Daily satisfaction surveys yield weekly improvements
Real-time data address staff, patient concerns
ED management and staff at Fairfield Medical Center in Lancaster, OH, have improved both internal and external customer satisfaction by instituting a system of daily satisfaction surveys. Patient satisfaction is now at 95%, and physician satisfaction is above 90%, when they had both been at about 80% to 85%.
It works like this: Every day a patient representative surveys 13 ED patients (10% of the average daily census), five staff members and two physicians. Each time, the representative uses the same set of questions and receives a rating of 1-5 (5 being the highest) from the respondents for each question. (See form.) Based on the responses, a "goal of the week" is established for targeted improvement.
"One of our corporate goals is decreased turnover," adds Susan G. Cook, RN, BSN, nurse manager of the ED. "This year, we were at 2% for this department, which met that goal." Nationwide, average turnover rates for the year 2000 were between 12% and 16%, and the projected rate for 2005 is 16% to 25%, she explains.
The initiative began a couple of years ago when Cynthia Pearsall, RN, vice president of nursing, attended a conference at which she learned of a model of surveys used to address staff resistance to customer service and changing behaviors. While impressed, she felt changes were needed to make the model effective at Fairfield, Pearsall adds.
"I wanted do measurements daily, because if you collect data for a quarter and then take a month or two to compute it, it’s behind the actual behaviors of people," she notes, "So I said, Let’s do something fast and benchmark against ourselves.’"
She first met with Cook and the hospital medical director. Subsequently, Cook met with the charge nurses, who developed the initial set of questions. Pearsall next attended staff meetings, explained the initiative, and solicited volunteers for a steering committee. "People were reluctant at first," says Cook, "but they saw the potential to make a change."
Once the daily surveys are completed anonymously, they are brought to Cook’s office. She enters the responses into an Excel program, which is set up to calculate the satisfaction percentages for patients, staff, and physicians.
The goals of the week do not have to be big issues to be important, Cook notes. "Our very first goal had to do with physicians being unhappy because there were not always blankets and sheets on the beds," she recalls. So the first goal of the week was to have blankets and sheets on all the beds, along with the patient’s gown.
"That was a potential problem, because there were not enough sheets, and the laundry person figured that it would cost an additional $23,000 to replace the missing sheets," says Cook. The expenditure was approved, and an item than had been ranked as a 2 or 3 in satisfaction went up to a 4 or 5.
One thing Cook has learned from the experience is that it’s sometimes preferable to address easy changes. "We haven’t tried to change things like the waiting time in our waiting room," she says. "We’ve worked on issues like respecting the patient’s privacy, introducing yourself to patients, or avoiding negative speech or thanking each other."
Comfort issues were made a priority. "Many patients would write a 1 when asked about the amount of time they had to wait for treatment," Cook notes. "Over time that has improved — not because they were waiting any less, but because we were more in tune to keeping people informed."
Many 2s and 3s were turned into 4s and 5s by focusing on communication and patient comfort, she asserts. The ED staff has focused on simple things such as making sure patients have blankets, maintaining privacy, and keeping patients updated on their status (i.e., labs and X-rays), notes Cook.
In the early days of the program, the changes were impressive. Patient satisfaction moved up to about 95%, physician satisfaction moved up into the low 90s, while staff has remained in the mid-80s.
"Part of [the problem with staff satisfaction numbers] is some of the questions we ask them," notes Cook. "Some things are harder to change, such as patients being seen in a timely manner, and those kinds of things bring the numbers down." However, she notes, staff are reminded to check on their patients every 30 minutes, and to document those checks.
However, an in-house survey that asks patients if they would recommend Fairfield to family and friends is now at 85%. "When we started, it was lower — about 81%," Cook says.
Maintaining the improvement, as with any performance improvement program, is a challenge, Pearsall concedes. "I think in the beginning, it worked really well; we did see a big bump in customer service scores, but it got old over time," she says.
Managers now are looking at other options for boosting morale in the ED. "Still, it made people realize they are in charge of their own behavior, and that what they do impacts how patients feel about us," she says. They must be doing something right, because the medical/surgical and intensive care nursing units are now using the same concept, Cook adds.
For more information on measuring patient and staff satisfaction, contact: