Patient Satisfaction Planner

A NOD’ to patient needs boosts satisfaction rates

Proven strategies from other industries used

New York City may have a reputation as a fast-paced metropolis where most people are too busy to give you the time of day, but the emergency department (ED) at Jack D. Weiler Hospital, one of three EDs in Bronx’s Montefiore Medical Center, has won over patients with an approach focused on friendliness and TLC. A 2001 Press Ganey Associates patient satisfaction survey ranking the facility against its peer hospitals in New York City showed the ED to be in the 25th percentile in 2001; by 2004, it had reached the 70th percentile. In 2001, 5.2% of registered ED patients "eloped" (left without being seen).

In 2004, under a new fast-track system, only 1.5% of ED patients eloped. During that same period, community visits to the ED have jumped 15% and hospital admissions from the ED have soared 30%, while hospital ED visits in the Greater New York region have remained relatively flat, according to data from the Greater New York Hospital Association.

There were many factors that led to the turn-around. One was high staff turnover. "First, we had to replace nursing and physician leadership, which we did in 2001," recalls Peter Semczuk, vice president of clinical services at Montefiore. "Then we wanted all board-certified emergency medicine docs; we ended up hiring 50 for our three EDs."

A five-tiered triage system, including a separate fast-track wing to give patients immediate care, also had an impact, says Alice Corbett, RN, administrative nurse manager at the Montefiore ED. "Without the process changes, the other initiatives would not have enabled us to handle the volume and acuity, but all of these things working together have made a huge impact on the department."

In light of the poor Press Ganey numbers, the whole ED management team (the medical director, assistant medical director, the unit manager, and several nurse managers) sat down to determine why customer satisfaction was so poor and to devise a plan to turn things around. During their discussions, they turned their attention to concepts that had proven successful outside the health care setting.

One of those concepts was the NOD (name, occupation, duty) approach used by the Disney organization. Now, whenever staff members come in contact with a patient, they always share that information. "They might say something like, Hi, my name is Bonnie. I’m the manager of the department, and I’m here because I heard you needed to see a manager,’" Corbett offers. "Any staff member approaching any patient needs to introduce themselves and say what they are about to do."

The other key concept involves a commitment to avoid any patient being "hungry, angry, lonely, or tired. In order to increase communication with people in the waiting room, we started to have a food cart come around," she says.

This teatime cart is brought around just before dinnertime, "when everyone is hungry and cranky and we are most packed," Corbett notes. The cart contains coffee, tea, hot chocolate, juices, muffins, fruit, and yogurt, and has magazines on the bottom shelf. "If a mom shows up with kids in tow, we make sure to give them PB&J," she adds.

The department has a standing order of cold sandwiches, including peanut butter and jelly, which arrive fresh twice a day. All of this is free of charge. The dietary service doesn’t charge for the food, and an ED service associates passes around the cart. After about a year, the director of food services approached the ED and offered a morning tea-cart service, manned by a food service associate.

This also is not charged to the ED. The food service department prepares the morning and afternoon teatimes. During teatime, as with regular mealtime, the MDs and RNs let the server know which patients can eat. The servers will provide for visitors but will not give food or fluid to any patient unless OK’d by the clinical staff.

Joseph Braverman, MD, medical director of the ED, says, "To the extent that the patient is angry and hungry, and when other factors like a long wait take their toll, when you go in to see them you are already in a hole, and you have to dig yourself out. This approach makes that a rare event." Upon each visit, physicians also are encouraged to prop up patients with pillows.

Another key strategy at Montefiore is the solicitation of input from the patient, to ensure care is satisfactory, or determine the cause if it is not.

For example, the physicians call a small sample of seen-and-discharged patients the next day, he says.

"It’s always reassuring to double-check on their condition," Braverman explains. "If they feel they need be reevaluated, you can encourage them to see their doctor or come back; or if they were unhappy with their waiting time, it presents an opportunity to mend those fences."

Patients who receive these calls are very surprised and appreciative, he adds. "All of the thanks you may not get when the patient is in pain and stress in the ED, you sure get then."