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For a dozen years, administrators at Delnor-Community Hospital in Geneva, IL, had seen patient satisfaction scores fluctuate between the 50th and 75th percentile. And for a dozen years, management felt that while that was "pretty good, we wished we could do better," says Michael Kittoe, MBA, the chief financial officer of the 118-bed facility.
"We had gone through all of the usual efforts we had heard other organizations do, like working on call-light response time, forming continuing process improvement teams, and having campaigns to get our staff to do things like use patient names." Despite those efforts, says Kittoe, results never changed much.
About two years ago, though, the hospital administration started a campaign to make customer service a real competitive differentiation for the hospital. "It was a top priority, and we started seeking out new education." One of the leaders in the field that Delnor sought out was Quint Studder, the president and CEO of Baptist Hospital in Pensacola, FL, at that time. He was the first to tell Kittoe about rapid-cycle feedback, and by November 1999, Delnor had shifted from quarterly patient satisfaction reports to weekly feedback from surveys.
The impact over the last year has been marked. Combined average patient satisfaction results have risen from the upper 60 percentiles to the most recent figure of the 87th percentile. Inpatient results, says Kittoe, are No. 1 in the state, and outpatient surgery ranks in the 99th percentile in the country. The emergency department at Delnor is in the 98th percentile nationwide.
Even better, the rapid feedback of data is expanding to other data areas at Delnor. "Right now, we are experimenting with rapid-cycle feedback on financial performance measures," he says. Productivity is being measured using a product that looks at time and attendance, labor productivity, and management. "We e-mail department managers daily on yesterday’s productivity," explains Kittoe. Information on patient days, radiology procedures, or whatever is that department’s unit of service, is included along with how many staff hours were worked, how that data compare to budget, targets, and actual for the time period to date. "That means that if something is amiss, you can correct it quickly," he says. "If 10 days into a pay period you know you are 10 hours over the target for that period, you can use the last four days to make corrections."
In the future, rapid-cycle feedback will be used in the clinical arena too, says Kittoe. "We’ll provide physicians with feedback on their practice patterns in a more timely fashion."
While not "real-time" data, rapid-cycle feedback of data is just what it sounds like, says Kittoe. "It is quick and timely. You report survey results much faster than the traditional monthly or quarterly periods. We could do it daily if we thought it was appropriate and needed."
The faster you get the data to staff, he adds, the more meaningful they are. "It is hard to respond to something that happened two to five months ago," Kittoe says.
"It is easier to dispute or deny data at that point. With rapid-cycle feedback, people can relate to the data better, and it has the benefit of [being] a constant reminder of what is being measured and what is important," he says.
It wasn’t an easy transition for Delnor to go from quarterly patient satisfaction reports to weekly. "The biggest hurdle was developing a process for collecting, recording, analyzing, and reporting the data," recalls Kittoe. Most of the work was done in-house, but the hospital did make use of its satisfaction survey vendors, Parkside Associates, to help convert data into benchmark measurements in a faster time frame and put them into a report format.
Four or five questions from each survey are included in the weekly reports for each area: same-day surgery, inpatient, emergency department, and testing and therapy/outpatient. Delnor tallies up the results and submits them to Parkside by e-mail. Parkside looks up the percentile rankings for those questions and replies with the rankings for Delnor against past performance and against national norms. (See sample weekly report.)
The questions are on only those key areas that administration feels need attention at the time. "It narrows what the focus now should be," he says. "So far, we have cycled through a couple different questions. We make the changes when we have two consecutive quarters of improvement in an area of focus."
Kittoe compares trying to effect change under the old quarterly format to "trying to eat an elephant. You just don’t know where to start sometimes. So you zero in on the things that are really, really bad, like call light response times."
Because that’s always an area needing improvement, Kittoe says there were several performance improvement projects undertaken to improve the issue at Delnor. "But with a quarterly measurement cycle, we weren’t as successful in getting information back to line staff. They lost interest before we got the data back to them." Having the data available weekly, and data on specific questions that are of interest, helps to focus attention. "On the big survey, we didn’t know how to pick the right questions that were actionable. We didn’t have real success stories. With particular questions now, we have more success stories and more buy-in from staff."
There are still hurdles. It takes education to help managers and supervisors understand how to read the new reports. And there is a tendency to overreact to the variations in weekly results, Kittoe says. "Because of smaller sample sizes with weekly reporting, there will be more statistical variation in the results. We will have a 99th percentile one week and the 4th the next on the exact same question. This was hard for our associates to understand at first. What we had to focus on was the fact that to become the Best of the Best’ — the 99th percentile — we had to excel every day in every way. This helps us to look for opportunities for improvement all the time."
Change is never an easy thing, Kittoe admits. "We had the usual reactions to change: What is this? Why are we doing this? This won’t work. But we stayed committed and stayed the course." And it wasn’t just an attitudinal commitment that was needed. There were other resources required, too, including about 100 hours of staff planning time, and an additional eight hours a week of staff time to support the new process.
But so far so good, he says. By starting small and thinking big, Delnor-Community Hospital has made real progress in customer care, and if the expansion of rapid-cycle feedback continues, Kittoe thinks that progress will be mirrored in financial management and clinical areas, too.
"Pick a few questions from your survey that you know you can act upon," he advises. "Celebrate your small successes to keep the momentum going."
Kittoe says that with the increasing use of the Internet, external benchmarking companies will be better able to provide more timely data in the future. But for now, "you just have to do it for yourself."
[For more information, contact:
• Michael E. Kittoe, MBA, Chief Financial Officer, Delnor-Community Hospital, 300 Randall Road, Geneva, IL 60134. Telephone: (630) 208-4172.]