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
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