Patient Satisfaction: Patient Satisfaction ACUTE CARE, INC. Team
March 2, 2007
Paul Hudson, Chief Operating Officer
ACUTE CARE, INC.
Objectives: Objectives The participant will be able to:
Describe the characteristics of the “new healthcare consumer”
Describe healthcare consumer expectations
Explain the difference between patients and customers
List two questions from an ED patient satisfaction survey Objectives, Continued: Objectives, Continued The participant will be able to:
Describe how sitting down during the physician-patient interaction affects patients' perception of that encounter
Define "scripting" in the context of an Emergency Department encounter with a patient or family
Discuss a minimum length of time a physician should allow a patient the opportunity to talk before interrupting
Describe “managing up” coworkers Why are we here?: Why are we here? The New Healthcare Consumer: The New Healthcare Consumer Today’s patient is more discerning and demanding.
She also has more access to information and a wider array of choices.
In many ways, today’s patient shouldn’t be thought of as a patient, but as a consumer.
She wants to know the quality of care provided by her doctor and hospital and how much procedures will cost. The New Healthcare Consumer: The New Healthcare Consumer In some cases she can find that out with the click of a mouse. A savvy Internet user, the new consumer also expects health care to adopt the same functionalities as other industries that allow her to buy movie tickets, book a hotel room and pay a bill online.
If she doesn’t like what she sees, she is more likely now than in the past to shop around with her health care dollars. The New Healthcare Consumer: The New Healthcare Consumer According to research by Press Ganey Associates Inc., people between the ages of 35 and 49—a major part of the new consumer cohort—have the lowest patient satisfaction scores compared with other age groups.
They are more likely to have health problems than younger people, so they have more encounters with health care providers.
They also tend to be more computer-literate than older consumers and are more comfortable looking for health care information. What Do Patients/Clients Want?: What Do Patients/Clients Want? The new healthcare consumer:
Wants positive outcomes
Wants relief from symptoms
Is Internet active
Insists on customer service
Insists on control
What Do Patients/Clients Want?: What Do Patients/Clients Want? Consumers find it easy to attribute both positive and negative experiences to the hospital itself—for example, holding the hospital responsible for the behavior of those who work there.
So if bedrooms and bathrooms are not kept clean, if nurses fail to deliver medication on time, if staff physicians rush through examinations or explanations, someone in a leadership position must be held responsible for seeing that the problems are corrected. Five Things that Matter Most to Patients: Five Things that Matter Most to Patients Doctors treat patients with courtesy and respect.
Doctors explain the facts in a way that patients can understand.
Doctors, nurses and other hospital staff do everything they can to help patients with their pain.
The hospital room and bathroom are kept clean.
Patients get information in writing about symptoms or health problems to look for after they leave the hospital.
What Do Patients / Clients Expect?: What Do Patients / Clients Expect? Retail shops, hotels and the Internet have all influenced consumer expectations about health care and, by extension, hospitals. They have primed consumers to value customer service, convenience and easy access to information. What Do Patients / Clients Expect?: What Do Patients / Clients Expect? Hospitals should have better amenities
When they are staying overnight in a hospital, many patients expect hotel-like amenities.
Many hospitals are starting to implement changes that will improve the patient/consumer’s experience, including improved food service (such as improved menu options for patients), concierge services, spa treatments such as massage, and Wi-Fi connections in the hospital. A hospital that offers this type of customer service may have better patient satisfaction and loyalty than competitors without such services.
What Do Patients / Clients Expect?: What Do Patients / Clients Expect? Basic health care should be inexpensive and convenient
A number of retailers, including Walgreen's, CVS, Wal-Mart and Target, are starting to provide some health care services. Store-based clinics offer convenient hours and basic health care services at a lower price.
Though clinics can help keep patients with minor conditions out of emergency departments, they also often refer patients with more serious conditions to specific hospitals. Some health care providers partner with retailers to provide these services and ensure customers build a relationship with them.
Patients’ Expectations: Patients’ Expectations Experience + Needs + Communication = Expectation
If Perception exceeds expectations: Satisfaction
If Expectations are less than perception: Dissatisfaction A Story: A Story A Story: A Story We have relatively low unemployment in our town. My own company won several key employees away from other local firms because of our health and sick leave plans. We insure our employees through our health plan, a plan that offers one of four local hospitals as the in-network provider. If an employee wants to go to one of the other hospitals or other doctors, then he or she has to fork over a larger co-payment. How many valuable staff have to complain about the company’s plan’s hospital before we decide to dump the plan for another that offers a rival institution? Certainly no more than 10 percent, and probably fewer. When we switched health plans several years ago, it was because the new plan was moderately less costly, but especially because a significant number of our staff (eight out of 100 employees) had complained about service at the previous plan’s hospital. They were particularly displeased with ED staff. None of the employees complained about the switch. A Story, Continued…: A Story, Continued… When we switched, the previous plan lost several hundred thousand dollars worth of business (and they did call us to find out why we took our business elsewhere). The hospital lost far more than that. At the time we switched, it lost 100 insured workers plus their average two to three dependents. We now have over 170 insured employees. For the hospital we no longer use, the lost opportunity cost will total in the millions of dollars over the next decade. Both cost and employee satisfaction drive our selection of health plans now. We can’t afford a generalized loyalty to any particular hospital. It doesn’t matter how many testimonials to their quality they publish in the local paper and on local TV or even whether their name appears among the “best hospitals in the United States” list published by a major national magazine. If enough of our employees don’t like the hospital, we won’t use it! Patients or Customers?: Patients or Customers? Patient or Customer?The “Patient- Custometer”: Patient or Customer? The “Patient- Custometer” Horizontal – Patient
Vertical - Customer Patient Satisfaction Surveys: Patient Satisfaction Surveys Survey Questions: Survey Questions Press Ganey – ED Providers: Nurses
Courtesy of the nurses
Degree to which the nurses took the time to listen to you
Nurses' attention to your needs
Nurses' concern to keep you informed about your treatment
Nurses' concern for your privacy
Survey Questions: Survey Questions Press Ganey – ED Providers: Doctors
Courtesy of the doctor
Degree to which the doctor took the time to listen to you
Doctor's concern to keep you informed about your treatment
Doctor's concern for your comfort while treating you The Likert Scale: The Likert Scale 1= Completely Disagree
3 = Neutral
4 = Agree
5 = Completely Agree The Likert Scale: Example: The Likert Scale: Example The staff did a good job at answering my questions.
3 = Satisfactory
4 = Very Good
5 = Excellent The Likert Scale: Example: The Likert Scale: Example The nurse explained the procedure clearly
1= Not at All
2= Not Really
3 = Somewhat
4 = Yes
5 = Exceeded My Expectations Raw Score and Percentile Ranking: Raw Score and Percentile Ranking Raw Score
Small and Large ED
AHA Region Another View: “Only 5’s Matter”: Another View: “Only 5’s Matter” So, what’s our plan?: So, what’s our plan? Quality Service: Quality Service The Four Key Elements of Quality Service: The Four Key Elements of Quality Service Customer
Continuity Patient Satisfaction Tools & Techniques: Patient Satisfaction Tools & Techniques Sit Down and Listen: Sit Down and Listen Slide34: Remember…
Multiple Visits Sit Down and Listen: Sit Down and Listen Patient satisfaction surveys ask respondents to evaluate “The degree to which the physician took time to listen to you”
Optimizing patient responses can be accomplished by increasing the frequency of specific physician behaviors: an introduction, sitting down, use of scripted phrases, and multiple encounters. Sit Down and Listen: Sit Down and Listen There are effective ways to demonstrate concern for a patient even when you’re trying to do things quickly.
How You Enter the Exam Room is Important: How You Enter the Exam Room is Important Walk into the room with a smile,
Apologize for the wait,
Introduce yourself to all those assembled (remember to include the family),
Shake the patient’s hand,
Call the patient by name and
When possible and appropriate, sit down. Sit Down: Sit Down Sitting down places the physician at or below eye level and reassures the patient that you are paying attention (listening)
Sitting down relaxes the patient so that he or she will communicate more openly
Now That You’ve Set The Stage, It’s Time To Listen: Now That You’ve Set The Stage, It’s Time To Listen After a general prompt about the reason for their visit to the ED, let the patient talk for a minute without interruption – you will get information you otherwise might have missed
When the patient has finished speaking, paraphrase what they’ve said to confirm that you correctly understand their concerns Scripting: Scripting It Helps To Have and Use Effective Communication Tools: It Helps To Have and Use Effective Communication Tools The consistent use of conversation that has been proven successful in advancing patient satisfaction is called “scripting’
You may want to consider utilizing one or more of these phrases as part of the patient encounter: It Helps To Have and Use Effective Communication Tools: “How can I help you?”
“I’m sorry this happened to you.”
“Do you have any questions? I have plenty of time.”
“You’ll probably think of some questions. Here’s a notepad to write them down.”
“Have you thought of any other information I might need to know?”
“Come back any time. We never close.”
“I’m going to be here all night. If you have any questions when you get home, give me a call.” It Helps To Have and Use Effective Communication Tools Check Back Frequently: Check Back Frequently Give Evidence of Your Continuing Interest in and Involvement with the Patient’s Care: Give Evidence of Your Continuing Interest in and Involvement with the Patient’s Care Check on the patient’s progress with multiple, brief encounters.
When things are busy, at least stick your head in an exam room and let the patient know you’ll be with them soon
As information becomes available, provide an update to the patient Service Recovery and the Blameless Apology: Service Recovery and the Blameless Apology Service Recovery: Service Recovery If you have made a mistake, or the patient has perceived an error:
Follow Up Managing Up: Managing Up Advantages of Managing Up Self, Skill Set, Experience and Certifications: Advantages of Managing Up Self, Skill Set, Experience and Certifications Communicate that we are health care professionals
Create patient confidence and trust in healthcare provider
Another opportunity for key words … connect the dots
Advantages of Managing Up Coworkers: Advantages of Managing Up Coworkers Patient feels better about their next care giver
The patient feels more at ease with the handoff, thus their coordination of care
Co-worker has a head start in winning confidence Manage Up Coworkers: Manage Up Coworkers “Hello Mrs. Smith. I will be going home to my family now. Ken is taking my place. I just shared with Ken all your important information. Ken is an excellent nurse and I have worked with him for over seven years. I hear such nice compliments about him from his patients. . .” Advantages of Managing Up Other Departments: Advantages of Managing Up Other Departments Reinforces coordination of care and teamwork
Positions other department well to reduce them from having to win the patient over
Decreases patient anxiety and concern Manage Up Other Departments: Manage Up Other Departments “Hello Mrs. Smith. I see this afternoon you will be going down to the Radiology department. Radiology has state of the art technology and a very friendly and courteous staff. They are aware you will be down there this afternoon and are well prepared for you.” Advantages of Managing Up Physicians: Advantages of Managing Up Physicians Shows coordination of care between staff and physician
Lessens anxiety for the patient
Physicians will appreciate this being done
Hardwires positive word of mouth
Emphasizes “team” Manage Up Physicians: Manage Up Physicians “Mrs. Smith, I see Dr. Richards is your physician. He is one of the best. He explains things well and is so good at listening and answering patient questions. You are very fortunate he is your physician.” Other Resources : Other Resources Summary: Summary Introduce yourself in a professional fashion
Address family members - bring them into the encounter
Establish a high level of professionalism and courtesy
Provide information as it becomes available with frequent updates
Check the patient’s progress using multiple, brief encounters
Sit down and listen
Manage Up your co-workers
Remember…: Remember… Patients won’t remember what you said to them
Patients won’t remember what you did to them
But they will always remember how you made then feel Sources: Sources “Patient Satisfaction Scores: Improving Them in Your Emergency Department” Presentation notes from a program at the ACEP Scientific Assembly, October 18, 2004, Thom Mayer, MD, FACEP.
Leadership for Great Customer Service. Satisfied Patients, Satisfied Employees. Health Administration Press 2004, Thom Mayer and Robert Cates.
Hardwiring Excellence. Fire Starter Publishing 2003. Quint Studer.
“Variables Contributing to Emergency Department Patient Satisfaction” Academic Emergency Medicine Volume 12, Number 5, Catherine A. Marco
“Towards a Bold Love for ED Systems: 25 Practical Strategies to Improve Emergency Department Patient Satisfaction”, The Press Ganey Satisfaction Monitor, July / August 2000, James A. Espinosa, MD, FACEP
Questions and Comments? Patient Satisfaction: Patient Satisfaction ACUTE CARE, INC. Team
March 2, 2007
Paul Hudson, Chief Operating Officer
ACUTE CARE, INC.