Special Report: Making the Satisfaction Grade

Measure satisfaction when you can still improve it

One volunteer position might make the difference

Hospice families repeatedly report needing more education to help their dying loved one, according to the new satisfaction survey the Hospice of St. Mary’s in Leonardtown, MD, began using in January 2004. So the small hospice, which has 16 employees, created a new volunteer position that involves the volunteer meeting with each hospice family to ask them about their needs and concerns during the hospice stay, says Charlene Taylor, RN, BSN, hospice director. "Our volunteer loves her role because she can be a little bit of help to every family," Taylor says. "She talks with the family and comes back with excellent suggestions."

As a result, the hospice’s family satisfaction levels have improved and now are higher than benchmark averages in all indicators, Taylor says.

The hospice’s new survey, which is distributed by the National Hospice and Palliative Care Organization of Alexandria, VA, polls family members after their loved one has died about their specific needs and concerns during hospice care. The new survey has been shown to produce more useful information than a typical survey that only asks for ratings from "very good" to "very dissatisfied."

Meeting with families during hospice care

However, the information arrives well after the episode of hospice care has ended, so Hospice of St. Mary’s took the process a step further and now has the volunteer meet with hospice families during care to ask them some of the same types of questions as those on the survey. This way, there still is time to make improvements for that particular family, Taylor explains. "She goes out about one or two weeks after a patient is admitted and sits with the family to find out if there’s anything else we need to do to raise their level of confidence and emotional support, Taylor says. "She comes back with answers, and we sit together as an interdisciplinary team and address the cases where families feel they need more help."

The volunteer was trained to ask questions that are more specific, such as:

  • Is there anything else the hospice could be doing?
  • Do you have a financial concern that is not being addressed?
  • Do you feel comfortable that you have all the tools you need to care for your loved one?
  • Are you receiving the emotional support you need?

"In about one-third of the cases, something comes up where the family member will say, I’ve been worrying about how to pay for the funeral,’ or I’m worried because I have a family member coming to visit who hasn’t seen our family in 10 years, and I don’t know how to talk to them,’" Taylor says.

Hospice families typically don’t share these types of concerns with hospice staff, but since the volunteer is there solely for the purpose of listening to their worries, they will speak freely, Taylor notes. "It makes a difference when one person goes out to meet with them and that’s all that person is there for," Taylor says. The hospice team will address the family’s needs by sending out a chaplain if the need is spiritual, or sending out a social worker if there are financial concerns, Taylor adds.

As a result of this fast response to client concerns, the hospice’s satisfaction scores are high, with the hospice receiving 100% on the indicator of hospice caregiver confidence about care that’s being delivered. That item has a benchmark of 95%, Taylor says. The benchmark for pain control and symptom management is 74.49%, and the hospice’s score was 87.5% for the last quarter, Taylor says.

With the previous survey, the hospice had achieved improvement in some areas, but the new survey tool has more extensive questions and information that’s more readily useful for quality improvement, Taylor says. "I see a decrease in the amount of people who want to answer all of those questions, but what I’m getting back is a much more valuable tool," Taylor says.