Published on August 9, 2007
Improving Patient Satisfaction in the Emergency Department: Improving Patient Satisfaction in the Emergency Department 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, cont.: Objectives, cont. 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 A savvy Internet user, the new consumer 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 healthcare information What Do Patients / Clients Want?: What Do Patients / Clients Want? The new healthcare consumer: Wants empathy Wants positive outcomes Wants relief from symptoms Wants information Is Internet active Is empowered 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. What Do Patients / Clients Want?: What Do Patients / Clients Want? 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 valet parking, concierge services, spa treatments such as massage, and Wi-Fi connections in the hospital. What Do Patients / Clients Expect?: What Do Patients / Clients Expect? Hospitals should have better amenities 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. What Do Patients / Clients Expect?: What Do Patients / Clients Expect? Basic health care should be inexpensive and convenient 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 Slide18: 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. Slide19: 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? Patients or Customers?: Patients or Customers? 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 2= 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 1= No 2= Somewhat 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 Another View: “Only 5’s Matter”: Another View: 'Only 5’s Matter' Slide29: Raw Score and Percentile Ranking: Raw Score and Percentile Ranking Raw Score Percentile Ranking Comparative Databases Small ED Small and Large ED Network Hospitals AHA Region 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 Commitment Expectations Continuity Patient Satisfaction Tools & Techniques: Patient Satisfaction Tools andamp; Techniques Slide35: Remember… Sit Down Listen Multiple Visits Sit Down & Listen: Sit Down andamp; 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 & Listen: Sit Down andamp; Listen There are effective ways to demonstrate concern for a patient even when you’re trying to do things quickly. Sit Down & Listen: Sit Down andamp; Listen 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: 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.' Check Back Frequently: Check Back Frequently Check Back Frequently: Check Back Frequently 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 and the Blameless Apology: Service Recovery and the Blameless Apology If you have made a mistake, or the patient has perceived an error: Listen Apologize Fix it Something Extra Follow Through Follow Up Managing Up: Managing Up Advantages of Managing Up: Advantages of Managing Up Communicates that we are health care professionals Creates patient confidence and trust in healthcare providers Another opportunity for key words … connect the dots Advantages of Managing Up Coworkers: Advantages of Managing Up Coworkers Patient feels better about their next caregiver 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 Co-Workers: Manage Up Co-Workers Advantages of Managing Up Other Departments: Advantages of Managing Up Other Departments Reinforces coordination of care and teamwork Positions other departments 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' Advantages of Managing Up Physicians: Advantages of Managing 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 Slide56: Sources / Resources: Sources / Resources http://www.acutecare.com/patientsatisfaction.php '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. Two Words to Improve Physician-Patient Communication: What Else? Patricia Barrier, et al. Mayo Clin Proc. 2003;78:211-214 Patient Satisfaction: Understanding and Managing the Experience of Care Health And=ministration Press2006, by Irwin Press Summary: Summary Introduce yourself in a professional fashion Address family members - bring them into the encounter Summary: Summary 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 Questions?Comments?: Questions? Comments? [email protected] ACUTE CARE, INC. 800.729.7813 Improving Patient Satisfaction in the Emergency Department: Improving Patient Satisfaction in the Emergency Department Paul Hudson Chief Operating Officer ACUTE CARE, INC.