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Team up with clinical areas to improve satisfaction
Are patients complaining that they're waiting too long? Don't forget that clinical areas are closely connected to this common complaint.
Helen Contreraz, manager of patient access services at University of California-Los Angeles Medical Center, recommends having clinical departments survey patients about issues involving access. "The organization has taken a view that good customer services starts in access. That sets the tone for the rest of the patient's stay," she says.
In additional to national Press Ganey surveys, the access department does its own independent surveys in conjunction with various clinical partners. "We do this with customers who are very engaged with us, to make sure we are delivering superb customer satisfaction," says Contreraz. "With the OR and the ED, we meet regularly to talk about how our performance is."
In turn, those clinical areas survey patients about their experience with access. For example, patients are asked about their admission experience, how easy it was to find registration, whether someone called them before their appointment, the courtesy of staff members, how organized staff were, and overall satisfaction.
"Through that process, many patients will name individual employees. That gives us the opportunity to recognize certain individuals who demonstrate excellent service," Contreraz says. "This is done by the COO, who sends out a broadcast to praise that employee. For the past six quarters, access has scored in the 99th percentile out of 600 patient responses."
Recently, the patient access department worked on a performance improvement project with the operating room. The goal was to ensure that cases started on time. "That starts with us," says Contreraz. "So we worked on improving parking and signage."
Working together, it was identified that the hospital's parking kiosks didn't open early enough. "Just 30 minutes made a huge difference, since cars were lining up and waiting for the parking kiosks to open. In turn, that made our patients late in arriving to us, and it was a domino effect," says Contreraz.
Each week, patient access compares check-in data for OR first cases with the OR's data. "We discovered differences in our clocks, as well, and now we are measuring the same way," says Contreraz. "Even one minute late is counted."
Patient access realized that it needed to allow time for patients to get from the registration area to the OR, in order to meet the start time goal. For its part, the OR identified that the clinical check-in area needed to start 15 minutes earlier.
In addition to this ongoing collaboration, "the patient experience" is a topic at every access staff meeting. "Every quarter, we go through our performance," says Contreraz. "We talk about the tone of voice we use, the words being spoken, and our body language."
These are things that Contreraz looks for during rounds at the hospital, which are done with the rest of the management team one hour a week. "Staff are directly observed for their interactions with patients," she says. "We always give them feedback, whether good or bad." For instance, one employee was told that she seemed friendly enough but didn't make eye contact with patients.
Team approach is taken
At North Carolina Baptist Hospital, the outpatient clinics have a unique reporting structure, with one nurse manager responsible for both patient access and clinical staff. This unified management structure allows for a team approach to setting standards, problem solving, improving patient satisfaction, improving clinic flow, reducing waste, and improving communication.
"Our clinics do more than pay 'lip service' to the team concept between patient access and clinical staff," says Jo Anna Gresham, MSN, MHA, CMSRN, RN, associate director of the outpatient department.
"Because we have open lines of communication now, issues are dealt with as they come up. This makes everything flow smoother and everyone happier," says Sheila Stevens, RN, adult medicine nurse manager. "We are able to brainstorm together and much more productively since we have so many minds to work with now."
When nursing and registration were first merged, however, there was a need to "narrow the division" between the two areas. "Even though their work was parallel, they rarely interacted with one another and consequently did not really 'know' each other," says Stevens.
A monthly meeting time was established to discuss shared issues and ways to resolve them. "Before we could get to that level, though, we needed to recognize and respect each other as individuals and contributing members of the team," says Stevens.
Before the first meeting, Stevens interviewed all the members of the team regarding likes, dislikes, hobbies, and accomplishments. "I then made a sheet of all these facts mixed up without names attached. The meeting was a 'party' where everyone mingled, asking each other questions to try to match up people with facts," says Stevens. "The person with the most correct answers at the end of the meeting was awarded a prize. It was a great way to get to know one another."
After that, a portion of time in each meeting was devoted to team quality, such as adaptability, collaboration, commitment, or enthusiasm. "The quality is presented jointly by a member of nursing and registration," says Stevens. "These two were paired by drawing names, so that they had to work with someone that they didn't necessarily know that well."
Issues are now routinely brought up during meetings, and staff enjoy working them out together. One example is that too many patients were knocking on the door for information.
"This had been a point of discontent between the two areas, with nursing thinking, 'Registration sends everybody to the door to keep from dealing with them,' and registration thinking, 'Nursing won't help anybody with anything! They just keep sending them to us,'" says Stevens.
By talking the issue out, each area could understand the frustrations of the other. A solution was developed to help patients meet their needs. First, the underlying reasons that brought patients to the door were identified. Next, scripts for what patients should be told were developed.
"This enabled the registration folks to know what patients needed to be told to help resolve their problems, and helped nursing understand that if a patient came to the door they had more than likely bypassed registration," says Stevens.
All members of the team participate in the shared governance process as well as in implementing the organization's model of care "relationship-based care."
"These are the venues that we use to identify problems and find creative, team-driven, patient-centered solutions," says Gresham.
Clinical surveys done at North Carolina Baptist assess patients' level of satisfaction with their entire experience, including access. "Patient access is the patient's first level of communication, whether by phone or in person," says Monica T. Brown, MPH, manager of the outpatient department. "If we are to have an accurate picture of our strengths and areas for improvement, we must start at the beginning of service delivery patient access."
Prior to January 2010, an internal survey was used to measure patient satisfaction. Now a Press Ganey tool is used, with questions listed in the same order as a patient's visit progresses. "This way, even if the patient does not know whether it is an access or clinical issue, we are able to determine the appropriate area," says Brown.
One area of patient dissatisfaction that involves patient access as well as clinical staff is wait times. "These are the two groups of people that stand between the patient and the provider," says Brown. "Due to the necessary tasks that must be performed by both patient access and clinical staff, the groups may be perceived as barriers to the patient whose goal is to interact directly with his/her provider."
Early in 2009, patients were complaining to their providers that they were waiting a very long time to complete their registration. "A provider investigated the process and found that our current process was not very efficient and created dissatisfaction," says Brown. "We were having the patients sign in, have a seat, then be called back to complete their registration. Now, patients stand behind a designated sign and wait for the next available registration representative. Patients are much happier with this process."
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