Agency focuses on causes of dissatisfied patients
Solutions ranged from easy to time-consuming
Raising patient satisfaction can be difficult, particularly when home care agency managers do not fully understand the causes of a lower-than-desired satisfaction rating.
This is why a performance improvement (PI) program usually is necessary in order to bring about any lasting changes in how patients perceive a home care agency. Such a program can highlight the problem areas and offer clues to turning these around.
Shore Home Care in Easton, MD, is a good example of an agency that treated a patient satisfaction program as it would any PI program, with committees dedicated to various areas in which improvements needed to be made.
Here’s an example of how such a PI program might work. (Shore Home Care focused on the five previously mentioned areas related to patient satisfaction; see related article, p. 6.) The following changes were made:
• Plan of care: Patients expressed a desire to be more involved with the care-planning process. Since it’s very easy for nurses and therapists to overlook the patient’s involvement in planning, the PI team developed a 31-page patient orientation booklet that educates home care staff on how to involve the patient from the onset of care.
"From the start, we talked about the patient being the partner with us," says Kay Satchell, RN, performance improvement specialist at Shore Home Care.
"We have a welcome letter that [explains] how their medical treatment is important to us, and we talk about our mission as promoting physical and emotional wellness," Satchell says. "We talk about their rights, respect, our policies, and our criteria for admission."
The PI team decided the agency had not been educating patients well on how they were included in the plan of care.
The booklet covers all areas of home care visits and details how the patient can be included in each step of the care process. Another change was to color-code the agency’s two home care teams so that it’s easier for patients to ask for assistance when they call the agency. The staff have sweatshirts and hats with their team’s color, and the patient folders are the team color. When a patient calls for help, the home care receptionist only has to ask them what color is on their folder and their team can be easily found.
"Before, when a patient called in for assistance, we’d say, Where do you live?’ and Who is your nurse?’" Satchell says.
• Complaints: Previously, the agency identified patient complaints when the care had ended and someone had called the patients to ask how they were doing.
At the PI team’s suggestion, the agency has begun to call all patients at two weeks after admission. "Instead of waiting until the end of care, we try to identify these issues as soon as possible," Satchell says.
The intake liaisons that accept referrals call the patients to set up an initial visit. Two weeks later, the liaisons contact the patients and ask whether they are pleased with their services or are having any problems.
During the PI process, the agency had the staff call most patients at two weeks. But that has proved to be time-consuming; eventually, it will be changed to a smaller sample of patients who are contacted.
The PI team also made a change to improve staff communication. Many employees were unaware that they could send a voice mail message simultaneously to several colleagues, which saves a lot of time. The agency then taught staff how to use all of the phone system technology.
Home health aides
The agency increased the face-to-face supervision of aides from once every 60 days to twice every 60 days. This will better ensure the aides are following the patient’s plan of care.
Patients expressed concern about aides understanding their need for privacy and being more sensitive in the scheduling of visits. Aides were then taught patient privacy issues.
Also, the agency now has a central binder that holds all plans of care for aides. This way, the scheduler will know when an aide visit needs to be changed because it coincides with another health care need of the patient.
In assessing patients’ comments about aides, the PI team realized that the agency needed to provide more aide services. But this couldn’t be done with the current aide staff level.
"What caused our patients’ dissatisfaction was that we really had to give a little bit of service to everyone, and we weren’t meeting their needs, so we went to our vice president and said, Our satisfaction shows that we aren’t providing as many services as we need to,’" Satchell recalls. "So, management gave us a special exception to hire another home health aide even though that position wasn’t in our budget."
Keeping patients informed
The home health agency’s therapists come from the health system and have separate scheduling through the rehab department. It’s often difficult to make sure all staff are informed about when the therapists will be visiting patients.
"The rehab department has commitments to inpatient, home care, skilled nursing facility, and an outpatient rehab facility," Satchell says. "That has been a challenge."
One solution has been for the home care agency to contract with two therapists who will work strictly for home care patients. This way, the agency knows exactly when they will visit and can control the scheduling process.
The therapists dedicated to home care will be placed on teams that cover a specific geographic area. "We felt that we really didn’t educate our patients about the expectations for an on-call nurse," Satchell says. "We didn’t do a good job of letting patients know what kind of response to expect."
Nurses were told to explain to patients how an on-call nurse might not always visit their home, but will at least call to see how to help the patient. Also, when patients call in, the phone system automatically gives them a message that says the nurse might not be able to answer their call right now; but if they would please wait, the nurse will be right with them.
To ensure on-call nurses respond in a timely manner, the agency began to keep an on-call log book that tracks staff response to calls. The phone system times the inbound calls from patients and those made by nurses. The response time now averages 30 minutes, and the PI team wanted to improve that time. Just letting staff know that their response time is being recorded has helped to improve it, Satchell says.
"We now have an administrative on-call team; if the answering service can’t get through to the first-line call team within 15 minutes, then our administrative on-call team is notified," Satchell says. "That really does make us respond more quickly."
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