Patient Satisfaction Planner: EDs report success with service guarantees

Free visits and movie passes pay off

Imagine promising that every patient who walks through the door of your emergency department (ED) will be seen in 15 minutes.

Does this sound like an invitation for a public relations nightmare? You may be surprised to learn that an increasing number of EDs are offering patients similar service guarantees.

At Northern Nevada Medical Center in Sparks, ED patients are guaranteed they will be seen within 15 minutes or the visit is free. The guarantee is posted in the ED and advertised via newspapers, radio stations, notices in telephone directories, and billboards.

If the time limit is not met, the patient complains to the nurse, who reports it to the nurse manager, who then instructs the business services manager not to bill the patient for the ED visit, says Jean Lyon, RN, chief nurse executive at the medical center.

"With a designated triage nurse, the only way the guarantee is not met is if several patients arrive in the ED at the same time and can’t all be triaged within 15 minutes," she says. "This does not happen very often."

30-minute guarantee

ED patients at Oakwood Hospital Medical Center in Dearborn, MI, are guaranteed that they will be seen by an ED physician and care will begin within 30 minutes of arrival.

"If we do not meet this, the patient receives a letter of apology signed by myself and the ED medical director, along with two movie passes," says Corinne G. Victor, RN, CEN, administrator for emergency services.

Each patient’s arrival time is entered into the computer by a greeter at the front desk, and if the 30-minute guarantee isn’t met, the staff will inform the patient, she explains.

If for some reason this delay is overlooked by the staff, it will be caught when the charts are reviewed by the ED billing department, Victor says.

"If we missed the guarantee, those charts are copied and given to the ED clinical manager," she points out. "She will call the patient and send out the tickets and letter of apology at that time."

The guarantee is in place for all five EDs in the Oakwood Healthcare System and is heavily advertised, with a prominent sign posted in the ED’s waiting rooms, says Victor.

"We have also done postcard mailings to our market share, which could be as many as 150,000 for one ED at a given time," she says.

ED managers report that the service guarantees have succeeded in their goal: to set their department apart from competitors. "Our 15-minute guarantee has become Northern Nevada Medical Center’s brand in the market," Lyon says.

Here is what EDs offering service guarantees have experienced:

Not many patients were dissatisfied.

Victor reports that from the start of the program in July 2000 through September 2002, all five EDs in the Oakwood Healthcare System have collectively given out movie tickets to only 638 patients out of 361,234 patients seen.

"Star Theatres gave us the first 200 tickets at no cost, which was wonderful,"she says. "We have had to pay for 438 tickets at $6 each, for a total of $2,628."

Likewise, Lyon reports that the ED has written off just a single visit over a two-month period. "The average is five or six a year, in a volume of 1,750 to 1,850 visits a month," she adds.

Patient satisfaction has increased.

Lyon attributes high patient satisfaction in large part to the guarantee program.

"Letters, telephone calls, and patient and family comments show that many people come to our ED not because it is closest, but because they have heard from friends and neighbors that they will receive fast and high-quality treatment," she says.

Making an impact

"It had an incredible impact on our patient satisfaction," Victor reports. In fact, patient satisfaction scores rose from 70% to 96% after the service guarantee program was implemented, she says.

Most staff responded positively.

The majority of ED staff were enthusiastic about the guarantee, but not everyone, Victor says.

"In the beginning of the guarantee, we lost some staff," she acknowledges. "These were folks who for one reason or another just couldn’t change their way of thinking."

Overall, the guarantee program resulted in greater staff satisfaction, she says. "The staff are happier because patients aren’t always upset with the wait," she explains.

Census increased significantly.

Lyon says the ED’s volume has increased steadily over the past five years, which made it harder to meet the 15-minute guarantee. As a result, she says additional nurses were hired, including a designated triage nurse.

"This change in the staffing pattern ensures that the guarantee is achieved," she says.

In addition, an ED expansion is under way that will increase the number of beds from eight to 18.

"If the volume continues to increase, we will add more ED nursing staff to make sure we meet the guarantee," she says.

Because of the program, the ED’s volume has outgrown its capacity, Victor says.

"Be careful what you ask for! We have experienced a 45% increase in volume since 1999," she reports. "We wanted an increase in market share, but this was phenomenal."