Hospital vs. freestanding: Which setting is the best?
Hospital vs. freestanding: Which setting is the best?
Parking, waiting times challenge all programs
(Editor’s note: This is the first in a two-part series that looks at patient satisfaction scores for freestanding and hospital-based same-day surgery programs. This month, we look at overall scores and key issues for all same-day surgery programs. Next month, we will look at areas of greatest opportunity for improvement for each type of program.)
Patients prefer hospital-based same-day surgery programs for their proximity to other medical services. Patients prefer freestanding same-day programs because they don’t have an institutional environment. Patients prefer hospital-based programs because they attract the most experienced physicians and nurses. Patients prefer freestanding programs because they don’t have to wait as long for procedures.
These claims from members of the outpatient surgery community have resulted in a long-standing lively debate about whether patients prefer hospital-based or freestanding outpatient surgery programs. As both types of programs have evolved over the years, they each have begun to resemble the other as hospital-based programs address ease of access issues, and freestanding programs incorporate more services to respond to patient and physician needs.
Press Ganey Associates, a health care satisfaction research and improvement company based in South Bend, IN, performed a comparison of patient satisfaction scores for same-day surgery programs that are freestanding, hospital-based, and affiliated with a hospital, but located off-site, exclusively for Same-Day Surgery.
"The difference among the three categories is not statistically significant," says Deirdre E. Mylod, PhD, manager of research and development for Press Ganey. "However, the pattern seems to be that the group of facilities that are affiliated with a hospital but located off-site have the highest score for almost every issue," she adds. (See "Patient Satisfaction Scores in Same-Day Surgery" on the Same-Day Surgery website (under the "toolbox" link). Your user name is your subscriber number from your mailing label. Your password is sds (lowercase) plus your subscriber number.)
When asked about likelihood of recommending the same-day surgery program to others, hospital-affiliated off-site programs received a score of 93.4 by their patients, freestanding centers a score of 92.6, and hospital-based programs a score of 92.4.
While freestanding center managers always have pointed to convenience of parking as an advantage for them, patients still have complaints. Press Ganey data show that hospital-affiliated, off-site centers received a score of 83.6 for convenient parking, but hospital-based programs rated higher than freestanding centers with scores of 82.5 to 80.
"Parking was a major problem for us when we received our first Press Ganey report in 1999," says Sharon Jordan, RN, CNOR, director of perioperative services at Thibodaux (LA) Regional Medical Center. "We had designated parking areas closest to same-day surgery as same-day surgery parking, but patients complained that there were never enough spaces."
Because she knew that there should be enough spaces, Jordan and her staff began to monitor the same-day surgery parking area and found that hospital employees were using the spaces, especially when the weather was bad, she says.
The solution to the parking problem was twofold, says Jordan. "First, our chief executive officer sent a hospitalwide memo telling employees to park in employee lots only and not in lots designated as patient parking," she says.
Next, her facility began giving same-day surgery patients a parking permit when they come for pre-admission testing. "The permit includes the date of surgery and is placed on their dashboard on the day of surgery," Jordan says. Although the hospital doesn’t charge for parking, patients appreciate the fact that the hospital is making special arrangements for their convenience, she adds. As a result of these efforts, patient satisfaction scores for parking have risen, although Jordan would not release specific scores.
Press Ganey also produced a priority index for each of the three categories of same-day surgery programs. "We look at each question’s mean score and the question’s correlation with overall satisfaction to produce the priority index," Mylod says. "Questions that appear high on the list would be considered high priorities for improvement because they are both low in score and high in importance to patients."
One issue that appears high on the priority index for hospital-based programs, but not in the freestanding categories, is concern for privacy of patient. Protecting a patient’s privacy in a busy same-day surgery program is an extra challenge in small towns where everyone knows each other, Jordan adds. "Our patients don’t complain about our placing them in cubicles with curtains," she says. "In fact, we usually have several patients who insist on not closing the curtain because they want to see who else is there and talk with them."
Nurses do close curtains and respect a patient’s desire for privacy, but there are always some patients who converse with each other during recovery, she says. Reducing waiting times are a challenge for all three types of same-day surgery facilities, but staff at the Thibodaux same-day surgery program have a secret weapon to reduce complaints, says Jordan.
"If any of our staff members notices that a family member or patient has had an unusually long wait, they have the authority to give a gift of either a free meal in the hospital cafeteria, a picture frame, or a gift certificate, with the level of gift determined by the amount of inconvenience the patient experienced," she says. During 2002, staff members distributed approximately 32 $5 gift certificates to the hospital cafeteria, seven $10 picture frames, and nine $25 gift certificates to local merchants for a total of $455, she adds.
"While the gifts are small in cost to us, they mean a lot to our customers because they know that we recognized the inconvenience to them and apologized," Jordan says.
Resources
For more information about patient satisfaction measurement and improvement, contact:
• Deirdre E. Mylod, PhD, Manager, Research and Development, Press Ganey Associates, 404 Columbia Place, South Bend, IN 46601. Telephone: (800) 454-8032 or (574) 232-3387. Fax: (574) 232-3485. Web: www.pressganey.com.
• Sharon Jordan, RN, CNOR, Director of Perioperative Services, Thibodaux Regional Medical Center, 602 N. Acadia Road, Thibodaux, LA 70301. Telephone: (985) 493-4870. E-mail: [email protected].
This is the first in a two-part series that looks at patient satisfaction scores for freestanding and hospital-based same-day surgery programs. This month, we look at overall scores and key issues for all same-day surgery programs.Subscribe Now for Access
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