leads to superior patient satisfaction. "The Press Ganey results and comments are regularly provided to the staff," notes Howard Eikenberry, assistant administrator of quality and patient safety, who served as the ED administrator until early this year. "They react to patient complaints not as a personal attack, but as a learning experience, and we examine how we can work on those problems in the future."

Success brought pressure

In fact, as the ED started receiving these high scores, it brought pressure to perform, adds ED staff nurse Mark Addy, RN. "It's almost expected, but it's definitely self-imposed," he says. "The ED staff feel a lot of pressure to keep up."

The staff knew it was doing a good job, he says, "but until we started winning the awards, we never realized how high it was." For himself, Addy says he always tries to make sure patients are satisfied before they leave; if they aren't, he addresses the problem then and there. "For example, if they tell me the doctor did not explain things well enough, I will bring them back in, or they could have had a test and maybe just need a further explanation on why it was done."

As the patient is getting to leave, he adds, he will specifically ask them if everything was done to their satisfaction and if there is anything else he can do for them. "Patients have two options to voice complaints, before they leave or on the Press Ganey survey," he notes. He'd rather have them voice them before they leave. "Once a complaint is on the survey, there's nothing you can do to prevent it," Addy says.

However, when the complaints do make it to the survey, the staff swing into action. It's a frontline approach, Eikenberry says. "We look at all the comments and complaints and decide where to focus," he says. It's up to the staff to make decisions about what to work on in terms of patient care, safety, and satisfaction, he says. When the staff saw a number of patient complaints about test result delays, "one specific area we targeted was keeping patients informed of those delays," Eikenberry says.

Addy says, "We found as long as people understood why they were waiting they became more content. We have a small waiting room, so it's easy enough to pop your head out and ask if everything is OK." In fact, he notes, when patients are placed in the patient care area, "We encourage them to come back and let us know if something in their condition changes or if they have questions."

Source

For more information on achieving and maintaining high patient satisfaction ratings, contact:

  • Mark Addy, RN, ED Staff Nurse; Howard Eikenberry, Assistant Administrator of Quality and Patient Safety, Boone (IA) County Hospital. Phone: (515) 432-3140.

ED director responds to patient complaints

Although the ED staff at Boone County Hospital in Boone, IA, takes a proactive approach to patient satisfaction, a certain number of unsatisfied customers is probably inevitable. When complaints are made, however, the director of the ED usually becomes personally involved.

"Each patient complaint is taken very seriously and addressed individually by the ED director," says Howard Eikenberry, assistant administrator of quality and patient safety, who served as the ED administrator until early this year. "We contact these patients, give them the opportunity to express their frustration, and apologize for their negative experience," he says.

This follow-up is done by phone or via letter, says Eikenberry. If the ED director is not able to personally make the response, then Eikenberry will.

The Boone County ED, which has earned a Summit Award from the South Bend, IN-based patient satisfaction firm Press Ganey for maintaining levels of 95% or higher for three consecutive years, has implemented several other initiatives to keep those scores high, including:

  • allowing as many family members as possible in the room with the patient;
  • arranging follow-up care for patients who don't have a primary physician, and ensuring that treatment plans are carried out;
  • rewarding staff members for their hard work and dedication through complimentary meals, gift certificates, and small tokens of appreciation.

Each department manager decides who to reward, Eikenberry explains. "Many times when an employee does something positive, it will be brought to their attention, and they may give the reward right then and there," he says. The small token could be a dessert coupon or a $5 gas card. For more formal recognitions, such as the Summit Award, there is a recognition ceremony.

Each department has its own budget for these intermittent rewards. "We probably spent about $1,500 last year in the ED," says Eikenberry.