Beyond a “one-size-fits-all” solution
Early in my career, the concept of patient satisfaction was a distant thought to healthcare executives and providers when considering the delivery of care. The primary consideration was, of course, the quality of that care – not realizing the vital connection between improved patient satisfaction and positive health outcomes. The rising force of consumerization of healthcare, alongside the advancing science of measuring patient experience, has propelled healthcare leaders to focus on the driving forces of patient satisfaction.
Because of this, it is more important than ever for hospital and health system executives to find the one approach that will solve the patient-satisfaction puzzle. Unfortunately, however, one approach isn’t the answer. Repainting all patient rooms isn’t the silver bullet. Training nursing staff in customer service won’t do it. And developing your doctor’s bedside manner won’t guarantee great patient experiences.
In actuality, the key to boosting patient satisfaction requires multiple approaches specifically tailored to the particular care setting, as we discovered after analyzing our patient-satisfaction scores at Nemours/Alfred I. duPont Hospital for Children. In short, we found that patients are not looking for multi-tasking practitioners, but rather for providers who assign the best practices in multiple ways depending on patient needs.
While we found that physician care and nursing care, in correlation with personal concern, had the biggest impact on patient satisfaction in general, our team found that patients and their families placed more importance on certain characteristics of care depending on the setting:
- In the emergency setting, personal concern had the largest impact.
- In inpatient settings, nursing care was valued the most.
- For outpatient specialty visits, the quality of physician care had the greatest influence
- In primary care, personal concern and physician care, along with ease of scheduling were most important.
When you think about it, these findings make a lot of sense. People coming into the emergency department want to feel assured that they will be taken care of and that hospital staff are paying attention to them: they don’t want to be treated like a number. In the inpatient setting, patients and their families easily spend 90-95% of their clinician time with nurses so they feel better knowing that their nurses know who they are, understand their needs and engage personally in their care.
The outpatient setting is a different story. When patients go see a specialist, they’re more satisfied if the specialist demonstrates genuine interest and clear expertise in addressing their concern about diabetes or coronary artery disease. And because the relationship with primary care providers (PCP) is more about ongoing preventive care, patients want a PCP who demonstrates personal concern, knows them well and can address their overall health and medical needs.
Healthcare executives need to recognize that patient satisfaction comes down to whether or not patients and their family members believe the system is working for them at that specific point of care. This awareness will help leaders design customized experiences to achieve optimal patient engagement and satisfaction in all environments within a health system.
We took these findings to heart and have incorporated them into how we’re coaching staff, designing clinical interactions and even planning the layout of new facilities.
With the support of our leadership, we are taking the bold step of publicizing patient satisfaction data internally, and soon with all of our patients and families, for each doctor and each clinical unit (while remaining HIPAA compliant, of course). This level of transparency allows staff to hear directly from their patients and gives them another point of reference as they build on their professional skills.
Along with working to reduce wait times in our emergency departments, our staff makes the effort to connect with patients who are waiting for care. Staff knows how long it has been since a clinician has checked in with a patient, and takes action if too much time has passed. After the patient is discharged, we have a team that calls the family to make sure they understand the steps they need to take following their visit to our emergency department. We’ve found that this gesture has a huge impact on patient satisfaction.
We’ve also partnered with family members of former patients to form Family Advisory Councils (FACs). These FACs provide hospital leaders with valuable insight and actually have significant input regarding the final design of hospital facilities. They’ve advocated for features that make patient rooms more family friendly and feel more like home. For example, nursing care areas are separate from family space. Nemours clinicians also conduct rounds at predetermined times of day, with family member present or participating so that they no longer feel excluded from care discussions.
While these initiatives have increased our patient satisfaction scores, we know there are opportunities to do better. Our strategic goal is to have a “top box” (5 out of 5) percentile ranking of greater than 95%. In 2015, we made progress on this goal, ranking in the 90th percentile overall and 80th to 99th percentile in specific service areas. Patient-and family-centered care is a core area. In addition to continually evaluating patient and family feedback to provide care that exceeds their needs and expectations, our leadership often walks through our hospitals to witness clinical care from the eyes of our most important stakeholder – the patient.
Stephen T. Lawless, MD, MBA is the enterprise vice president of quality and safety and is a member of the Nemours Executive Team. In this role, he oversees Nemours-wide quality and safety (patient, environmental, and associate), risk management, clinical peer review, infection control and clinical outcomes. Lawless uses Nemours’ combined technologies, and knowledge to make systems simpler and error-free, whether those systems are used for business or healing. He is also a professor of Pediatrics at Thomas Jefferson University and Staff Critical Care Physician in the Department of Anesthesiology and Critical Care Medicine at the Alfred I. duPont Hospital for Children. He earned his BS in biology from Fordham University in Bronx, N.Y., and his medical degree from the University of Medicine and Dentistry of New Jersey’s Robert Wood Johnson Medical School. He completed a pediatric residency and chief residency at St. Christopher’s Hospital for Children and a pediatric critical care fellowship at Children’s Hospital of Pittsburgh. He subsequently earned a Master’s in Business Administration from the Wharton School of Business of the University of Pennsylvania.