It’s not just the score, but how you use it
It’s not just the score, but how you use it
Innovative use of surveys nets improvements
The emergency department (ED) at Valley Hospital in Ridgewood, NJ, has always ranked above average in patient satisfaction. But leaders and staff wanted to continue to find ways to better serve their patients — about 43,000 of them a year — and thus developed some unconventional strategies that over the past two years have brought satisfaction scores up by about five points, says Donna Madar, RN, CCRN, ED manager.The ED’s patient relations committee, an eight-member group made up of staff and one volunteer, developed a detailed plan that outlined 12 improvement initiatives that would impact patient satisfaction. Some of the more effective initiatives include:
• Staff education and communication.
In different types of staff meetings, all 132 staff are provided with the results of patient satisfaction reports and informed about issues important to patients. In addition, Madar shares published articles about ED patient satisfaction so staff can keep abreast of the literature on the topic. The staff receive inservices on patient relations, and some have attended a seminar on patient satisfaction.
Madar also writes and distributes a monthly newsletter, a portion of which is dedicated to patient satisfaction, including excerpts from the literature and specific items on the department’s South Bend, IN-based Press, Gainey and Associates patient satisfaction survey that have shown improvement or decline. "Patient satisfaction is a driving force behind all we do," she says. "Aspects of it are included in any way I can."
In addition, letters and survey responses are posted on a bulletin board in the employee lounge.
• A specially trained volunteer corps.
Twenty-four volunteers, most of whom are retirees, have been specially trained to serve Valley’s ED. This volunteer corps has been the most important tool in increasing patient satisfaction, says Gail Callandrillo, director of planning and marketing. "It is an extraordinary program," she says, "and has had tremendous impact."
Led by a retired dentist, volunteers work four-hour shifts in pairs and are usually on hand between about 9:30 a.m. and 9:30 p.m., Madar says. Their jobs are "to keep their eyes and ears open to need." They make rounds doing whatever they can, from fetching coffee for family members to checking on the status of lab tests. They have been trained in special communication skills as well as when to recognize that a task is out of their realm and requires a staff member. They chat with patients and families — a simple thing that has a dramatic effect on patient satisfaction but that nurses just cannot take a lot of time to do with their busy schedules, Madar continues.
The volunteers’ biggest impact has been in the area of communicating to patients about waiting times. The ED has a computerized tracking system that follows all patients from registration to discharge, including the status of tests — ordered, drawn, in progress, or completed — as well as exact time of arrival. A volunteer can scan the patients’ names in the system, determine who has been there for awhile, and go to that person to explain the situation, Madar says. The volunteer also can tell the patient the status of tests and how much longer he or she can expect to wait. "It’s this communication with patients that has been a key satisfier," she says.
Volunteers also have been trained in patient satisfaction, safety and health issues such as infection control, and patient confidentiality issues.
• A team-based system.
Simple clinical procedures have been deployed from a department-based to a unit-based environment. ED patients are now served by teams of caregivers including physicians; nurses; clinical care technicians who draw labs and do EKGs, as well as other patient care responsibilities; and service associates who take care of housekeeping and transportation tasks.
• A patient brochure and other communication strategies.
Brochures titled Emergency Care at Valley are available in ED waiting areas and help explain how the department works as well as billing policies. A section explains the concept of patient priority and questions that will be asked by the triage nurse. Information explaining visitor regulations helps patients better understand the reasons for such rules. Tests, and the time they might take, are also explained, in addition to the hospital’s admission protocol. Billing policies are explained in detail as well.
Other communication strategies developed
ED staff have developed and adopted other strategies for communicating with patients and keeping them informed. For example, patients who register but leave before seeing a physician are called so appropriate treatment can be scheduled if necessary. Staff members also call patients who have made positive or negative comments on patient surveys and follow up with an appropriate course of action. A bereavement program involves communicating with friends and family of those who die in the ED.In addition, the ED patient relations committee is being expanded to include an "open chair" that will allow former patients or other members of the community to provide input into patient satisfaction issues, Madar says.
Dramatic rise in satisfaction scores
ED patient satisfaction scores have risen dramatically since these efforts began in 1995. Some scores are as follows:• courtesy shown family/friends — +5.2 points;
• adequacy of information to family/friends — +5.7 points;
• let family/friends be with patients — +4.9 points;
• informed about delays — +5.9 points;
• staff cared about you as a person — +5.7 points;
• likelihood of recommending the ED — +5.3 points.
Because of competition with 19 other hospitals in Pinellas County, FL, as well as the influx of managed care, 300-bed Sun Coast Hospital in Largo was feeling the effects. "ED employees have traditionally been of the mindset that the supply of patients would never end, but this just isn’t so," says one hospital leader.
An overall score of 80 — placing the hospital in the 45th percentile — was disappointing to ED staff and leaders. The score for "let family/friends be with patients" was in the lowest percentile possible.
When ED Director Peggy Dobbins joined the staff in June 1995, she found that the Press, Ganey reports were, for the most part, ignored. Her plan was to use the surveys and reports to help staff determine where they needed to make changes.
"There was no accountability," she says. "Staff needed to be made accountable for how they interacted with patients."
She includes survey results on personnel reports and developed a new process to instill a sense of accountability in the department:
• The hospital CEO reads all survey forms and forwards any with written comments or particularly high or low scores to Dobbins.
• If the patient doesn’t identify a staff member by name, Dobbins uses other information on the survey, such as time in the ED and services provided, to help trace which personnel were involved.
• Dobbins forwards a copy of the survey form to the staff members involved.
• Outstanding comments or scores are noted and the employee commended.
• If the comment is negative, Dobbins requests the staff member review the problem constructively and identify how it could be avoided in the future. The employee’s action is noted.
"This process was an eye-opener for some personnel, and even prompted one to undertake a concerted effort to change," Dobbins says. "She asked co-workers to let her know if they thought she was getting short with a patient."
Quarterly reports posted
Dobbins also posts each quarter’s survey reports so staff members can see areas where changes occurred, as well as news clippings and related articles from the medical literature.According to Dobbins, the survey reports and news clippings have been instrumental in helping change the staff’s opinion about family and friends being allowed in treatment areas with patients.
Now, in many instances, family and friends are allowed to stay with the patient, and ratings in this area have been steadily improving. The score for "let family/friends be with patient" has risen from the first percentile (lowest score among a national sample of 167 EDs surveyed) in 1995 to the 48th percentile currently.
Other scores have increased as well, including the overall score, which has risen from the 45th percentile to the 89th percentile.
"The survey process has provided a vehicle for providing objective feedback to staff in a manner that is difficult to refute," Dobbins says. "Instead of a supervisor confronting the employee, the employee is able to see for him or herself what the problem was."
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