Boost satisfaction scores with key words and quick response

Staff education and involvement are keys to success

One way to make sure discharge planners, physicians, and other referral sources continue to send you new patients is to make sure your patients and their family members are happy with your services.

Ensuring your patient satisfaction program is top-notch takes more than just sending out surveys, according to winners of a national patient satisfaction improvement award offered by Press Ganey Associates in South Bend, IN.

"The first step we took was to make sure all of our staff members were familiar with the survey and knew what questions our patients would be asked," says Tricia Bussell, RN, manager of Avera McKennan Home Care in Sioux Falls, SD. "While we don’t write scripts for our nurses to use, we do point out how the questions are worded and remind them to use the same words when talking with their patients," she says. For example, patients are asked questions on their survey about staff members’ concern for safety and privacy, as well as their explanations of medications or medical conditions. Therefore, nurses should use wording such as safety and privacy when explaining things to patients, she explains.

At Baptist Health Home Health in Heber Springs, AR, nurses also use phrases such as, "We’re concerned about your privacy," or "We want your family members involved in your care," says Ann Roberson, RN, MSN, CNS, director of the agency. "Patients may not receive the survey forms for several weeks after discharge, so we need to make it clear during our visits that we are concerned about their privacy or safety or involvement in the care plan," she explains. The best way to ensure patients remember your concern is not to take for granted that they interpret your actions to indicate concern, she adds.

Because Bussell wants to deal with a complaint immediately rather than a couple of months later when she receives survey forms, she encourages nurses to be aware of patients’ or family members’ actions that indicate dissatisfaction. "If a nurse believes that the patient is not happy about something, she reminds the patient that our home health agency wants to make sure we’re providing the best possible care, and if there are any concerns, we want to know about them immediately," Bussell explains.

"Nurses handle many of the complaints immediately, but they always let me know if there was a concern expressed by the patient," she says. "This is important for me to know so that I am not caught by surprise if the patient or a family member contacts me about the same thing."

It also is important to look at complaints as a chance to evaluate your agency’s service and make improvements, Bussell points out.

"When we do get complaints, they are usually related to scheduling or continuity of staff. We have initiated a performance improvement project that is looking at continuity by evaluating our scheduling practices and geographical location of patients," she explains.

The project should result in a process that increases the likelihood that the same staff person will see a patient over a period of time and should also result in a savings in mileage costs, Bussell adds. "We recognize that it is more beneficial for the same nurse to see patients each time, but we have to balance vacation time, sick leave, and weekend coverage," she says. Even with these challenges, Bussell’s goal is to improve continuity of staff for each patient.

Another way her agency addresses complaints about scheduling is to take the patient’s schedule into consideration when setting up visits, Bussell says. "We try to work around the family’s schedule," she explains. Sometimes, this means avoiding the time slot for the patient’s favorite television program, she adds. "While watching The Price is Right’ is not important to us, it is important to the patient, so we try to respect their schedule."

Roberson’s review of complaints or concerns expressed by patients showed patients don’t understand their financial responsibilities. "We now have a sheet in each patient information booklet with boxes for the nurse to complete," she says. The forms indicate the expenses for which the patient will be responsible.

"If the patient’s visits are covered by Medicare, we indicate that Medicare will pay in full. We leave this information in writing with the patient so that he or she, or any family member will be able to read it whenever they have questions," Roberson adds.

When reviewing results of your patient satisfaction surveys, be aware of the sample size and how that size affects results, she warns.

"We are a very small agency with only nine staff members. We don’t have hundreds of patients returning surveys, so when we do have a poor rating from one or two patients, it significantly affects our overall score," she says. In this situation, be aware that it may be only a few poor ratings but also be ready to look at the reason for the complaints, Roberson adds.

"We have also noticed that when our staff members are stressed due to a change in software we use or a staff shortage caused by someone on family medical leave, our patients did complain more," she explains. This means managers must be ready to recognize times of stress for staff and counsel them not to take office-related problems into the patients’ homes, Roberson adds.

"If you are part of a hospital system, be aware that the patient’s experiences within the hospital may affect their perception of your service as well," she notes. That is why it is important to keep your staff members attuned to identifying and handling patient complaints quickly so you know which complaints are truly home care-related and which relate to previous care, Roberson says.

One way to improve staff members’ recognition of the importance of a patient satisfaction program and increase their efforts to address patient satisfaction is to share the survey results with them, Bussell says. "We hold a unit meeting once each month to discuss a variety of issues, but patient satisfaction is always on the agenda. I review the results and point out areas in which we’ve improved or declined." She encourages group input for ideas to address weaknesses.

"When I can identify the specific clinician in a patient’s complaint or compliment, I share that on a one-to-one basis with the clinician," Bussell says. "This feedback is important so that clinicians understand how patients perceive them."

Whether you contract with an outside firm to conduct your surveys or you handle them in-house, Roberson suggests you look carefully at the survey tool. "Make sure the tool fits your client base. If the form is too lengthy, hard to read, and contains repetitive questions, an older patient will get frustrated and not even complete it," she notes.

Although her agency has won Press Ganey’s award for improvement of patient satisfaction scores twice in the past four years, Roberson points out that the real benefit of working to improve your patient satisfaction results isn’t an award.

"We know that we provide excellent care, but the survey results prove to us and to other people throughout the hospital system that our patients also believe we provide excellent care," she stresses.

[For more information about using patient satisfaction programs to improve performance, contact:

Tricia Bussell, RN, Manager, Avera McKennan Home Care, 1016 Southcliff Ave., Sioux Falls, SD 57104. Phone: (605) 322-7740. E-mail:

Ann Roberson, RN, MSN, CNS, Director, Baptist Health Home Health, 1709 W. Main St., Heber Springs, AR 72543. Phone: (501) 206-0025. E-mail:

For information about patient satisfaction tools available for home care, contact:

Press Ganey Associates, 404 Columbia Place, South Bend, IN 46601. Phone: (800) 232-8032 or (574) 232-3387. Fax: (574) 232-3485. Web site:

Fazzi & Associates, 243 King St., Suite 246, Northampton, MA 01060. Phone: (413) 584-5300. Fax: (413) 584-0220. Web site:]