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(Editor's note: This is an update on Warm Springs Rehabilitation Hospital's patient satisfaction quality improvement project. Rehabilitation Out comes Review first featured the San Antonio facility's program in May 1999. Since then, the hospital has been named a finalist in the 1999 "Client Success Stories" by Press, Ganey Associates in South Bend, IN.)
Patient satisfaction is a quality improvement (QI) project that never ends. At least that's what Warm Springs Rehabilitation Hospital in San Antonio has discovered.
The hospital staff and management have worked hard to improve and refine the hospital's customer satisfaction rating. For example, the hospital's laboratory services area launched its own QI project after scoring poorly in 1995 on the hospital's first patient satisfaction survey from Press, Ganey Associates in South Bend, IN. The efforts soon were rewarded, and the laboratory services area's patient satisfaction scores rose considerably in the years after the first survey.
The lab department also has won the Ernest A. Codman Performance Improvement Award from the Joint Commission on Accreditation for Health care Organizations in Oakbrook Terrace, IL, and the hospital was a finalist for the 1999 Press, Ganey "Client Success Stories" award because of its improvement in patient satisfaction with laboratory services. However, hospital and lab managers since have learned a humbling lesson that you can't coast after reaching the top.
In the latest survey, for the period ended Aug. 31, 1999, the hospital's overall patient satisfaction score was 87.5% at a 58th percentile, and lab services scored 87.5% at a 48th percentile. The survey's mean score for lab services was 87.6%.
"Our latest scores weren't so good," says Beverly Rhodes, MSHP, RRA, director of quality standards/risk management. "But it's a good thing because it shows that making an effort does matter: You can't have a project and work real hard on it and then stop trying to improve it."
However, the hospital's very first patient satisfaction survey was a major disappointment to the lab staff, especially because they didn't know why patients had rated their services so low. To make matters worse, the patients who were surveyed said the lab services department was the No. 1 factor in determining their overall satisfaction with the rehabilitation hospital. "This was shocking to me," says Jackie Keene, MT (ASCP), director of laboratory services for the 66-bed hospital. "We're vital in determining a patient's health, but in terms of having one-on-one contact with patients, that's such a miniscule part of our day."
When she dug to find out why patients were displeased, she learned how important the seemingly trivial can be. For instance, patients wanted the person who was drawing their blood to be friendly, cheerful, and even bubbly.
Scheduling was another problem: Rehab hospitals, unlike acute care hospitals, try to avoid waking patients in the middle of the night for blood draws because patients need to be rested for therapy. So Warm Springs has all the blood draws conducted between 6 a.m. and breakfast time, which started at 7:30 a.m., Keene says. That created too much stress for phlebotomists who might have to draw blood from 25 people in an hour. Patients sensed that the phlebotomists were stressed, which led to their own dissatisfaction. To help resolve that problem, the hospital decided to have respiratory therapists help the laboratory staff draw blood during those crucial morning hours.
Here are some other strategies Warm Springs Rehabilitation Hospital devised as part of the quality improvement project:
1. Speak with patients. Managers now are assigned to certain patient rooms as part of the adopt-a-room program. Each manager is responsible for meeting patients and making sure they have everything they need.
2. Educate staff about what patients see as quality care. Patients were much more concerned with how the blood was drawn than what happened to it afterward. Moreover, patients assumed that the lab staff would handle the technical end of their work in an excellent fashion, so learning how well the lab did its behind-the-scene work did not impress them.
3. Educate patients and work with physicians. Keene solved the problem of disturbing patients with multiple blood draws by teaching phlebotomists and other staff how to educate patients about the reasons for them. Staff end the discussion by suggesting patients ask their doctors about the lab work if they need more information.
Lab staff began to keep a list of all add-on lab orders and pointed them out to the hospital's medical staff leadership. Keene showed physicians how the patients with add-on lab tests were the ones who gave low ratings to lab services and to the hospital. As a result, some physicians began to reduce their number of add-ons.