Press, Ganey winners are best in customer care
Share success with employees to keep patients happy
For years, officials at the East Alabama Medical Center (EAMC) in Opelika, AL, looked at their Press, Ganey of South Bend, IN, patient satisfaction reports as something to read and file away every quarter. The results weren’t widely discussed or shared, and action wasn’t taken to improve the 352-bed hospital’s 40th-50th percentile scores.
But that changed in 1998 when officials attended a Press, Ganey client conference and were inspired by the ideas other customers had. The result has been a series of programs that not only improved the patient satisfaction scores, but in December of 2000, led Fortune magazine to name the hospital one of the 100 top companies to work for in America.
One of the programs that the hospital implemented was a "gainsharing" program that financially rewards the 2,000 employees for meeting or exceeding patient satisfaction and financial goals, says Susan Johnston, director of human resources at the hospital. "When we started, we tied the rewards to cost, profit, and satisfaction goals," Johnston explains. Since then, the cost piece has been dropped. Financial goals are based on net income, and patient satisfaction scores are based on minimum acceptable scores from twice yearly Press, Ganey reports.
Initially, the patient satisfaction piece related only to the inpatient report, but this year, EAMC will add outpatient and emergency department surveys to the mix, too. Inpatient is weighted at 80% and the other two at 10% each. The goals, says Johnston, are meant to be achievable, but still a stretch.
Since the program was initiated, scores have increased from the 42nd percentile to the 99th percentile as of August 2001. "We used to communicate in raw scores because 83 looked better than the 70th percentile, but now we use the percentile," she explains. The minimum score for the next payout is the 92nd percentile. "That’s huge from where we started."
There are two payouts per year for the program, which makes up about 5% of the typical employee’s pay. The average is about $1,000 per employee, per payout.
The financial and satisfaction award pools are separate, and most of the money comes from the financial piece. For the coming year, if net income reaches $8.5 million, the award pool for the financial piece will be $950,000. Not every member of the staff gets the same portion, however, Johnston explains. Employees who make less than $20,000 per year are brought up to that level for the share purposes. Those who make more than $50,000 per year are brought down to that level. "The less you make, the higher the percentage of the pool you can get." The pool for patient satisfaction is $500,000 for each six-month period.
Johnston says employees have made as much of an effort for the financial effort as for patient satisfaction. "They can have an impact on net income based on the kind of instruments you use. You can ensure patients come back to our facility by being nice to them." Eliminating cost from the mix was done in part because it was so much harder to explain to employees. "When you tried to break it down, their eyes glazed over. The bottom line is a good, simple idea."
Employees are reminded of the gainsharing program every year through a brochure. Initially, explaining the program took 12 pages, Johnston recalls. This year, it’s down to one page. "They want to know when they will get a check, how much it will be, and when they will be eligible. We do a really good job of explaining that."
The CEO does a quarterly video for employees, too, where financial information and the Press, Ganey scores are discussed. "We do a constant bombardment of information that talks about this," says Johnston. "It is something that employees live and breathe."
Gainsharing isn’t the only effort made to increase patient satisfaction. "Our patient satisfaction scores have skyrocketed and we are making money. Our net income targets have increased every single year," she says. "But we think all the programs together have achieved this. Gainsharing is just our way of saying thank you to our employees."
Implement several types of rewards
Another program implemented by the hospital was a mystery shopper who went through the emergency department, was admitted, had a series of tests, and was discharged after a day. She came with a "family member" who wandered the halls taking note of customer service. She even went to the human resources department and asked about applying for a job. The program, when divulged to the staff, got the employees’ attention. Employees who performed well under the test were rewarded with a steak dinner. Problem areas were addressed with immediate action plans.
EAMC also has a "Behavior of the Month" program where a positive behavior — such as service recovery to fix a situation that has gone bad with a patient or employee, whoever the customer is — is emphasized. The behaviors often are developed from the satisfaction reports’ priority index. Each new behavior is communicated in a monthly Customer Service Forum that is videotaped and distributed to all employees.
Employees who can recite the Behavior of the Month when asked get to select a goodie, such as chocolate, potato chips, or other snacks from a goodie basket. "It sounds silly, doesn’t it?" says Johnston. "But it’s one of the most popular things with the staff. They really look forward to it. They chase you down the hall to recite the behavior. I even have an employee who can tell me the last 12 behaviors in order."
Frontline employees are rewarded for exemplary service, and there also are monthly awards for the Best Department based on Press, Ganey scores. These "GRID" awards (Great Rewards in Devotion) also include a Best Supporting Department nominated by the Best Department to include those who were instrumental in helping a department win. Department members are given a pizza party and a trophy.
All of these elements help to keep employees as satisfied as patients, and Johnston says that keeping employees happy is certainly a way to impact patient satisfaction. "We do employee surveys, our vice presidents have feedback sessions with employees sans management," says Johnston. "Every quarterly meeting results in five or six things to focus on for improvement, and we require the manager to create an action plan. We put as much stock in employee satisfaction as patient satisfaction."
It appears to be working. The hospital has low turnover, and doesn’t have to use temporary or contract nursing staff. "We want our employees to understand that patient satisfaction affects the bottom line," says Johnston. "If you go to a hotel where you get bad service, you won’t go back. And we are very much a service industry. Patients have more choices now. We have to corner our market or lose it."
Patient satisfaction and the bottom line
For proof that patient satisfaction can impact the bottom line, look no further than Memorial Medical Center in Johnstown, PA. The facility was losing $2 million a month a couple of years ago. Consultants recommended a redesign, and the leadership redesigned every process imaginable. "We continued to lose money and struggle with low employee morale," says Suzanne Ross, MSN, MBA, director of performance improvement resources and outcomes management at the 566-bed hospital. "We knew that drastic action was required and we needed help"
The hospital management decided to focus less on financials and more on clinical excellence, customer satisfaction, and cost-effectiveness.
The hospital restructured its Hospitality Team, which developed a list of golden rules that all employees were supposed to exemplify. (See "Learn to follow the hospitality golden rules," in this issue.) Those who do are rewarded through the Gold Star program. Staff, physicians, and volunteers are nominated for awards. Winners receive a gift certificate to the gift shop and a gold star for their name badge. Quarterly winners get a bigger gift certificate and a three-month parking pass to the hospital garage (where parking is at a premium, says Ross). Annual winners get a $500 gift certificate and a gift basket.
Over the months, the criteria have become more stringent for selection. The most recent winner was a telecommunications worker who learned that a trauma patient from out of the area had no visitors. "She visited every day since the family couldn’t come and communicated with the family regularly," Ross explains. But when the program started, just escorting lost patients could win one the prize.
The hospital also developed a new performance improvement program that emphasizes interdepartmental communication. "No one used to talk to each other," says Ross. "They just tracked their own departments." Now, every administrative director and a physician counterpart (if it’s a clinical area) are on a Council for Performance Improvement (PI). The departments talk about their PI initiatives on a rotating schedule, allowing for departments to share strategies and information that may relate to a particular initiative. For instance, the med/surg nursing areas were working on patient restraints, but the behavioral health department previously had done a project on that topic and now is restraint free. "One didn’t know the other was working on it," Ross says. "Now they are working together so that med/surg can become restraint free. That benefits the patients."
With the changes that the PI and hospitality teams were implementing came the realization of the need for national patient satisfaction benchmarking. Memorial scrapped its internal patient satisfaction survey and turned to Press, Ganey. The initial score: the 22nd percentile.
Ross says PI teams took the data back to their departments immediately to find areas for improvement. One area the hospital scored low in was courtesy and friendliness of staff. "We had education sessions at every management meeting. One of the members of our hospitality team looked at why it is so hard to greet a stranger and did a program called Hello Therapy." That program was brought back to the staff, and even expanded to Smile Therapy, Ross says. Smiley face signs were posted around the hospital as a reminder to staff to smile. Scores dramatically improved and now are in the 90th percentile.
A hospital team also visited a more successful Press, Ganey client to learn from their successes. "We learned that we really did need to focus on the patients. We knew it all along, but the financial focus seemed to still creep to the forefront now and then." The hospital then created nine multidisciplinary teams that use Press, Ganey data to facilitate broad-based organizational change. For example, staff now make post-discharge courtesy calls and send thank-you cards. There also is an enhanced infant bereavement process.
The impact of Memorial’s programs has been dramatic. "Overall, our nurses section started at the 44th percentile and our most recent ranked us at the 97th," says Ross. "And our dietary department started at the 16th percentile; last time it was at the 90th."
The consulting and benchmarking company Solucient named the hospital a top 100 hospital for cardiac and orthopedic care. Admissions increased more than 6% in fiscal year 2001, and are up 9% so far this fiscal year. And that $2 million per month loss? It has turned around to an average monthly income of $400,000.
"At first, we didn’t believe that we should put less emphasis on financials," Ross says. Consultants were brought in and recommended cutting staff, but that didn’t work. "But when we put patient satisfaction at the top of the list, our finances turned around. That was a hard lesson to learn. We listened to our patients and staff, and suddenly things are better. All this from a change of emphasis and priorities."
[For more information, contact:
- Susan Johnston, director of human resources, East Alabama Medical Center, 2000 Pepperell Parkway, Opelika, AL 36801. Telephone: (334) 705-1300.
- Suzanne Ross, MSN, MBA, Director of Performance Improvement Resources and Outcomes Management, Memorial Medical Center, 1086 Franklin St., Johnstown, PA 15905. Telephone: (814) 534-9000.]
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