Program aims to exceed patients’ expectations

Hospital’s projects heighten staff awareness

In today’s highly competitive health care climate, it’s not enough just to meet your patients’ expectations. You must go the extra mile and exceed them, says Verne Royal, MA, MS, CCC/SLP, quality and business systems manager for Detroit Medical Center-Sinai Hospital.

"One of our initiatives was to get away from the idea of patient satisfaction and to move to delight the patient. We wanted to figure out what it is that makes the patients tell their friends, ‘Not only did I get better, but these were the nicest people,’" Royal says in describing how DMC-Sinai’s physical medicine and rehabilitation department created a climate in which the staff is committed to the patients.

Until a few years ago, rehabilitation questions were included on the hospital’s patient satisfaction questionnaire. The rehab team decided to devise a separate survey for the rehab stay so it could address the problems rehab had control over, says Julie Libcke, RN, BSN, CRRN, inpatient manager for DMC-Sinai’s department of physical medicine and rehabilitation.

Comprehensive plan

When the rehab department joined the national database system administered by Press, Ganey Associates, a South Bend, IN, satisfaction measurement firm, the results were not as good as the administration would have liked, Libcke says.

That’s why the staff developed a comprehensive plan to increase patient satisfaction and to make going the extra mile to delight patients a high priority for every staff member. Already, they’ve seen results. In the first two quarters of 1997. DMC-Sinai’s physical medicine and rehabilitation (PM&R) department went from a score of 85.2 to a score of 91.9 on its patient satisfaction surveys.

The rehab administrative team decided to focus on three major initiatives during 1997:

Increase the response rate for patient satisfaction surveys. Although the PM&R department was discharging 120 to 150 patients per quarter, only 20 to 30 were returning surveys.

"That’s a lot of patients who weren’t giving feedback," Libcke says.

In the past, patients were mailed the satisfaction surveys a few days after discharge. The hospital tried a pilot project in which the surveys were placed with the patient discharge instruction folder, but it also failed to show a consistent return rate. Now, a rehab aide meets with the patients and gives them the surveys a few days before discharge. The patients are asked to place the survey in a special box before they leave the hospital.

The aide has been trained to interpret the surveys for patients who have difficulty understanding or reading. However, the aide doesn’t fill out the survey for the patient because statistics have shown patients tend to respond far more positively to oral surveys, Royal says.

Since the project was initiated, the response rate has doubled.

Identify problems earlier in the stay so they can be turned around more quickly.

If something happens in the beginning of a patient’s stay, and the staff doesn’t find out about it until he or she fills out the patient satisfaction form at discharge, the patient winds up with a misperception about his or her care and a less positive view of the hospital, Libcke says.

"The survey is only one way we measure satisfaction. We are always getting information from the patient, the family, and other staff members and acting on it. I don’t think you can just wait around for quarterly results," Libcke says.

The staff came up with several projects to help identify and deal with patients’ concerns, problems, or misconceptions throughout the rehab stay. The nursing unit’s "Adopt-A-Patient" program, for instance, assigns each patient to a member of the management team, such as the nurse manager and nursing educator, who do not routinely provide patient care. The managers check in with the patients after admission to see how orientation went and leave their phone numbers so patients can call with any concerns. They visit patients throughout their stay to hear their concerns and complaints, particularly about nursing care and environmental issues.

The therapy staff initiated a hospitality log sheet that encourages therapists to do more than just sympathize when patients complain about hospitality issues such as room temperature or receiving the wrong food.

Because patients spend more one-on-one time with therapists than other staff, they often express their dissatisfaction to therapists, Libcke says. And while the therapists may be sympathetic, they don’t have control over hospitality issues and historically have not take action on the complaints. In the past, patients assumed they had shared their concerns and didn’t complain to anyone else, which created a bad impression of the hospital when the problems weren’t solved.

Now the unit clerk in each area of the hospital keeps a hospitality log of complaints by patients. If a patient mentions a hospitality problem, the therapist tells the unit clerk, who reports it to the appropriate staff for correction.

Help the staff develop a culture in which patient satisfaction is "lived" instead of just talked about.

At DMC-Sinai, patient satisfaction is a topic for discussion at every biweekly staff meeting and at the weekly administrative meetings. A group of staff, chosen because they exemplify good customer relations, has been appointed to a committee to create projects to encourage all staff to make good patient relations a part of their everyday work culture. (See story, below right.)

When the administrative staff receive patient satisfaction survey results, they go through them question-by-question during staff meetings. Staff are asked to discuss what may have contributed to each rating, what they feel patients’ perceptions were, and other things they see that might be hindering satisfaction. Copies of each patient’s survey are passed around so the staff can see more than just the final numbers.

When the staff discussions were first instituted, the staff often tried to minimize the results, saying things like, "That’s not what the patient told me" or "He seemed really happy," Libcke says. "We have gotten the staff to realize that they do give good care, but sometimes the patients don’t perceive that they are getting good care. People are now looking at their own behaviors to see how it affects satisfaction," she adds.

In addition to quarterly reports from Press, Ganey, the PM&R department has developed an internal monitoring system that gives weekly feedback from the patient representation office.

Addressing concerns

Patient satisfaction is a topic at biweekly staff meetings and weekly management meetings. "Staff historically haven’t thought of good guest relations as something tangible, like forgetting to sign their chart for the day. We have tried to heighten the importance for our staff," Libcke says. (See guidelines, inserted in this issue.)

The management team has integrated attitude into the overall performance evaluation and works with staff who have bad attitudes. Now, if a patient identifies a nurse or therapist who may have been curt with them, a member of the management team sits down immediately and discusses the complaint.

"We no longer just let things go. If a patient tells me a concern, it is addressed," Libcke adds.

While she keeps a sharp eye on the department’s satisfaction surveys, Royal cautions staff not to make hasty program changes just because the numbers on the surveys change.

Surveys show that provider performance is uniformly strong in health care, with little variance among competition, she says.

"We’re not dealing with a lot of people at the bottom of the rung, and it takes just a few points to change your percentile," she adds.

For instance, DMC-Sinai’s PM&R department went from the 13th percentile to the 99th in a year, but its score went up only from 85.2 to 91.9.

She warns against hastily making changes in reaction to normal variability. "Everything has variability. If you respond to variability that is not representative of real change, you are making unnecessary adjustments," she says.