American College of Physicians: Internal Medicine — Doctors for Adults ®

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Satisfying patients—one or many at a time

From the August ACP Hospitalist, copyright © 2013 by the American College of Physicians

By Stacey Butterfield

Unfortunately, the patient satisfaction experts who spoke at Hospital Medicine 2013 in National Harbor, Md., this May hadn't found a perfect script to magically raise hospitalists' patient satisfaction scores.

“Our patients have good BS detectors,” said Richard Slataper, MD, ACP Member, medical director of the hospitalist service at Our Lady of the Lake Regional Medical Center in Baton Rouge, La. “Improving service delivery is more important than scripts.”

However, they have found several techniques that, when employed with a genuine desire to satisfy patients, can improve their experiences and your scores. “This is absolutely learnable and teachable and you'll get good at it,” said Steven B. Deitelzweig, MD, FACP, chairman of hospital medicine for Ochsner Health System in New Orleans.

The experts' suggestions range from small tweaks in the patient encounter to entirely new systems of surveying patients about their satisfaction.

A satisfying visit

The effort to provide satisfaction should start before you even enter the patient's room, with a knock on the door or doorframe. “You're asking the patients for permission to come in,” said Peter H. Short, MD, chief medical officer of Addison Gilbert and Beverly Hospitals in Gloucester and Beverly, Mass.

After you've been invited in, introduce yourself, and if necessary, explain your role. “A lot of the people who are hospitalized for the first time still don't know what a hospitalist program is. It's our job to explain it to them,” Dr. Short said.

If the patient's room has a white board, make sure your name is on it. (Since the markers tend to disappear, it's helpful to carry one in your pocket.) “A white board that's not filled out can be worse than no white board at all,” said Dr. Short.

Then, sit down. “I can't stress enough how important it is to have a chair,” Dr. Short said. Research has proven that a seated physician makes patients feel more satisfied and less rushed.

Before you leap into discussion of the patient's medical problem, make a little small talk. “Show them your human side and get to know their human side. It really doesn't take that long,” said Dr. Short. The conversation could even include a little front-line research about some major drivers of patient satisfaction, he suggested: “‘How's the food?’ It takes seconds to ask, and the benefit you get from that is tremendous.”

Dr. Short and his colleagues learned the hard way about the importance of these details when the Red Sox were in the World Series. “You walked into the room, the first thing you heard were complaints. ‘I couldn't watch the Red Sox game,’” he said. The hospital now carries sports channels.

Don't try to bond with your patients by trading complaints, though. “Never tell a patient that you're so busy or that you have so many patients. They don't want to hear it. They want to hear that they're the most important patient to you, or feel like they're the only patient,” Dr. Short said.

Speaking of being busy, no one in the hospital should be too busy to respond to a call light. “If you ring the call bell, the door's open, you see all these people in white coats going by the room not even looking, how does that make you feel?” Dr. Short asked. “Never pass a call light. That means any physician in the hospital, administrators, nurses, environmental workers.”

Obviously, putting such a policy in practice requires the cooperation of many other departments, from specialist physicians to food service workers. “If you have any one of those areas not working together, they can disrupt the whole team,” said Dr. Short. A similarly high level of teamwork is required for many satisfaction improvement interventions, the experts agreed.

Team strategies

Building a team that will satisfy patients starts during the physician hiring process for Dr. Slataper. He encourages physicians applying for jobs to submit reference letters from patients and nurses. “How do you get a peek at how folks play in the sandbox before you hire them? Sometimes these letters can be very helpful,” he said.

Requesting these reference letters also makes it clear that your hospital or hospitalist program has a culture of caring about patient satisfaction.

That culture should be suited to local conditions (“We figured out what our patients in Baton Rouge, Louisiana, wanted: Listen for a minute or two before hitting them with 20 questions.”) and participating physicians (“It's important that they come across as genuine…Allow each physician to pick what works.”), said Dr. Slataper.

The culture should be comforting, but the numbers should be hard. “Which tactic you pick is not as important as monitoring it,” said Dr. Slataper.

Dr. Short agreed. “You want to be [working on satisfaction] in ways that you can demonstrate the benefit,” he said. The data can be rough, he reassured attendees. “Don't try to make sure that every little piece of information you have is perfect. Go with information that is mostly correct and act on it.”

From Medicare's HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) to Press Ganey surveying, most hospitals have a growing array of patient satisfaction data available. “There is a dizzying number, only increasing, of people who are measuring us,” said Dr. Slataper.

Nonetheless, his hospitalist program decided to develop its own simple patient feedback process 13 years ago—a form that accurately names the hospitalist(s) who saw the patient and asks for a rating of excellent, satisfactory or unsatisfactory on the doctor(s), as well as any comments. The form is mailed to patients after they have already received their HCAHPS survey. The process is separate from any hospital surveys and instructions direct patients to complete any hospital surveys before opening the physician practice feedback form. Medicare prohibits hospitals from surveying patients before they do.

The form, which is returned by approximately 30% of patients who receive it, allows the program to accurately measure patients' satisfaction with individual physicians. “It's so gratifying that you can change your approach and actually see the needle move,” said Dr. Slataper. Scores are used to determine a small percentage of hospitalists' compensation and comments are shared with clinicians (positive ones in group meetings, negative ones individually).

A comment or a letter from a really satisfied patient could be reason enough for a group reward. “When you do have success, celebrate it,” said Dr. Short. “It's better to do frequent small celebrations than one infrequent large celebration.”

The team should also be involved in development of new patient satisfaction projects. Dr. Slataper's hospital found success with a “team nurse” system in which each physician works with a clinical care coordinator who assists patients in arranging post-discharge care. “Our patients' care is enhanced when a discharge plan actually comes together as designed. Not surprisingly, improved patient satisfaction follows,” he said.

One highly successful pilot at Dr. Short's hospital involved hourly rounding by nurses. Call bells decreased by 50% and everyone noticed the floors were quieter. “The nurses said they were able to work more efficiently,” said Dr. Short. “They started initiating it on other floors before we had a chance to roll it out.”

A project that satisfies patients and clinicians and provides quality care—that's the ultimate in patient satisfaction improvement. “It's the care that you would expect from others,” said Dr. Deitelzweig. “It actually will save lives [and] you'll enjoy the profession more.”

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