Another Satisfied Customer?

Do you believe in patient satisfaction?  For the majority of my training, I had my doubts.  As an impressionable intern, I remember a conversation between 2 seniors discussing a patient complaint about the wait.  The conclusion was something like this: "This isn't Burger King.  In the ED, you don't get it your way, right away."  For a long time, I believed that good care comes first and satisfying the patient comes second.

I'll also admit that my opinion was further skewed by the wealth of poor data collected by various "satisfaction" surveys that using a sampling that would be laughed at by any respectable researcher.  We see  more than 200 patients per day.  One month our sample was derived from a sum total of 14 patient responses.  Hard to make valid conclusions with data that is derived from <1% of total patients.

Needless to say, as I mature in my practice, I have come to realize that there is a lot of truth to the statement, "They don't care how much you know until they know how much you care."  With that in mind, I want to share some key points from a nice review of customer satisfaction that I stumbled upon from the Emergency Medicine Clinics of North America.

So why pursue a goal of having more satisfied patients?

There are multiple demonstrating benefits from hospitals which perform better:

-Staff morale improves
      (Turnover decreases, work is more enjoyable)
-Malpractice risk decreases
     (Happy patients sue less frequently)
-Patients respond better to treatment
     (Patients follow instructions when they believe that they received good care)
-Hospital finances improve
     (Patients recommend the facility and will come back)

The list is pretty impressive.  I'd be happy with improvement in one of those categories!  So we know that happy patients can bring us happiness, but how can we improve the current quagmire that is emergency medicine?

Obviously, you know your local environment best.  Each department will need to tailor a program to its needs.  The first step is figuring out those needs: what is the goal you want to strive for?  If you already have a program, great!  Hopefully you've been keeping tabs.  The data gleaned from your surveys can highlight areas in need of immediate attention.  What if you haven't kept tabs?  Look at complaints, get staff input, administrative input, and use good ol' common sense.

Leadership will be vital.  You'll be attempting to change something fundamental about emergency care: our culture.  First, get the key players on board: administrative, nursing, and physician leaders.  Don't forget the "leaders" within the ranks who may not formally hold a title.

As the leader, you'll be tasked with the following:
-Setting goals
-Modeling and insisting on specific behavior
-Monitoring the behavior and progress towards the goal
-Delivery of rewards and recognition for good performance

Goals take on two forms: philosophic and specific.  The philosophic goals helps set the vision for the change, the specific gives the down and dirty expectations and guidance for attaining the vision.  Remember to involve the staff.  Using goals that they create will help promote buy-in.

Some specific examples:
-Answer all phone calls within X rings
-Door to Doc of X minutes or less
-Door to discharge of X hours or less
-Door to bed of X hours or less
-Each patient will be re-evaluated by a provider every X minutes

Once you choose your goals, it will be up to the leadership to hold people accountable.  Some people will resist.  Giving that person an exemption will deep six any cultural change before it even has a chance.

Educating the staff will be important.  Everyone will need to learn to modify their behavior: physicians, nurses, registration, techs, transporters, housekeeping, etc.  The success of your program will depend on universal participation.

Remember to reward the people who contribute.  Publicly acknowledge them, give bonuses, a parking spot, etc.

Remember the need for a scoreboard.  Even if you missed the first half of a game, you know who's winning by looking at the board.  So it is with the staff: they need to know where they're at in order to improve.  Publish your results widely: newsletters, emails, bulletin boards, etc.  Let patients know too.  Success is contagious.

Invariably, there will be some people who choose not to come on board.  Once they become obvious, they will need to be removed.  Letting them stay within the department will create a division amongst the staff and hurt your chances of success.

There are tools available to help you succeed:

Scripting: developing specific comments for registration, nursing, and even docs can help diffuse anger and demonstrate an attitude of caring.

Patient advocate: This person can make sure that patients who are waiting are up to date with an explanation.  They can also help keep the patient comfortable while waiting.

Surveys: You can't change without data.  Develop your own, and distribute them widely.  The more the merrier.  Don't forget to allow family members to fill them out as well.

Call Back System: This tool can help to salvage what may have been a negative impression.  You can target specific conditions: Against Medical Advice discharges, left without being seen, etc.

Patient Satisfaction is a worthy goal to persue.  It's not easy, that is obvious from our day to day practice. Start by being honest with yourself.  Would you want your mother, father, spouse, or child to receive the same care given to the majority of the patients waiting in your waiting room.  If you answered no, then step up, become a leader, and promote the improvement that is within your reach.

Reference:
K Worthington. Customer Satisfaction in the Emergency Department. Emerg Med Clin N Am. 22; 2004: 87-102. PMID: 15062498