For "The GrAde" Tutor Only (All Others Will Not Be Accepted) THANKS

Patient Satisfaction

Patient Satisfaction Today • Has become an important buzzword in health

care. • Patients have access to hospital “report card”

patient satisfaction and quality scores. – Ex: Hospital Compare

• Hospital placing high priority for patient satisfaction due to scores being tied to reimbursement rates.

Patient Satisfaction Today

• Patients are better informed. • Patients want to understand their medical

care and be a part of the decision-making process.

• Health care is featured almost daily in the media, increasing patient expectations of the care provided.

How is Patient Satisfaction Measured? • Hospital Consumer Assessment of Healthcare Providers

and Systems (HCAHPS) Survey. • Standardized survey to gather and compare data across

the nation. • 27 questions based on:

– Physician/Nurse/Staff Communication – Hospital Environment – Pain Management – Overall rating – Recommendation of Hospital

• Conducted through mail and/or telephone. • Conducted after patient discharge.

Sample HCAHPS Questionnaire • During this hospital stay, how often did nurses treat you with courtesy and

respect? 1. Never 2. Sometimes 3. Usually 4. Always 5. Non Applicable

• During this hospital stay, how often did doctors treat you with courtesy and respect?

1. Never 2. Sometimes 3. Usually 4. Always 5. Non Applicable • During this hospital stay, how often was the area around your room quiet at night? 1. Never 2. Sometimes 3. Usually 4. Always 5. Non Applicable

• Would you recommend this hospital to your family and friends? 1. Definitely No 2. Probably No 3. Probably Yes 4. Definitely Yes

• Using any number from 0–10, where 0 is worst hospital possible and 10 is the best hospital possible, what number would you use to rate this hospital?

Hospital Compare

Impact of ACA on Patient Satisfaction

• Pay For Performance (P4P). • DRG payments are adjusted based on

performance on HCAHPS (30%) and clinical process measures (70%).

• Patient satisfaction makes up 30% of hospital’s score. – Recommend Hospital – Rate Hospital 9–10

Excellent Patient Satisfaction • Excellent customer satisfaction goes beyond

patient interaction during hospital stay. • Organizations judged on customer service the

instant contact is made with patient or family member (phone, face-to-face, email, etc.).

• Higher patient satisfaction with inpatient care and discharge planning is associated with lower 30-day readmission rates.

» Source: AM J Managed Care, 2011; 17(1): 41-48

Trickle Down Effect of Excellent Service

• Providing excellent service leads to happy patients who are less anxious.

• Less anxious patients are more cooperative, leading to positive results.

Patient Needs • Customer-friendly environment. • Compassionate, caring, and individualized

care. • Respect for privacy. • Cultural sensitivity. • Timely and proper explanations about their

care/treatment. • Involved in decision-making.

Barriers and Facilitators to Patient Engagement

• Patient Barriers: – Fear and uncertainty – Low health literacy – Provider reactions

• Patient Facilitators: – Self-efficacy – Information – Invitations to engage – Provider support

Essential Elements for Building a Strong Foundation

• Leadership strategies. • Strategies for partnering with patients and

families. • Workforce strategies. • Data/use performance improvement.

Leadership Strategies • Celebrate achievement and improvements. • Eliminate/streamline as much as possible. • Patient experience is integrated and aligned

with organizational priorities. • A dedicated champion and structure is in

place to support patient-centered care.

Capitalize on Opportunities to Partner with Patients/Families

• Patients and families are treated as partners at every level.

• The organization seeks input from patients and families on a routine basis from methods other than the HCAHPS survey. – Ex: rounding, patient and family advisors.

Workforce Engagement Strategies

• Restore sense of purpose through: – Recruit members for patient-centered values. – Patient centered care is rewarded and celebrated. – Accountability and incentives support patient-

centered care. – Participation in and brainstorming with patient

experience improvement teams.

Data Use • Hospital-wide and unit-specific targets are set

based on historical data and national benchmarks.

• Staff are provided with tools for easy access to data and support.

• Frequent, regular feedback to staff is provided on performance.

Process Improvement Plan

Strategy

Develop & Test

Strategy

Monitor Strategy

Reassess and

Respond

• Improvement teams and committees are created and adequately resourced.

• Best practices are identified and implemented.

• Strategies are shared across units.

Source: CAHPS Improvement Guide

Examples of Tools Used to Improve Patient Satisfaction

• Compassionate and caring communication through AIDET: – Acknowledging the patient – Introducing yourself – Duration of the conversation – Explain – Thanking the patient

• Constant communication through rounding. • Timely response to call lights. • Providing “service recovery” to reduce anxiety or

dissatisfaction. – Ex: Parking validation, meal tickets, etc.

DUKE UNIVERSITY HOSPITAL Case Study #1

Duke Organization

• 900 beds. • Provides Tertiary and Quaternary care. • Affiliated with Duke University and Duke

University School of Medicine.

Leadership Commitment and Training

• In 2007, Duke established a “Patient Satisfaction University” for directors and managers.

• Training cultural competence due to increasing population of Latino patients.

Balanced Score Card • Leadership bought into idea that all 4 areas

were interconnected.

Best Practices and Problem Solving Methods

• Leadership rounding. • Communication boards in every room. • Low satisfaction scores in clinical unit prompt

action. – Managers pull together process improvement

team. – Use Six Sigma process of DMAIC problem-solving

model. • Define, Measure, Analyze, Improve, Control

Performance Improvement Examples

• Duke Orthopedic Unit – #1 reason for dissatisfaction: Patients not knowing

care plan. – Action plan: Nurses began to systematically inform

patients each morning of their daily schedule (PT, OT, baths, etc.).

– Scores jumped above 90th percentile.

Recognizing and Rewarding High Performance

• Duke regularly rewards units in the highest percentile compared with other academic medical centers.

• Staff nominate individuals who have gone above expectations in: – Demonstrating special, compassionate care. – Making significant difference in patient or family’s

experience.

Results

Lessons Learned • It is important to deploy both organizational

and tactical strategies; not every strategy fits every unit.

• Hospitals must educate staff to access and understand performance data.

• Understand importance of racial diversity and cultural competence.

• Reinforce emphasis of customer satisfaction through rewards and recognition.

THE VALLEY HOSPITAL Case Study #2

Organization

• 415 bed not-for-profit hospital in New Jersey. • 52,400 admissions and 71,200 ED visits. • 4,000 employees and 900 physicians. • Part of Valley Health System.

Hospital Leaders Set the Tone

• Introduced Leadership Institute – 3 x/year bring together hospital leaders, frontline

supervisors, and top executives for 2 days of educational sessions and talks.

– Discuss leader responsibility for reaching and maintaining Valley’s 5 standards: Service, Excellence, Respect, Value, and Ethics.

Measurement and Tracking

• Two groups formed – Measurement team and Patient Satisfaction Council. – Measurement team: meet twice a month to evaluate

and submit trend data to unit managers. – Patient Satisfaction Council monitors and reviews

scores weekly to ensure all problems are identified and addressed.

• Any dip in patient satisfaction scores on a unit leads to unit staff and measurement team working together to implement improvement strategies.

Rounding

• Hourly rounding by frontline nurses. • Daily rounds by nursing manager. • Monthly leadership rounding to ensure staff

has right tools for providing best available care.

• CEO and CFO rounding every morning to meet with staff and visit patients.

Policy and Practice Changes

• Comprehensive Noise Reduction Campaign introduced.

• Placing associates from business office at the call bell desk during shift changes to watch for calls and notify nurses.

Staff Recognition

• CEO notes. • Annual recognition dinners. • Financial incentives if patient satisfaction and

financial targets are met.

Results

Employee Satisfaction