To please patients, timing is everything
In 1997, the emergency department (ED) at Parkview Hospital in Fort Wayne, IN, was in the 45th percentile in South Bend, IN-based Press Ganey Associates satisfaction rankings. That same year, Southern Ohio Medical Center in Portsmouth, languished in the ninth percentile.
Since 1998, however, Parkview has consistently been between the 90th and 99th percentiles almost every quarter, and Southern Ohio also has gotten its Press Ganey numbers into the 90s.
What were the keys to Southern Ohio’s dramatic turnaround? "Our hospital made the decision in 1997 that we wanted to become known for service," says Mary Kate Dilts-Skaggs, RN, MSN, CAN, director of nursing for emergency and outpatient services at Southern Ohio.
"We had to use what the public was saying about us to really improve processes." And what did the customer surveys say? "The No. 1 complaint was time," she explains.
Parkview saw the same overriding issue. "The No. 1 goal we always have is to get the patient to the doctor [quickly]," adds Deb Richey, MPA, director of emergency services.
"They come to the ED to see the physicians, so any opportunity you have to streamline processes will benefit satisfaction," she notes.
Richey says it’s important to take a broad-brush approach. "Obstacles can be in the parking lot, in triage, in registration. There is a variety of things that can impede access."
One step at a time
With such a long way to go, Dilts-Skaggs says that success did not happen overnight. "It took slow but sure increments of improvement."
One of the keys at the starting point was an interdisciplinary team. "If you want to make changes, you need all the stakeholders at the table," she explains. Have all the departments interface with the ED so they know what the goals are. "For example, it’s hard for the laboratory to understand that all work in the ED is STAT unless they are at the table and hear it, because the [intensive care unit] and everyone else all want their attention," Dilts-Skaggs says.
The team, which included physicians, nursing, unit clerks, patient representatives, ED technicians, registration, medical imaging, the laboratory, and human resources began meeting monthly. Here are some of the key changes they implemented that have reduced process times:
• STAT lab. Some testing is performed in the ED, which has decreased the time it takes to get results to the physicians. "We do general screenings and a fair amount of testing," says Dilts-Skaggs.
• Rapid-cycle change. This tool, which enables staff to turn change on and off rapidly, was learned though work on a Veterans Health Administration initiative to decrease door-to-doctor times. Southern Ohio has cut their time from 90-100 minutes to 37.
• Bedside registration. There are dedicated registrars in the ED who use bedside computers on wheels.
• Computerized medical imaging. The doctors have reviews stations in the ED so they can look at X-rays and computed axial tomography (CAT) reference scans.
In addition, several initiatives were adopted that directly addressed patients and their families:
- A new ED was built with all private rooms.
- If patients have to stay all night in the ED because a bed is unavailable, the hospital sends them a small flower or plant to acknowledge their inconvenience.
- Beverage cart service is provided twice a day, and patient representatives regularly check on patients and families to see if they need anything.
Outside consultants were brought to Parkview to train staff in customer service to get patient satisfaction efforts started, Richey recalls. The combination of lectures and role-playing helped increase awareness of the need to serve customers. Then, several timesaving measures were instituted:
• The registration process was streamlined, and bedside registration was instituted.
This produced immediate positive feedback from patients and reduced turnaround time by 40 minutes.
• Nurses were trained in a faster triage process.
"If there is a bed available and you can look at a patient and see what kind of bed [he or she] needs, it’s not critical to do vitals or a huge history in the triage area," Richey explains.
• TVs were put in most exam rooms.
"This creates white noise and helps pass the time," Richey notes.
Interestingly, both Parkview and Southern Ohio adopted the "FISH philosophy of customer service." The approach draws its name from a series of books based on the successful customer service approach in Seattle’s Pike Place Fish Market. "They include a number of simple principles that help make your team passionate about customer service," Dilts-Skaggs says. "It makes it fun."
Richey adds, "We’ve really gotten a lot of mileage out of it. We’ve repeated the program each year and presented new customer service goals for each year."
Drawing on the FISH philosophy, Dilts-Skaggs says she celebrates the successes of staff.
"For example, the first time monthly bedside registration hit 800, we had ribs and chicken," she relates. "Happy employees make happy customers. It all plays into patient satisfaction."
[For more information, contact:
• Mary Kate Dilts-Skaggs, RN, MSN, CAN, Director of Nursing for Emergency and Outpatient Services, Southern Ohio Medical Center, Ports-mouth. E-mail: SkaggsMK@somc.org.
• Deb Richey, MPA, Director, Emergency Services, Parkview Hospital, 2200 Randalia Ave., Fort Wayne, IN 46805. Phone: (260) 373-6040. E-mail: Deb. Richey@parkview.com.]