Satisfaction climbs with smiles, other soft skills

Patient satisfaction improves dramatically if your staff pay more attention to the soft skills of ED care, such as the way you talk to people, while simultaneously improving the physical surroundings.

That was the experience of managers at one ED in Arkansas, who also found that staff morale improved significantly.

The ED at the University of Arkansas for Medical Sciences (UAMS) in Little Rock, has been trying to improve patient satisfaction for about two years, using a multipronged approach, says Glenn H. Raup, RN, MSN, director of the ED, which sees about 31,000 patient visits a year. When Raup took over as director in 2001, overall patient satisfaction scores were in the mid-60s.

He reviewed the primary complaints from patients and staff. They were the same problems that many EDs face, such as waiting times and the difficulty of conveying information adequately to patients during busy periods.

"We focused on the perceptions that nurses weren’t taking problems seriously, weren’t taking time to listen, and weren’t attentive to [patients’] needs," Raup explains. "We’ve shown dramatic improvements in those areas, going up one to four percentage points for all nursing areas."

The ED’s overall patient satisfaction scores now are consistently in the mid-70s, and Raup expects them to continue climbing. Eventually, the ED’s goal is to reach 95% patient satisfaction and stay there. "That is a very lofty goal, and we all realize that, so we’re taking incremental steps like focusing on soft skills: eye contact, a smile on the face, all of those things that demonstrate we care what [patients’] needs are," he says.

Can be a tough sell

The idea of telling overworked ED staff to smile more may seem unrealistic, and Raup confirms that it is no easy task.

Role modeling by managers was important in convincing staff to give it a try, says Colleen Jordan, RN, a care delivery facilitator in the UAMS ED. Jordan’s managerial position was created to continually monitor patient care, ensure resources are allocated properly, and provide constructive feedback to nurses — all with the goal of improving care and satisfaction levels.

"They’re accepting it, and I think part of that comes from seeing that others can smile and still get their jobs done, can take a few minutes to say something nice to a patient, and keep up with the patient load," she adds.

UAMS also convinced staff of the importance of soft skills by having them meet in small groups to discuss other situations they may have experienced outside the ED in which soft skills made a difference.

"We ask them to think about times in restaurants or hotels or airports where they were having a stressful time and the other person’s demeanor made a difference in whether that experience got worse or better," Raup continues. "It helps them understand that this is something that has real impact on our patients and isn’t just a crazy idea from management."

He also asks staff to consider how much time they would have to spend with one angry patient vs. smiling at 10 patients who were on the verge of being dissatisfied, and which one they would prefer to do. They always choose the latter.

Avoid judging patients

ED staff members are encouraged to read patients’ comments and read between the lines to see what’s at the root of the dissatisfaction. Many times, the problem is that the patients felt staff members were judging them, based on things such as the tone of voice, facial expressions, and standing over instead of sitting with the patients, Raup says.

Nursing rounds also were implemented to improve patient satisfaction, Jordan points out.

"All the nurses go to the bedside every four hours and talk to the patient, let them know what we’re doing, what’s going on with their treatment, and ask simple things like whether they want a blanket," she says.

"That way the nurses stay in contact with the patient. We also have some patient liaisons that round with us to help handle issues that might not be nursing-related."

Look for total immersion

To make a soft skills approach work, Jordan says ED managers have to employ it with staff, not just patients. And you have to back up the smile on your face with a sincere desire to make things better. "They need to see that your intent is genuine, and you’re not just going into a patient room and putting on a fake face because you want your scores to go up," she notes. "Some of the nurses look at me and say, If you can do this after being here 14 years, maybe I can, too.’"


For more information on patient satisfaction, contact:

  • Glenn H. Raup, RN, MSN, Director of the ED, University of Arkansas for Medical Sciences, 4301 W. Markham, Slot 600, Little Rock, AR 72205. Phone: (501) 686-8998.