Waiting times are top improvement opportunities

Similar problems in freestanding programs

(Editor’s note: This is the second in a two-part series that looks at patient satisfaction scores for freestanding and hospital-based same-day surgery programs. Last month, we looked at overall scores and key issues for all same-day surgery programs. This month, we will look at areas of greatest opportunity for improvement for each type of program.)

Waiting room comfort, waiting times in various departments, privacy, and staff courtesy are areas in which all same-day surgery programs, freestanding and hospital-based, need to improve, according to an analysis of patient satisfaction data performed exclusively for Same-Day Surgery by Press Ganey Associates, a health care satisfaction research and improvement company based in South Bend, IN.

As part of the analysis, 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," says Deirdre E. Mylod, PhD, manager of research and development for Press Ganey. "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." (See priority index for improvement, below.)

Areas that need improvement to raise patient satisfaction scores

The following areas are the highest priorities, in descending order, for improvement for same-day surgery programs based on analysis of Press Ganey Associates in South Bend, IN, patient satisfaction data performed exclusively for Same-Day Surgery. These areas are important because they rank low in actual patient satisfaction scores but are high in importance to patients.

Hospital-based programs:

1. waiting time in X-ray;

2. waiting time in EKG;

3. courtesy of X-ray technician;

4. comfort of family waiting room;

5. staff concern for privacy.

Hospital-owned programs that are off site:

1. décor and cheerfulness of center;

2. comfort of family waiting room;

3. instructions regarding preparation prior to surgery;

4. courtesy of X-ray technician;

5. waiting time in X-ray.

Freestanding, independent programs:

1. waiting time in X-ray;

2. comfort of family waiting room;

3. waiting time in EKG;

4. (tie) comfort of main waiting room;

4. (tie) waiting time for registration.

Concern for privacy only showed up on the priority index for hospital-based programs. "Privacy is a big issue, and we learned a lot after opening our first same-day surgery unit at one hospital," says Mary Nash, RN, CNOR, director of the surgical services line at Gwinnett Hospital System in Lawrenceville, GA. "In our same-day surgery department that is attached to the hospital, we have side walls in our recovery area, but always have to make sure that the front curtains are pulled shut and that we talk quietly with the patient."

Because patients don’t feel like they are in a private area when curtains are involved, the freestanding center that was built on the campus of another system hospital has small rooms with doors in the recovery area, Nash says. "We also included a private consulting room for physicians to talk with family members before the patient arrives in recovery," she adds.

Waiting times in X-ray, EKG, and registration were areas of improvement identified for all types of same-day surgery programs. The only employee group identified as needing to improve courtesy was X-ray techs.

Wait times always are a concern, admits Jackie Scott, RN, CAPA, performance improvement coordinator for surgical services at Gwinnett Hospital System. Her same-day surgery programs have reduced wait times by scheduling pre-op visits several days to two weeks prior to scheduled surgery and by adding staff to handle pre-op testing.

"In addition to reducing waiting times, we’ve found that we don’t get complaints about staff courtesy when the employee is a part of the same-day surgery staff," Scott says. When an ancillary employees are a true "part of the same-day surgery team," they view same-day surgery patients as their patients and are more committed to making sure they have a good experience, she adds.

Instructions about preparation prior to the surgery is an area in which hospital-owned freestanding centers can improve, according the Press Ganey data.

"We don’t hear a lot of complaints about lack of preparation for our patients because we do bring them in for a pre-op visit," says Nash. "We also ask that a family member come with the patient so we can give instructions to both." Nurses also call patients one to two days prior to surgery to make sure they don’t have any questions, she adds. The combination of face-to-face and telephone contact along with written instructions means better prepared patients, she explains.

Keeping patients and family members informed throughout the entire process is important, adds Scott. "When the OR circulator goes to get the patient, he or she tells the family member how long the entire surgery should take," she says.

Although the surgeon may have given a timeframe, the surgeon doesn’t always take into account the time for preparation or recovery, she says. During surgery, it is the same nurse who calls the waiting room to update the family members on the patient, especially if the procedure is running longer than anticipated, she explains.

The same-day surgery staff at Gwinnett Hospital System go one extra step to make sure patients don’t feel as if they are sent home before they are fully prepared for discharge.

"We tell patients why they are clinically ready for discharge and then ask them if they feel ready to go home," says Nash.

Because the surgical experience leaves patients feeling as if they have no control, this is one way to give them some control and make them feel that they are prepared to go home, she explains. Patients rarely choose to stay longer, she adds.

Comfort of waiting rooms showed up on the Press Ganey priority index for all types of same-day surgery programs. The comfort of waiting rooms is always a key area to address for patient satisfaction, says Vickie Axsom-Brown, a same-day surgery consultant with Practice Resources in Anderson, SC. Axsom-Brown and Scott suggest that same-day surgery managers look closely at issues such as separate waiting areas for different ages, televisions, snack areas, and current reading material.

The most important step in improving patient satisfaction is to focus on the patient’s need, says Scott. While same-day surgery staff members focus on clinical issues to provide good patient care, patients and their family members will not notice the level of training, the type of equipment, or the infection control procedures, she points out.

"I don’t care about the amount or variety of the reading material in our waiting rooms, but our patients do, so we make sure we have current magazines that appeal to all types of people," Scott says.


For more information about patient satisfaction issues, contact:

Mary Nash, RN, BS, CNOR, Service Line Director for Surgical Services, Gwinnett Hospital System, Medical Center Blvd., Lawrenceville, GA 30045. Telephone: (678) 442-4179. E-mail: mnash@ghs.net.

Vickie Axsom-Brown, Consultant, Practice Resources, 116 Bradley Park, Anderson, SC 29621. Telephone: (864) 245-0265. Fax: (864) 224-0404. E-mail: vaxsombrn@aol.com.