Hospital's priorities are usually not aligned with how we pay hospitalists. In fact, the two are often in direct conflict with each other. In my last post, I argued that...
Last month, Christy Dempsey, the Chief Nursing Officer of Press Ganey, visited our medical center to discuss strategies hospitals can use to improve patient satisfaction. She had some really insightful comments. Improved patient satisfaction doesn’t just improve your hospital’s scores on the Medicare Hospital Compare website, but it also results in lower length of stay and lower readmission rates.
The 3 most important factors that affect inpatient satisfaction are (1) a perception of teamwork, (2) nursing courtesy, and (3) cleanliness. From the patient’s perspective, “teamwork” = “safe work”. For cleanliness, it doesn’t necessarily mean brand new & spotless; instead, patients think of “clean” as “safe” so patients will perceive your hospital as being clean if they feel that they are safe in the hospital. Some of the simple things that you can do that will improve patients’ perception of cleanliness include:
- The brighter the light, the cleaner the room and hallway will feel
- Avoid clutter in the hallway.
- Be sure that the staff break rooms, nursing station, and conference rooms are not cluttered – inevitably, patients will peek into these areas when they are walking by and the break room door is open.
- Anything on the walls needs to be in frames – do not tape paper notices and memos to the walls.
The 3 most important factors contributing to patient loyalty in the outpatient setting are: (1) confidence in the provider, (2) the providers work well as a team, and (3) communication.
In the hospital, patients want to perceive that the doctors and nurses exhibit compassion. There are 6 key ways that your staff can do this:
- Acknowledge suffering.
- Coordinate care – make sure the patient perceives that everyone is on the same page. One great way of doing this is with physician/nurse rounds or multidisciplinary rounds.
- Use the right body language – it is not just words that you use to communicate with the patient – body language matters.
- Recognize that the patient’s anxiety equates to the patient’s suffering.
- Autonomy reduces suffering. When the patient is admitted to the hospital, they are relinquishing their autonomy and have a loss of sense of control. Little things can make a difference, such as asking the patient what time they want to have their bath or their walk in the hallway.
- Caring transcends diagnosis.
One of the toughest questions on the HCAHPS survey relates to the hospital being quiet at night. As providers, we equate “quiet at night” to mean “noise at night”. But for the patient, “quiet at night” means “minimal interruptions at night”. Make sure that the staff minimize waking the patient up at night by coordinating nocturnal vital sign checks to happen at the same time as their nighttime IV antibiotic dose. If your hospital practice is to draw routine daily labs at 4:00 AM… then stop. Try to give the patient as much uninterrupted sleeping time as possible each night.
Another HCAHPS survey question that hospitals struggle with is pain control. Be sure that the doctors and nurses set patient expectations for pain control and that the pain score goal is not a “zero” – patients are going to have pain if they are post-op or admitted with fractures and the goal is not to completely eliminate their pain but instead to make the level of pain tolerable. In this sense, your staff have a lot more influence on pain control than your medications do.
Communication with the patient by both doctors and nurses are also a part of the HCAHPS survey. Taking a few seconds to learn something about the patient other than their disease and symptoms can make a big difference in how the patient perceives communication. Do they have grandchildren? What are their hobbies and pastimes? Where did they grow up? Communication with the patient can be improved with scripting but don’t script the exact words, script the sentiment. It is important, however, avoid faking emotions since this will cause burn out in the nurses and physicians. Unfortunately, you can’t teach compassion – you either have it or you don’t so it is important that you identify compassion in nurses and doctors when they are first applying for their jobs.
- The patient is scared
- The patient has lost all control
- The patient hurts
- The patient needs information
- The patient needs compassion
Improved patient experience is not only good for the patient, but it is good for your nurses and doctors. For example, nurses job satisfaction correlates better with patient experience than with staffing adequacy. A favorable work environment correlates with fewer patient falls and pressure ulcers than the staffing in that environment.
April 12, 2017