Rehabilitation Outcomes Review-Increase patient satisfaction with comprehensive program

Hospital also uses 'comfort zone' measures

When patients and their families walk into a rehabilitation facility or a hospital, one of the first things they'll do is either look for the floor or department they need to find or ask someone for directions to get there. If they feel that it's easy to find the right place, then they'll have a pretty good first impression of the facility.

If they can't find the direction signs or quickly obtain directions from staff, they may become frustrated and have a poor first impression of the facility, says Carol Martin, RN, BSBA, director of cardiopulmonary/rehabilitation services for Brockton (MA) Hospital. The hospital has 291 beds, rehab services, and a skilled nursing facility.

Good or bad initial first impressions will be reflected in patient satisfaction surveys. That's one reason Brockton Hospital created a comprehensive patient satisfaction program addressing all of the little, but important, facets of a patient's hospital stay. "If a patient needs instructions, the building staff provides it. If the air conditioning doesn't work well in the room, then we bring in a fan. We try to handle everything before complaints get out of hand," Martin says. Brockton Hospital started the patient satisfaction program after receiving a dismal customer satisfaction score on a survey conducted by Press, Ganey Associates of South Bend, IN.

The initial score, based on a 1998 survey, placed the hospital in the 34th percentile, meaning nearly two-thirds of the other hospitals surveyed scored higher. After the hospital started its new program targeting patient satisfaction, the scores rose, and finally, in October 1999, the hospital's score placed it above the 90th percentile. Press, Ganey recognized the hospital's success by naming it one of the finalists receiving the 1999 "Client Success Story" award.

The hospital has reaped some tangible benefits from the higher satisfaction rating. For example, a physician group from the other side of town recently switched from working with another hospital to referring exclusively to Brockton Hospital. "One reason they cited for the change was our high customer satisfaction," Martin explains.

Making patients happy

Raising a facility's patient satisfaction scores isn't easy, but it can be done with methodical attention to all services and care, including those that staff often deem unimportant. Martin offers these descriptions of some of the changes Brockton Hospital made as part of the project:

1. Form teams. The hospital put together five active teams to work on different areas that would contribute to improving patient satisfaction. All staff are encouraged to participate on a team or a subcommittee, and if they participate, they are expected to attend all meetings. The teams included:

Measurement team. This team analyzes patient satisfaction scores and determines how the hospital could raise them through quality improvement initiatives. One objective is to make priorities and develop action plans specific to nursing units. Team members look for plans that will give the hospital the most improvement for the least amount of money.

Communications team. This team is in charge of getting out the news about how the hospital is doing with the various quality improvement initiatives. For instance, the hospital has a newsletter that highlights employee achievements, and the team has developed a bereavement letter sent by the hospital's chief executive officer to every employee who has lost a family member.

Standards and value team. This team constantly reinforces the hospital's standards and values by holding events that reinforce them. When the hospital's patient satisfaction score reached the 90th percentile, the team spearheaded a celebration. It also kicked off the hospital's "WE CARE" campaign, which stands for welcome, empathy, caring, accountability, respect, and excellence.

The team educates staff about what is acceptable WE CARE behavior and what isn't. For instance, the team tells employees that letting a phone ring five times or longer is not answering it quickly enough. "We want to treat people as we want them to treat us," Martin says. "People are held accountable on their evaluation for those behaviors."

Reward and recognition team. This team sets up the employee recognition programs and determines awards. One such award is the "Pacesetter of the Month" honor, given to the employee who most exemplifies the values the hospital wants in an employee. Those values relate to patient satisfaction.

The monthly awards for the Pacesetter honor include an anniversary clock and a personal letter from the hospital's president. The reward and recognition team, a hospital vice president, and the entire department gather around the employee to announce that he or she has won. Then, the employee's photograph is hung in the main lobby.

The 12 monthly Pace setters are entered in a contest to see who will be named "Pacesetter of the Year." The winner, chosen by the team, receives a private, nearby parking space, coupons for entertainment items, and a gift certificate to use on a weekend trip.

Removal of irritants team. This team looks for all the little things that might irritate patients and corrects them whenever possible. Sometimes the problems are so minor that — without the team focusing on this area — no one would have known they were sore points with patients.

One such example is that the hospital's emergency department didn't have any pillows. Previously, the department had supplied pillows, but they would often end up somewhere else in the hospital and never reappear. The team solved the problem by ordering green pillow cases. The housekeeping staff make sure there are enough of these pillows each day. If pillows disappear, they can be found easily because of the unique green color and then returned to the emergency department after washing.

2. Make sure patients are comfortable. The hospital's director of facilities became personally involved in making sure patients were comfortable in their rooms, implementing a "Comfort Zone" program. As part of that, he has assigned facilities workers to visit each new patient, handling a total of 20 to 60 admissions. They show patients how to use their call buttons, how to operate the television, and how to make sure their bed adjustments work.

Also, workers show patients how to adjust the temperature through the room's individual controls. If the patient's air conditioning isn't sufficiently cooling the room, the worker will bring in a fan. These visits take place within 24 hours of admission. The workers also ask patients if they are bothered by ambient noises or anything else related to their rooms.

"We've had several comments on patient surveys where people say, 'Even the maintenance man came in and asked me if things were OK,'" Martin recalls. "It made a big impact on patients that a nonmedical person checked on them."

3. Remove irritants. The hospital put together an entire team, consisting of managers and employees from the areas of maintenance, dietary, purchasing, housekeeping, emergency room, quality control, and medical/surgical, to work on removing patient irritants. The team met weekly, analyzed the patient satisfaction survey, and then interviewed patients, nurses, phlebotomists, clerks, and other staff to find out what most irritates patients.

The team first notified a particular hospital it planned to visit and then went to that unit to interview staff about both patient irritants and problems they themselves might encounter. "We brought coffee and bagels and sat in the nursing lounge," Martin says. "We spoke to respiratory therapists and social workers and others and said, 'What gets in the way of your doing your job?'"

Team members learned that patients were very concerned about privacy. For example, when a dietary aide delivered a tray to their room, they didn't want the aide to just walk in without first knocking.

"You want the staff to respect patients," Martin says.

Another privacy issue was that sinks were outside of the bathrooms in patient rooms. This meant patients had to wash up at the sink without the privacy of a door to shut. "So we installed a curtain around the sinks," Martin says.

They also learned that patients complained of receiving cold food. This resulted from the meals all being delivered within the same half hour, which meant that the staff didn't have time to deliver all the meals straight from the kitchen and instead had to leave some on a cart long enough for the food to cool. The hospital's dietitian solved this problem by staggering meal delivery times, so all the dinners could be delivered while hot.

Patients complained that the coffee tasted terrible: It was too watery and weak. Staff began to make it stronger, and the complaints stopped.

4. Welcome all patients and visitors at the door. The team decided that first impressions are very important, so they gave all managers an assignment to spend time in major entrance areas of the hospital to assist visitors and patients.

Managers each have one hour a week in which to play host or hostess. They welcome people at the emergency department entrance and the main entrance, and they escort people who need help in finding where they are going.

"We each have one hour a week we own for life, and if I can't make it to my hour, I have to find my own coverage," Martin says. "This has been really effective."

While the hospital can't pinpoint this program as a specific cause of greater patient satisfaction, it clearly adds to the whole perception of quality in the facility, and it has made managers more sensitive to patients' and visitors' needs. "So now when I see someone who looks like they're lost, I will take that person to their destination," Martin adds. "Everyone has become more helpful, because it's catchy."

When hourly workers see their managers providing this hosting service, they realize how important customer service is to their own jobs.

At first, managers resented this time away from their "real work." But after they became used to the idea of this one hour a week of service, they grew to look forward to it, Martin says.

Plus, the hourly commitment is part of their job performance evaluations, and no one is exempt. "We had vice presidents doing it," Martin says. "One vice president of finance was carrying a baby carrier and showing someone how to get to the maternity department."

5. Reward staff. Rewarding staff does not directly relate to patient satisfaction, but it can have an indirect effect. Satisfied employees, who feel their own contribution to an organization is noticed and appreciated, will be more likely to go out of their way to make patients comfortable.

The hospital's reward and recognition team has worked on a variety of ways to show employees how important their contributions are to patient satisfaction and quality care.

Awards go to employees who have perfect attendance for a month and to those who provide beyond-the-call-of-duty service to patients and their families. The "Associate Excellence" award goes to employees who are caught in the act of doing something extraordinary. One such honor went to a registration clerk who helped a woman whose son had just died from a gunshot wound. The woman was leaving the hospital alone and waiting for a bus to take her home. The clerk followed the woman and brought her back inside, giving her coffee and a bagel and letting her use the telephone to have a friend or family member come and pick her up. The clerk's co-worker told a supervisor about what she had done, and the supervisor nominated her for the award.

A "Manager's Choice" award is presented to managers who show extraordinary leadership skills. They receive a plaque.

All honors and recognition relate to quality care and patient satisfaction. "This is all about putting the patient first," Martin says. "It's not as difficult as one would imagine to understand and focus on what patients need and want, but implementing measures to make sure every patient is treated that way is by no means an easy task."