ED takes personal approach to boost satisfaction levels
Focus on survey questions IDs targets
The ED management team at Botsford General Hospital in Chesterfield, MO, has adopted and adapted quality improvement principles from The Studer Group, a quality improvement consulting organization in Gulf Breeze, FL, to boost its patient satisfaction rates from the high 80s to the 99th percentile.
"We had the whole nursing staff read 'Hardwiring Excellence,"1 notes Barbara Smith, RN, the ED manager, referring to a book written by Quint Studer, head of the Studer Group.
Part of the book's lessons include implementation of the "AIDET" mnemonic device to improve patient communication:
- Acknowledge the patient when you see them.
- Introduce yourself.
- Duration: Let the patient know how long an exam or procedure will take.
- Expectations: What the patient can expect to experience.
- Thank the patient for coming to the hospital.
Kim Guesman, RN, MSN, the hospital's nursing director, says, "The ED adapted some additional behaviors, like knocking before entering the room, announcing their name, identifying their skill, and telling the patient why they are there." Guesman is a key member of Botsford's Service Excellence Council, which is run by the CEO and president and comprised primarily of the administrative leaders and some directors of the hospital.
Seeking to do better
Two years ago, the top leadership at the hospital decided that customer service was going to be one of the pillars of its mission, says David Walters, DO, medical director of the ED.
"We kicked our effort off with a departmental meeting that included all ED employees and physicians," he recalls. "We set out where we were and where we wanted to be, and tried to get buy-in from everyone."
The CEO, himself an emergency physician, took the time to attend the meeting. "He let everyone know that he was interested and that he would be watching, and since we were interested in bettering our patient satisfaction rates, we jumped at the opportunity to be the first department to get started," says Walters.
Smith says, "We started teaching the key principles, and put up posters [in the locker room and break room] to get them used to the new approach." The posters, she adds, were bullet-pointed to identify five service standards:
- positive first impressions;
- respect and courtesy;
- teamwork;
- professionalism;
- safety.
One of the most effective strategies employed in the program was random rounding on different shifts by Walters and the nurse managers. "We'd show up and ask the staff what they had done for customer satisfaction and if they could give us examples," Walters says. "Sometimes, we'd ask them to tell us what we could do better as leaders."
The department had used patient satisfaction surveys from Press Ganey Associates in South Bend, IN, for years, but the ED leaders decided to focus on four of the 30 topics addressed in the survey:
- the concern nurses have for patient privacy;
- the information given to patients about delays;
- the care staff show about the patient as a person;
- the likelihood of the patient recommending Botsford.
Walters and his leadership team tracked departmental and shift scores on a biweekly basis.
These four topics, plus the rounding, were very effective, says Susan Belenchia, RN, one of the ED nurses. "Their presence in the department provided positive reinforcement and kept our goals fresh in our minds," she says. "For example, what really helped is that it encouraged me to verbalize my concerns for the patient's privacy, so now I actually say, 'I'm closing the curtain to give you privacy.'"
When the staff does well, they are rewarded, notes Belenchia. "For example, we once had a little ice cream social," she recalls. "And last year, they served us a really nice dinner after we achieved the highest score in our Press Ganey group, and that made us feel proud."
Other units involved
The ED's efforts were reinforced by the participation of ancillary departments such as housekeeping, radiology, registration, and the lab, says Smith.
"We set up a subcommittee on which both Dr. Walters and I sit," she says, "And we talk to them about how they can help us." Radiology has a "great champion" who greets the patients, informs them about delays, and thanks them for coming, Smith says. "Housekeeping gets blankets for patients, asks them if they want water, and so forth," she adds.
In addition, the department has instituted a "service recovery" program in which gifts such as coupons for coffee or dinner in the cafeteria and Blockbuster gift certificates can be given to patients who voice dissatisfaction with their ED experience.
Finally, Walters relates a recent incident that demonstrated to him the culture change was taking hold. "I was driving in to the ED on New Year's Day, and we had just discharged a patient who did not have an overcoat," he says. "One of the staff ran outside with a blanket and gave it to her."
Reference
- Studer Q. Hardwiring Excellence: Purpose, Worthwhile Work, Making a Difference. Gulf Breeze, FL: Fire Starter Publishing; 2004.
Sources
For more information on quality improvement principles for improving patient satisfaction rates, contact:
- Kim Guesman, RN, MSN, Nursing Director, Botsford General Hospital, Chesterfield, MO. Phone: (248) 471-8271.
- Barbara Smith, RN, Manager, Emergency Department, Botsford General Hospital, Chesterfield, MO. Phone: (248) 471-8803.
- David Walters, DO, Medical Director, Emergency Department, Botsford General Hospital, Chesterfield, MO. E-mail: [email protected].
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