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 ...

1. 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.

2. 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

3. • 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

4. 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

5. 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.

6. 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.

7. – 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

8. 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.

9. • 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.

10. 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.).

11. – 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

12. 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.

13. 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

14. • 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
Patient SatisfactionSlide Number 2Slide Number 3Slide Number
4Slide Number 5Slide Number 6Slide Number 7Slide Number
8Slide Number 9Slide Number 10Slide Number 11Slide Number
12Slide Number 13Slide Number 14Slide Number 15Slide
Number 16Slide Number 17Slide Number 18Slide Number
19Slide Number 20Slide Number 21Slide Number 22Slide
Number 23Slide Number 24Slide Number 25Slide Number
26Slide Number 27Slide Number 28Slide Number 29Slide
Number 30Slide Number 31Slide Number 32Slide Number
33Slide Number 34Slide Number 35Slide Number 36