Teaching hospital uses staff to reverse satisfaction lows
The importance of strong patient satisfaction levels as a litmus test for managed care contracts and renewals has become standard. A few simple steps proved to be the key for turning around one ED
In 1993, the ED staff at the University of Kentucky Hospital in Lexington took some bold steps to correct the dismal satisfaction ratings they were getting from patients.
They began by taking virtually the entire department on a retreat. "We scheduled the RNs, the nursing assistants, the financial advisers, the medical staff, even the housekeepers and materials managers who could attend," recalls Linda Holtzclaw, RN, MSN, CEN, division director of emergency services.
The goal of the one-day conference was to find ways to make the department more user-friendly. Throughout the meeting, a mandate to keep the discussion focused on positive, problem-solving achievements was strictly enforced on participants.
Meeting set a milestone for staff
The day, spent at a one of the university’s bucolic conference centers surrounded by open fields and rolling farm lands, proved to be successful.
It led to a strategy for boosting patient satisfaction scores that helped the 450-bed teaching hospital achieve national recognition in a benchmarking survey of ED trends.
Earlier this year, the Oak Brook, IL-based University Hospital Consortium released the findings of its wide-ranging Emergency Department Benchmarking Project Summary. The non-profit group surveyed 52 university-affiliated facilities in performance areas such as triage, registration, admitting, and provider [patient] satisfaction.
UK Hospital scored well above the average among participating facilities in overall achievement for patient satisfaction. It scored an 81 on the index, compared with an average for the entire group of 77. How did the hospital do it? Here are some answers:
Patient satisfaction goals were included in each staff member’s performance evaluation. Doing so helped make each employee feel accountable for helping to raise satisfaction levels, says Holtzclaw. At once, the staff became personally invested in how each patient perceived the level of caring and service in the ED. The strategy also helped ensure that employees would follow through on related measures.
All department staffers were made personally accountable for addressing patient complaints. Supervisors encouraged nursing staff and aides to speak with unhappy patients regularly about their status and show concern for delays. Most of the patient’s issues involved their perception of long delays, which can vary widely from person to person, Holtzclaw says.
Employees were told, "It’s part of the service." Patient perceptions count. The hospital financial performance depends on it, says Mark Birdwhistell, MBA director of managed care with UK Health Care, the hospital’s affiliated managed care organization.
Staff members were frequently reminded that the hospital operates in a competitive environment. "You want the patient to come back, to say nice things, to sign up with your managed care program," Holtzclaw says.
A little diplomacy became part of the treatment protocol. In the past, non-urgent patients were made to feel less important than true emergency cases. "They were often told either by words or actions that they weren’t as ill as a certain other patient, and therefore were not as important," Holtzclaw recalls.
Today, restless patients get a kind word of concern from floor nurses, who check in with them in regular intervals. "The show of concern changes people’s perceptions of a long wait," Holtzclaw says.
The department capitalized on volunteers and patient representatives. It also added one additional registered nurse during busy evening hours and increased staffing in its fast-track section for lower-acuity patients by adding a nurse practitioner. The high visibility of the volunteers and patient representatives in the lobby gave the positive impression that the hospital was genuinely concerned about the patients’ well-being and about keeping waiting times to a minimum, Holtzclaw recalls.
The hospital monitored its progress. Complaints dropped off significantly. Angry phone calls fell from three per day to the same number per week within a year following the department’s initiative.
But efforts at keeping patient waiting times to a minimum have seen mixed results, says Holtzclaw. "Our present goal is to move patients into treatment faster by cutting average waits from registration to 30 minutes from about triple that," she adds.
New Medicare charting guidelines hit ED physicians
ED physicians will likely be spending additional hours at the end of this year honing their documentation skills to avoid running afoul of vigilant Medicare reviewers.
Beginning Jan. 1, 1998, the new Medicare documentation guidelines for reporting Evaluation and Management (E/M) Services become effective. The guidelines offer specific, detailed instructions regarding the written information that must be present in the patient file to support the CPT-4 codes assigned on the claim form.
The guidelines focus primarily on the examination component of the E/M codes. While the four categories of examinations, (ie., problem-focused, expanded problem-focused, detailed, and comprehensive) have remained unchanged, under the new guidelines the documentation for each level must reflect specific clinical procedures.
The Health Financing Administration in Baltimore has developed 11 tables to guide physicians in identifying each procedure. Each of the tables refers to specific body-system examinations. Each table also lists specific "clinical elements" that are involved in each type of examination.
Providers must identify at least the minimum number of required elements in their documentation for each level of E&M services performed. Some physicians have already complained that the new guidelines are unnecessarily complex and cumbersome.
To obtain a copy of the guidelines, contact: the American Medical Association, customer service, 515 N. State St., Chicago, IL 60610. Telephone: (800) 621-8335.
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