Customer service training boosts survey ratings
ED gets many more compliments than complaints
Once the emergency department (ED) at Inova Fairfax Hospital in Falls Church, VA, began taking an aggressive approach to improving patient satisfaction, patient complaints were reduced by 80%, and patient compliments more than doubled. "We now get several times as many compliments as complaints," says Thom A. Mayer, MD, chairman of emergency medicine at Fairfax. "This year, we've had seven compliments per 1,000 patients, and that hasn't topped out yet."
Staff satisfaction has risen dramatically as well. Fairfax is a 65,000-visit level I trauma center and tertiary care medical center near Washington, DC.
Patient satisfaction survey ratings "skyrocketed" after ED staff received intensive customer service training, says Mayer, with the most dramatic improvement coming in patients' ratings of the skills of ED physicians and nurses. (See the listing of some of the questions asked, p. 140.) Surveys also documented the overall satisfaction with care and the likelihood that, more than ever before, patients were likely to return to Fairfax. Mayer says that, to his knowledge, this is the first statistical proof that customer service training can actually improve a patient's perception of medical care, quality, and outcomes.
The following 14 items on Fairfax's 50-item home-grown telephone survey showed substantial improvement:
• overall quality of medical care;
• skill of emergency physicians;
• skill of emergency nurses;
• overall satisfaction and likelihood of patient returning;
• overall respect shown to patients;
• doctors' ability to explain condition, diagnosis, and treatment options to patients;
• wait time;
• staff's effort to keep the family informed;
• meeting medical needs;
• rapidity of evaluation by triage staff;
• triage nurses' sensitivity to patient pain;
• overall discharge process;
• explanation by triage nurses;
• nursing staff's ability to keep patients informed.
No changes were made in the ED physician staff between the time a previous survey was conducted and the time those comments came in, and there was very little turnover among ED nurses. Mayer says this implies an important causal relationship between the technical care given and patient-provider interaction: He thinks patients are rating the quality of care and skill level based on less technical elements of patient service.
The patient compliments Fairfax is seeing are focused on the warmth, compassion, and skill of the ED staff. Complaints about perceived rudeness, lack of sensitivity, or coldness dropped most dramatically. Now complaints mostly focus on the areas of billing, wait times, or delays in obtaining inpatient beds.
Avoiding the 'talking heads' approach
Mayer first developed the patient satisfaction course in an effort to improve customer service in Fairfax's ED. "There are specific personal skills one needs in a busy ED," he says, "and we had been holding staff members accountable for those competencies even though they'd never actually been trained in them."
He and ED vice chairman Robert J. Cates, MD, looked at existing patient satisfaction courses but found that they offered "far too little substance," says Cates. "Too often, the courses were given by talking heads with little or no clinical experience, and they emphasized a simplistic 'smile even when it hurts' approach — one not well-accepted by clinicians. People in a busy ED don't like being told by nonclinicians how to take care of patients."
The two physicians' more realistic and aggressive course focuses on skills and competency, not touchy-feely concepts. It helps clinicians negotiate situations where physician and patient expectations are out of sync, says Cates, and helps resolve problems quickly before they take on a life of their own. The physicians also suggest that aggressive patient satisfaction training can increase a facility's competitive marketing advantage because happy customers come back and tell their friends. Patients who believe they are not treated well may go elsewhere in the future.
"For sure, attaining high patient satisfaction scores gives a facility a competitive advantage," explains Mayer. "But it also makes a difference internally. When scores go up for a department, that department can negotiate more effectively for the hospital's often all-too-limited resources." It also makes the clinicians' jobs easier, he says. "If we're going to be held accountable for these skills, doesn't it follow that we be trained in them?"
Course teaches three core competencies
To stress a team approach, Fairfax's entire ED staff — physicians, nurses, technicians, registration personnel, core secretaries, social workers, and radiology and respiratory therapy staff — was required to undergo the detailed customer service training. The eight-hour "Survival Skills" patient satisfaction course consisted of three core competencies:
• Making the customer service diagnosis and offering the right treatment. "Not only does every patient have a clinical diagnosis," points out Mayer, "he also has a customer service diagnosis."
• Negotiation and resolution of patient expectations. "Every patient comes to the clinical encounter with certain expectations about his care," says Cates. These expectations often are at odds with the expectations of the staff, and this disparity needs to be addressed.
• Building "moments of truth" into the clinical encounter. The phrase "moments of truth" refers to encounters between the customer and the employee of an organization, whether that organization is a hospital or an entirely different industry, such as an airline. "Patients expect technical competence from us, but they also expect caring competence," says Mayer. "In that 'moment of truth,' patients decide if this is a place they want to come back to or recommend."
Just as education in advanced cardiac life support (ACLS) improves cardiac resuscitation, he says, "we believe that a well-designed and rigorous customer service training can improve customer service outcomes. We've tried to create the ACLS of customer service."
Numerous hospitals around the country have taken advantage of Mayer's and Cates' formal patient satisfaction course. The entire full-day course costs $8,000 plus travel and lodging expenses for faculty. Classes are individually designed to meet a facility's needs based on questionnaires the doctors send out in advance. Hospitals sometimes opt for extra material on stress recognition and management or dealing with change, and those modules cost $2,000 over and above the basic cost.
For more information about the course, contact Joy Sparks-Gaviria, executive program manager, ED Survival Skills, 3300 Gallows Road, Falls Church, VA 22042-3300; (703) 698-3118.
Suggested reading
Schmittdiel J, Selby JV, Grumbach K, et al. Choice of a personal physician and patient satisfaction in a health maintenance organization. JAMA 1997; 278:1,596-1,612.
Levine C, Zuckerman C. The trouble with families: Toward an ethics of accommodation. Ann Intern Med 1999; 130:148-152.
Connelan T. Inside the Magic Kingdom. Austin, TX: Bard Press; 1997.
Dansk KH, Miles J. Patient satisfaction with ambulatory healthcare services: Waiting time and follow-up time. Hospitals and Health Services Administration 1997; 42:165-177.
Eisenberg B. Customer service in healthcare. Hospitals and Health Services Administration 1997; 42:17-32.
Herzlinger R. Market-driven Health Care. New York: Free Press; 1997.
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