Is your reorganization chasing off patients?

Satisfaction scores may offer wake-up call

Administrators at Holmes Regional Medical Center in Melbourne, FL, have some advice for other facilities in the process of restructuring: Watch your patient satisfaction scores to make sure you’re not scaring away patients before they can experience your improved care delivery system.

Holmes learned this lesson the hard way after their scores plummeted from the 85th percentile to the 60th. Now, as they continue to restructure, they have monitored scores and have implemented several programs to boost the scores and stave off future declines.

"Times of turmoil always take away from a person’s ability to care for others. You can see it during hospital re-engineering, mergers, acquisitions, poor financial times. Because of that fact, difficult times are extremely important times in which to measure patient satisfaction," says Mary Malone, MS, JD, vice president of corporate development for Press, Ganey and Associates in South Bend, IN.

Two years ago, Holmes’ management began discussing consolidating with other hospitals in the county. Three of the hospitals subsequently merged into a unified organization called HealthFirst, which also includes, a physician group, HMO, and PPO.

"We brought in so many different components under one umbrella," says Jean Huff, RN, MBA, director of Holmes women’s and children’s service line. Huff admits the hospital staff probably mixed up its priorities during the integration. Huff cites four specific problems she believes affected patient satisfaction scores:

1. Accreditation survey.

In 1995, Holmes was due for its triennial visit by surveyors from the Joint Commission on Accreditation of Healthcare Organizations in Oakbrook Terrace, IL. "With all we had gone through as an organization, everyone spent the year focusing on the JCAHO visit, and patient satisfaction just took a back seat," Huff explains. "We used to have teams working on patient needs, but those teams were diverted to JCAHO."

In that quarter, the mean score at Holmes dropped. The hospital’s actual overall satisfaction ranking declined by the second quarter. At its lowest point, Holmes plummeted to the 42nd percentile.

2. Downsizing.

The system commissioned a consulting group to determine where cuts could be made. Major downsizing was inevitable, especially in nursing management. To prepare for this, HealthFirst froze hiring. The freeze remained even during Holmes’ busy season. Staffing was tight and people were unhappy. "You could just feel the decline in morale," explains Mary Lou Tomblenson, coordinator of patient care services at Holmes. And, patients picked up on the staff’s dissatisfaction and anxiety.

3. Physicians left-behind.

While HealthFirst was formulating its health plans, not all physicians in the community were invited to participate on the provider panel. At the same time, managed care was penetrating the market. "There was a lot of animosity and a humongous amount of stress among our physicians. It carried over to the bedsides and dealings with families," Huff says.

4. Patient perceptions.

After the announcement of the HealthFirst merger, people thought Holmes was becoming "big," somehow meaning it was becoming a large, uncaring conglomeration. "Patients were coming through the doors already thinking that service and care were bound to have fallen off," Huff says.

Once they identified the sources of patient dissatisfaction, management developed a plan to remedy the problems. Here Huff shares some of its satisfaction improvement projects:

Educate Community. The hospital launched a community education program to let people know what HealthFirst is.

"We are trying to show that the hospital is basically the same and that it definitely has the same mission," Huff says.

Include patient satisfaction in staff evaluations.

Holmes’ new administration has told staff patient satisfaction is a priority. In fact, patient satisfaction scores are now discussed in personnel evaluations. Hospital administrators tell employees they will be held accountable for patients’ experiences. "Acknowledge worries, but don’t use them as excuses to take your eye off the ball. If you don’t measure patient satisfaction, it appears as though you’re giving in," Malone warns.

Train staff.

The hospital also formed a quality action team to address patient concerns. The team originally included only nurses, but slowly, other departments have been invited to offer input. "We talk about the behavior that is expected of caregivers," Tomblenson says. "The mission of the team is to "develop a consistent approach for staff development to enhance interpersonal relations, actions, skills, and behaviors." The measures of success are improved customer satisfaction scores and decreased complaints regarding a perceived lack of caring, concern, and staff availability.

HealthFirst now conducts classes on four elements of good service. These are:

— First impressions: Introduce yourself, explain what you do, and treat your patients and their families with respect. For example, address patients by their last names.

— Attention to tangibles and assurances: Maintain a professional demeanor and work area.

— Responsive and caring behaviors: Focus on the patient as you would a member of your own family.

— Empathy: Respect the patient’s privacy, and find or make opportunities to calm anxious patients and families.

The classes are two hours each. The first addresses "moments of truth," or real-life experiences with patients; during the second, attendees split into groups to discuss each of the elements of good service. This type of training also will be incorporated into orientation for new employees.

Recognize staff.

The staff has learned to enjoy small successes on the road to recovery. Monthly, the hospital honors caregivers who receive positive mention on surveys. The hospital president welcomes the patients back to meet with the staff. And positive comments are posted verbatim on unit bulletin boards.

A challenge, Tomblenson notes, is recognizing ancillary staff and the roles they play. "An employee in human resources won’t be named in a patient survey, but we make sure they realize that their research led to the hiring of the great people who work directly with the patients," she explains.

Take advantage of poor measures.

Malone says poor scores should be shared with staff and presented as an opportunity, not a tragedy. "This is bad news you need to hear. It’s a wake-up call," she explains. (See related story, p. 70.)

There’s still work ahead

In the latest quarter, Holmes’ scores took another downward turn. Huff says she knows exactly where the hospital is still experiencing problems. "We have to add beds during our busy times, like winter," she says. "We are holding patients too long in the emergency room and in recovery. Poor entrance into the system will kill patient satisfaction."

She says Holmes’ management plans to take a half-day retreat to refocus and revamp its patient satisfaction action plan. Meanwhile, Huff will continue to watch her hospital’s scores closely. "Hardly a day goes by that I’m not on the phone with our vendor, checking on things," she says.