Key words, eye contact boost satisfaction scores

Staff education, involvement key to score increases

Making sure your patient satisfaction program is top-notch takes more than just sending out surveys, according to winners of a national patient satisfaction improvement award offered by Press Ganey Associates in South Bend, IN.

"I knew that the only way we could go was up when I looked at how our satisfaction scores compared to other ambulatory surgery programs," says Marilyn Bergman, RN, clinical manager of ambulatory surgery for Providence Alaska Medical Center in Anchorage. "We were between the third and sixth percentile in rankings, so I knew we could put some programs in place to increase our scores," she says.

The first thing Bergman did was to educate her staff. "Staff members were shocked because we do provide excellent care, and they had no idea that our patient satisfaction scores were so low because they had never seen them before," she says. In addition to sharing the data, Bergman also shared the questions on the survey and the meanings of the different rankings.

"After our initial sessions of education on the meaning of the patient satisfaction scores, we set goals for improvement," she explains. "We wanted to improve to the 25th percentile by the first year, and we actually ended up reaching that goal in six months, and we reached the 50th percentile at the end of the first year."

Recent results are close to the second year goal of 75%. "We don’t always meet our goal every month or every quarter, but we are pleased with our efforts to improve," she adds.

Several activities contributed to Providence’s success, Bergman notes. "We did some scripting to make sure that patients understood why we were doing some things a certain way," she says.

The scripting didn’t require nurses to memorize speeches or specific sentences, but it did identify key words to include when explaining things to patients or their family members. "For example, when we close the curtain on the patient’s cubicle, we say I’m closing this curtain to give you some privacy,’" says Bergman.

Staff member repeat the phrase "I am doing this to protect your privacy" or a version of that phrase throughout the patient’s stay, she says. "When the patient receives the survey in the mail several weeks later, he or she is more likely to answer the question related to our concern for the patient’s privacy in a positive manner because we constantly described our reason for our actions."

Identification of key words and actions was also effective at the same-day surgery program at St. Edwards Mercy Health Network in Fort Smith, AR, which saw patient satisfaction scores climb almost six points in 15 months from a starting average of 86.05 to an average score of 91.65.

"We choose five areas that greatly affected patients’ perception of our service and came up with ways to improve our attention to those areas," says Michelle Gasaway, RN, clinical nurse manager of the ambulatory surgery department at St. Edwards. For example, acknowledgement of the patient is important, so employees know to make eye contact with people, even if they are coming up to a desk to ask for directions or for information that the employee may not have.

"It’s very easy to avoid interruptions by avoiding eye contact, but we make the eye contact, even if it means going elsewhere or making phone calls to help the patient or family member," she says.

In addition to acknowledgement, her staff identified other key areas of customer service: introduction by name, explanation of time that the patient or family member can expect for each step of surgery and recovery, explanation of delays, and use of the words "thank you." Gasaway’s staff also uses phrases such as, "I’m raising this side rail for your safety" or "I’m doing this to increase your privacy." Staff members who volunteered to serve on a patient satisfaction team developed the phrases and laminated cards that list the five fundamentals of good customer service for each employee.

One of the responsibilities of team members is to take time to observe the patient’s experience. "Too often, we get caught up in doing our job, and we don’t look objectively at what is happening to the patient," Gasaway explains.

Now, patient satisfaction team members take time to sit in waiting areas and go to different areas, such as lab, radiology, or business office, related to same-day surgery and observe the patient’s experience, she says. "This doesn’t take a lot of time, and each staff member who observes a different area becomes more aware of his or her own area," Gasaway adds.

"This increased awareness enables all of us to be more proactive and take steps to correct long wait times before patients complain," she notes. Because her program involves lab, radiology, and other areas of the hospital to which ambulatory patients go, staff members feel comfortable pointing out to other employees that they didn’t hear an explanation of the long wait given to the patient, Gasaway says. "Staff members also make suggestions about the way they handle scheduling of lab work and other tests to avoid long waits."

Have a process to immediately address patients’ concerns, Bergman adds. Nurses in her program know to ask a patient if there is a problem if they notice behavior that suggests dissatisfaction, she points out. "Many times it is a matter of apologizing for a delay and thanking the person for their patience, but nurses also can give coupons to the hospital coffee shop for family members to use, or some other simple thing. If necessary, nurses contact a supervisor who immediately talks with the patient or family member to resolve the problem."

Bulletin boards in staff areas are used to post current patient satisfaction scores, Gasaway adds. "The actual report is very complicated, so it is summarized so that staff members can easily see the areas of improvement and decline, she says.

"When we see that we are not doing as well in areas that are rated most important by patients, we take a look at what we are doing and add new key words or emphasize the area such as concern about pain, delays, or privacy," Gasaway explains. "Sometimes, we do see a drop in one area if we’ve been concentrating on other areas, so it is a constant process of review, evaluation, and changes to our approach."


For more information, contact:

  • Marilyn Bergman, RN, Clinical Manager, Ambulatory Services, Providence Alaska Medical Center, 7529 E. Sixth Ave., Anchorage, AK 99504. Phone: (907) 562-2211. E-mail:
  • Michelle Gasaway, RN, Clinical Nurse Manager, Ambulatory Surgery, St. Edwards Mercy Outpatient Surgery Center, 7301 Rogers Ave., Fort Smith, AR 72917. Phone: (479) 314-1792. E-mail: