Satisfaction turnaround requires persistence

ED staff ride 'roller coaster' before earning award

The ED staff at Saint Francis Medical Center in Cape Girardeau, MO, is justifiably proud of the Compass Award it recently received from Press Ganey Associates of South Bend, IN, for raising their patient satisfaction scores from the 36th percentile to the 96th. But they'll also be the first to tell you it wasn't easy.

The ED started using Press Ganey in late 1998 for external benchmarks, reports Marilyn Curtis, MSA, vice president of professional services. "As we started that process, our scores really bounced around," she says. "They could be as high as the 80s or as low as the 50s."

In fact, even some dramatic initial successes proved to be short-lived. Thanks to improved "scripting," which required staff to tell the patient their names, explain what they were doing, and ask upon leaving if the patient needed anything else, scores initially went straight up. "In February 2002, we hit the 97th percentile," notes Curtis. "We got so excited that we took out a full-page ad in the local paper and gave each employee a gift certificate."

However, she adds, they were soon to realize they did not have consistent focus. In fact, says Marcia Abernathy, RN, director of emergency services, "In August 2003, our score was in the 36th percentile."

Turning it around

To turn the scores around again and to ensure consistency, a service excellence committee was established that included ED medical staff, floor nurses, and registration and medical records staff. Their goals included the following:

  • Determine scripting effectiveness.
  • Determine customer perceptions of the staff.
  • Determine customer understanding of emergency/trauma services.
  • Obtain input on improved changes.
  • Determine patient perceptions at all levels of the emergency process.
  • Determine initial and final customer impressions.

The scripting was reintroduced to help ensure consistency, Curtis says. The team started tracking weekly satisfaction scores, posted them in the department, and compared each quarter's scores with those of the previous quarter. In November 2003, the ED went to 10-hour shifts for physicians. They had been 12 hours. "We had a couple of physicians who just did not seem to be able to meet customer service expectations, so we also made a couple of changeovers" in staff, she notes.

Gainsharing program included score

Another key motivator was the hospital's gainsharing program, which actually went into effect in late 2000 but later was modified for the ED. Your department had to exceed your budgeted gross margin, she says. "To even be eligible, your Press Ganey [score] had to hit the 70th percentile, and not until you hit the 90th would you be eligible for all the gainshare dollars," Curtis explains. This past year, staff members who did not take any sick days (another component of the formula) could have earned $5,500.

In April 2004, several key leaders, including the staff RN, the hospital executive team, and the ED's assistant manager, attended an ED service excellence workshop by Quint Studer of the Gulf Breeze, FL-based Studer Group, an executive coaching firm. "We really ended up using three components to help us go forward: the ideas from the workshop, our own internal service excellence committee, as well as several focus groups we held with employees of the medical center who had been patients or whose family members had been patients in the ED," says Curtis.

Actions still are being implemented. They include:

  • scripts for staff to remind patients to complete their satisfaction surveys;
  • altered doorway structures to keep cold air from entering the emergency waiting area;
  • waiting time posters comparing the amount of time waiting at Saint Francis to the national standard in emergency situations;
  • posters reinforcing the fact that patients are not in a typical doctor's office by focusing on trauma prevention and the urgent nature of injuries stated on the posters;
  • patient care cards thanking patients for their business, asking them to complete a forthcoming survey, and explaining that Saint Francis strives to provide the best care possible;
  • follow-up telephone calls to check on patient progress after discharge and remind them to complete the satisfaction survey.
  • additions to waiting and care areas, such as stools for physicians so they can sit and speak with patients eye to eye, boards for physicians to write their names on so patients can easily identify their caregivers, etc.

The stool had a significant impact, Abernathy says. "It removes the perception you are just breezing in and out," she says. "A lot of the staff used to just stand at the door and were not even aware they were doing it."


For more information on improving patient satisfaction, contact:

  • Marcia Abernathy, RN, Director of Emergency Services, or Marilyn Curtis, MSA, Vice President of Professional Services, Saint Francis Medical Center, 211 Saint Francis Drive, Cape Girardeau, MO. Phone: (573) 339-1265.