Award-winning ED treats its patients like family

Staff provide nonmedical services to its 'customers'

The ED at Martha's Vineyard Hospital in Oak Bluffs, MA, has consistently achieved extraordinarily high customer satisfaction ratings while operating in a unique environment. For example, being a resort destination, its patient population swings from an off-season low of about 15,000 to an in-season high of more than 100,000, which has a significant effect on it ability to maintain high levels of patient satisfaction due to issues such as staffing and space. More than 30% of its annual 14,000 ED visits occur during July and August.

On the other hand, say its leaders, the "family" atmosphere of its small-town locale easily translates into the ED, where the staff often know the patients personally.

"One of the things that strikes me most about this department is that people here try very hard to treat the patient the way they would like to be treated; maybe that is part and parcel of being a very small community," says Timothy Tsai, MD, director of the ED. "A lot of people who work in the hospital have grown up here and have a strong sense of connection with friends and neighbors."

Tsai notes that in previous jobs, "I could go a year without seeing a patient on the street. Here, I see friends, neighbors, and kids in the department, and there are automatic predisposing factors to wanting to provide good care."

Martha's Vineyard is one of 12 departments to receive the prestigious Summit Award in 2007 from the patient satisfaction firm Press Ganey Associates. Award winners must score in the 95th percentile or higher for three consecutive years.

Going the extra mile

As a small, critical access hospital, Martha's Vineyard must often transfer trauma patients to Boston on the mainland, notes president and CEO Tim Walsh. Here is where the staff often will go the extra mile for patients, he says.

"We try to eliminate the worries that patients and families might normally have about these transfers," he explains. "For example, we might call the ferry and have it held to wait for them, which only can be done by a hospital." The staff, he adds, often will set up the ferry rides and arrange the tickets for the family so they can immediately leave the hospital and drive to meet it. They are given preprinted directions to the ferry and to the appropriate hospital in Boston.

"If it's needed, the staff will print out directions from MapQuest," adds Tsai. "We also call cabs to take people home after they are discharged."

Tourists get same treatment

It might not seem that surprising to see friends and neighbors get such special treatment, but the same caring and courtesy are also extended to the tourists who make up most of the island population a few months out of each year. This change in patient population took much more planning, not only in arranging for additional staff, but in selecting the right staff and in keeping that staff together year after year.

"This is quite a busy, metropolitan place for three months in the summer," notes Walsh, who says the hospital has to rent 30-35 houses for the extra ED staff. "Tim has done a great job of lining up the same contingent of physicians."

"During the [summer] season, we add 12 hours a day of physician coverage and more than double the nursing staff from eight to eighteen," says Tsai. "We also open up a fast-track area."

He says the department benefits from the fact that people like to come to the area in the summer. "We try to bring the same staff back because it creates a strong esprit de corps, and it contributes to quality of care," he says. Having a "revolving door of strangers" does not lend itself to consistency, Tsai says. "People who come back summer after summer have a commitment to the patients and to the department," he says.

In terms of selecting summer staff, Tsai is cognizant of the type of staff he already has. "The people we invite back are quality people," he says. "There are also intangibles like chemistry and a sense of teamwork."

Reinforcing the message

Despite the built-in tendency to treat patients and families like family, Tsai says he takes care to reinforce the need to stress patient satisfaction in his department. "I believe in positive reinforcement," he emphasizes.

All Press Ganey surveys at the facility are reviewed carefully by senior management and passed on to department managers. "We get a lot of good feedback, but all of the survey results are posted on a regular basis, every six months," says Tsai. "I go over the results and highlight the areas we need to pay attention to."

Negative feedback, he continues, is given equal play. "I circle it on the form and post it along with the positive stuff. We will discuss the results at meetings with the nursing staff, but our staff is small enough and we know each other well enough that it's possible for nurses and physicians to talk about the results and think about ways to improve together."


For more information on dealing improving patient satisfaction, contact:

  • Timothy Tsai, MD, ED Director, Martha's Vineyard Hospital, Oak Bluffs, MA. Phone: (508) 693-0410, ext. 433. E-mail:
  • Tim Walsh, CEO, Martha's Vineyard Hospital, Oak Bluffs, MA. Phone: (508) 693-0410, ext. 487.