Special Report: Making the Satisfaction Grade

Can’t get no satisfaction? Communication is the key

Here are a few tips from pros

(Editor’s note: The September issue of Hospice Management Advisor included articles focusing on hospice client satisfaction. In this issue, hospice officials offer tips on how to improve client satisfaction.)

Everyone who works in hospice has a list of ideas for what needs to be done to improve client satisfaction, but one theme appears to be a common thread throughout the hospice world: communication. "Communication is always a challenge," says Jan Jones, RN, BSN, FAAMA, president and chief executive officer of Alive Hospice in Nashville, TN. "We’re looking at how we communicate with the families, what can be expected at the time of death, and how to improve tools we use to communicate," Jones says. "Pain management is an area where we certainly perform well, but we also feel there are ways we can improve in terms of communicating with families about pain management efforts being made."

Honing employees’ listening skills is a goal of Bayada Nurses in Moorestown, NJ, says Mark Baiada, president of the company. Bayada has more than 115 home care offices nationwide that work with hospices and care for patients with terminal illnesses. Nurses are trained to listen actively and observe clients’ facial expressions to look for nonverbal communication, Baiada says. "We teach them to look at the person’s face to see if the person is communicating fear, discomfort, or worry," Baiada says. "The patient may be fearful and cannot express how he’s really doing."

Communication skills constitute an important aspect of coordinating patient care among a multidisciplinary team, says Christie Franklin, RN, CHCE, vice president of professional services, acquisitions, and start-up for AseraCare of Fort Smith, AR. When hospices coordinate care, it’s important for the patient and caregiver to understand which services will be provided, Franklin notes. "The case manager will review that with the patient and family, and with the facility staff if the patient is in a facility," she adds.

There are other important aspects of improving client satisfaction that hospices need to implement. Jones, Baiada, and Franklin offer these additional suggestions for improving hospice client satisfaction:

Focus on pain management, even if patients do not have complaints. "Typically we find that families perceive pain to be at a higher level than patients do," Franklin says. "This is something that we’re working on, an area where we might be able to do something differently."

AseraCare has held a series of inservice training sessions on pain management this year, offering a focused approach to palliative care, Franklin says. After AseraCare began to use the family satisfaction survey promoted by the National Hospice & Palliative Care Organization of Alexandria, VA, pain management was one of the top three priorities identified in survey results, Franklin notes. "We always focus on pain management, and one of the indicators we are focused on is the amount of pain medication received," Franklin says. "We really look at pain management, how often the patient was treated with respect, and the overall rating of hospice care."

Pain management education has included instruction by pharmacists, who join in conference calls with hospice staff, Franklin says. "We have some drug formularies that we review for educational purposes, and we give an overview of all the medications utilized for a hospice," Franklin explains. "We had courses in Pain Management I and II, plus the overview of medications and how to use them."

Improve staffing and access after hours.

"One thing that’s always a challenge for hospice programs and for us, as well, is how after-office care is delivered," Jones says. "As a result of information gathered on patient and family satisfaction surveys, we’ve made changes in our after-hours staffing." For example, several people surveyed said the hospice didn’t have someone to respond in a timely fashion after hours, Jones recalls. "So that’s our trigger to look more in depth at what’s happening with our triage system and our after-hours staff and how we need to build it into our budget for more staff," Jones says.

This is how a quality improvement project should work once a problem is identified, Jones notes. "When we see a trend like that, we delve more deeply and we certainly go to patient records and talk to family members and get specifics about what their issue was," Jones adds. "We talk to staff, including triage staff, to find out what it was they experienced, and from that we begin to gather data and look at what needs to be changed, where the gaps are, and what our expectations are for what was delivered."

For instance, hospice management realized that the after-hours staff were dealing with a higher volume of calls than they used to. As a result, it was unrealistic to expect them to handle all of these cases as rapidly as management wanted them to, so the hospice included another triage position in its budget, Jones says.

Put the client first.

One speaker who taught Bayada’s staff about pain management said this to hospice nurses: "Remember one thing when you come to the door of a client’s home: Just remember to show love," Baiada recalls. "When you show love when you’re in the home, you’re helping patients with all of the needs they have, including the physical and emotional," Baiada says. "So you have to prepare yourself to be of service in a loving and caring way, and to be reliable and have the skills in place so you can do a good job."

Families must be able to trust staff 

Likewise, the client’s satisfaction is more important than scheduling concerns, Baiada says. "If the family is dissatisfied with a nurse, then bring in someone new," Baiada says. "Especially in hospice care, staff support is so important because it’s a time of crisis for most families, and if one thing goes wrong, they lose trust."

Educate staff about client satisfaction surveys and quality improvement.

AseraCare hospices provide short educational sessions through the "lunch and learn" training program, Franklin says. These hour-long sessions are conducted by teleconference and are attended by executive directors and directors of clinical services first, Franklin says. AseraCare held these training sessions to show staff how the company planned to use a new client satisfaction survey, including details about the scoring guide, frequently asked questions, and some sample information on the reports generated from the survey information, Franklin explains.

A second teleconference session teaches staff how to complete the survey’s spreadsheet and provides them with data to enter during the call, Franklin adds. "We go through the steps of entering data and have the information technologies department on conference call to answer any follow-up questions," Franklin says. "Then we go over the reports and how those are to be reviewed and utilized, and we continue with the training."