ED quadruples patient satisfaction rankings
How can one keep numbers that high?
In the third quarter of 2001, the ED at Methodist Medical Center of Illinois, Peoria, ranked in the 17th percentile in patient satisfaction surveys by Press Ganey Associates in South Bend, IN. By the end of 2003, that number had risen incredibly to the 95th percentile.
That happy ending, however, is not quite the entire story. "We've become victims of our own success," notes Elsburgh Clarke, MD, chairman of the department. You see, the boost in patient satisfaction mirrored a similar growth in caseload for the ED, which now sees 55,000 patients a year instead of the 37,000 it was seeing a few years ago. This increase has made the maintenance of a 95% patient satisfaction rate impossible, Clarke says; still, the ED's rankings consistently remain in the mid-80s.
When the downward trend in patient satisfaction rates became apparent, Clarke and James Sowards, MD, the medical director, were charged with the task of getting patient turnaround to 30 minutes, which, it was felt, would bring the satisfaction numbers up.
"As we all know, length of wait is one of the main determinants [of patient satisfaction], so I had to devise a process and procedure so that, no matter what a patient came in with, they could be seen in a timely fashion," recalls Sowards.
That timeliness can't happen with standard triage, he says. By moving the physician out to the patient, not only do they not have to see minor complaints in ED beds, but the patient is taken care of just as quickly, he says. If they triaged patients in standard fashion, someone with a toothache could wait four to five hours, Sowards explains. He says this new system "is a win for the ED and for the patient who comes in with a nonurgent complaint — and that represents a large portion of our patients."
Clarke says they have a physician out front from 9 a.m. to 5 p.m. and from 5 p.m. to 1 a.m. They also have a fast-track service that is open during those same hours, he says. These practices continue, he notes.
During the turnaround process, the ED managers kept a close eye on satisfaction performance.
"We get weekly updates on Press Ganey scores, and we post them in the department so everyone can see how we are doing," Clarke explains. Survey comments were shared with staff at least twice a week.
Patient satisfaction became a topic in the monthly physician meetings. Also at the physicians' meetings, the individual scores were posted.
"When you have peer pressure like that, you don't want to be in a lower percentile," Clarke says. "If a physician is under percentile for several months, we will have a separate meeting with them." The nurses, he adds, only see a graph that represents the performance of the entire department.
Sowards says another factor in improvement has been a financial incentive. "Doctors are paid on a base salary and an incentive bonus, which is partly based on customer satisfaction," he says. "While 90% of your salary is set, 10% is at risk for productivity, customer satisfaction, and coding."
Since the department volume hit 55,000 patients a year, the satisfaction scores have typically ranged between 83% and 85% — still far above their low baseline, but lower than their 95% target, Clarke says.
"The community knows this is just a better place to come, and it's put a lot of stress on the system," he says. "We're trying to get back" to 95%.
Clarke identifies several possible remedies. "We need a bigger ED and more people working, but that will not happen anytime soon," he says. However, he adds, "the nursing staff has basically bought into [the satisfaction goal] and knows we basically have to be fluid with staffing as volume shifts and changes on a daily basis." The nursing staff is at its maximum, he says, "but we've made changes in our schedule, and they have to accommodate those changes to help us out."
Sowards says they have adjusted their hours to meet the increased volume. "And we do have an on-call system if it gets even crazier, to bring in extra people and de-compress. We do whatever it takes to get the volume out of here."