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As the author of a book about customer service in health care, one might expect Kristin Baird, RN, MHA, vice president of business development at the small health system Watertown (WI) Area Health Services, to know the value of measuring patient satisfaction.
That assumption is correct. And since the system and its hospital, five clinics, and two senior housing complexes already engage in external benchmarking of financial and quality indicators, you might expect that they did the same with patient satisfaction. But here, you’d be wrong.
Until mid-1999, the system used an internal tool to measure patient satisfaction. "I think the reason we didn’t follow the same line for patient satisfaction was two-fold," says Baird.
"First, it was a lot to tackle all at once. In 1997, we were new to benchmarking and trying to get management buy-in for the quality and financial benchmarking that we were doing," she explains. "At the same time, we were launching a new patient satisfaction tool that we developed internally. People were comfortable with what we were doing, and the results were positive."
But Baird says she wondered, "compared to what and to whom? We knew we had to give our people an effective target. They have to know that raw scores of 92 aren’t enough. You have to do more than say, Wow! We got an A-. Aren’t we great?!’"
The success of the other benchmarking projects, however, spurred Baird on to bring external benchmarking to patient satisfaction. "It gave us legitimate targets and common goals to shoot for."
And the result has been positive. In the first year after Watertown Area Health Services started using the external comparisons for its hospital, scores increased from the 56th percentile for inpatient care to the 99th. They increased from the 43rd percentile to the 69th in the emergency department and from the 47th to the 73rd for outpatient rankings.
There were bumps along the way, though. The first hurdle was getting middle management to buy into the idea. "I just had to put it in front of them all the time, give them a sense of ownership in the idea and how it will help us get and keep corporate executives."
The new hospital CEO came in after a 30-year stint by the man he replaced, and Baird says his emphasis on "paying attention to the outside world" helped to sway some people. "He believes in setting what he calls big hairy audacious goals. Among them are cost effectiveness, getting the best people, high clinical quality, and stellar customer service. We had three of the four all set up, but had no goals for customer service. We had to have external benchmarking to give validity and teeth to that whole issue."
Another potential setback was the initial shock of the first set of low rankings. "I was really disappointed because I thought we were doing well," Baird says. "I was glad to have the information, but I expected it to be much higher. It was truly humbling."
It could have been worse, she notes. "At least our lowest scores weren’t in the single digits like some others." The hospital CEO — whom Baird calls "forward-thinking and supportive" — also felt it was a good beginning, considering the hospital was just starting out. But staff also were disappointed.
"I think we needed that shock," she says. "I believe in competition and the competitive spirit to keep people hungry. I think when staff saw these scores come in, and looked question by question to see where we compared in food, friendliness, call lights — well, it has an impact on them that just talking about something doesn’t."
An example is the call-light issue, Baird says. "We started out in the 13th percentile on that issue. But staff came up with some ingenious programs to make it better." For instance, when making rounds, they manage patient expectations by telling them how long before they will return.
The hospital also created a new policy where anyone, whether it is the CEO or a maintenance worker, can answer a call light. "The vast majority of requests have little or nothing to do with nursing and more to do with connecting with people. Maybe they need their blinds adjusted or something fell," she says.
Training for the entire hospital staff ensued, so that everyone would feel comfortable with the new policy. There was also a contest to kick off the new policy, where everyone had a punch card. The "Punch Your Lights Out" contest rewarded those staff members who had the most punches in their card, with one punch received for every call-light response. The result of those efforts was an improvement in the call-light response question from the dismal 13th percentile to 99th.
It’s important not to get too complacent, though, says Baird. "We are really grappling with that. Whatever got their attention and created these big turnarounds isn’t there anymore. Our outpatient scores are in the 89th percentile now after a steady climb. A lot of people were doing a lot of things. And maybe that will keep us from slipping. It isn’t just one person preaching fire and brimstone from the pulpit, but creating a whole new mindset among staff. We are rewarding people for their good ideas, we are promoting the standards that we want to live by. We introduce them at orientation, post them on walls, and carry them on pocket-sized cards."
There also are weekly team meetings to work on specific issues that need addressing. "It’s a lot of work and very labor intensive," says Baird.
But there are other benefits, too. For instance, some of the fervor from improving customer service has bled into other "big hairy audacious goals." she says that by being clear about the values and expectations in an organization, you find that people who don’t fit in leave.
"People on the edge may go one way or the other," she adds. "And those at the top are invigorated when you raise the bar. Our employee satisfaction has risen. The national benchmarks we measure against for overall satisfaction, trust, and whether they would recommend us as a place to work are all near 90%. The industry norm is in the 60s."
There also has been more employee input in cost-containment goals. Through the bright ideas program, people have recommended ways to cut costs and improve morale. One winning idea commented on the overuse of Styrofoam. "It was costly and nonrecyclable, so we bought everyone in the organization an insulated mug with our logo on it."
Another idea was to create a check sheet for nurses to go through prior to a physician’s rounds. "Nurses and physicians felt that the nurses weren’t prepared for physician questions. There was a lot of time wasted in that. Now they have a sheet to make sure they are ready to answer the questions," she says.
Nurses also reformatted how they change shifts. Before, two shifts of nurses were on at the same time, but none were with patients at the bedside. Now they use written reports and electronic records so that time and money are saved. "And there is pride, too, because the nurses came up with the idea," says Baird. "It also improves patient satisfaction because the nurses spend more time with patients, and physician satisfaction because the patients are happier."
All this from outsourcing patient satisfaction surveys? You bet, says Baird. It isn’t easy or cheap, "but unless people have a point of reference, you don’t have a clear goal post in sight. You may be saying that you want to improve raw scores, but that’s not enough. You want to compare yourself and be competitive with what others are doing out there."
[For more information, contact:
• Kristin Baird, RN, MHA, vice president of business development, Watertown Area Health Services, 125 Hospital Drive, Watertown, WI, 53098. Telephone: (920) 262-4309.
• Baird’s book, Customer Service in Health Care (published last year by Josey Bass and the American Hospital Association) is available for $34.95 on www.amazon.com.]