Reduce chaos to see satisfaction scores rise
Knocking on doors makes patients feel welcome
Patients and their families want to feel comfortable, informed, and respected when they come to your facility for surgery, and your ability to make them feel that way is reflected in your patient satisfaction scores.
Improving patient satisfaction usually doesn’t require major changes in the way you treat patients but does require paying attention to little things that affect a patient’s perception of your facility, according to winners of the 2004 Compass Award for improved patient satisfaction scores from Press Ganey Associates, a South Bend, IN-based patient satisfaction benchmarking company.
"It was easy to improve our patient satisfaction scores when I arrived, because our processes for handling same-day surgery patients was chaotic and confusing," says Susan M. Sherman, former director of surgical services at Gila Regional Medical Center in Silver City, NM.
No one reviewed charts prior to the day of surgery, she says.
The lack of prior review meant that missing labs or X-rays were not discovered until the patient arrived at the facility, which resulted in delayed or rescheduled procedures, Sherman explains.
"This was not only inconvenient for the patient, but also for the surgeon," she says.
The chaos continued when patients entered the pre-op area, Sherman adds.
"There were no restrictions on who could go back to the small, open pre-op area, so families and patients were standing in the hallway that led to the operating rooms, often having to move out of the way as patients were moved into surgery," she points out.
There was no privacy for the patients, Sherman says. "It was hard for the patient to concentrate on instructions from the nurse because of all the activity in the area, and it was stressful for staff," she adds.
The first step Sherman took to address the problems was to move the pre-op area to a room across the hallway from the surgery department. It is not an ideal situation to have to cross a public hallway to return to surgery, she adds.
"We are planning a renovation this next year that will move pre-op back into the surgery department," Sherman continues. "This is, however, better than our previous situation because we have curtained areas that do provide some privacy for the patients as the nurse conducts her pre-surgical assessment and answers the patients’ questions."
The hospital also prohibits family members or friends from accompanying patients to pre-op unless the patient is a child or an older adult who needs a caregiver with him or her, Sherman points out.
"This rule not only reduces the noise and confusion in the area, but also further protects the patient’s privacy in case there are sensitive issues to discuss," she adds.
Another change for the same-day surgery program was the addition of a pre-admission nurse who calls patients prior to the day of surgery to provide instructions on preparation for surgery and to conduct a pre-op assessment by telephone.
Patients can discuss surgery concerns
The biggest advantage to adding the pre-admission nurse is that patients have a chance to ask questions and talk about their surgery prior to the day of surgery, Sherman notes. "This makes the patient a lot calmer and better prepared."
The pre-admission nurse sits next to the scheduler so the two can coordinate preparation of charts, she says.
"The pre-admission nurse reviews the charts prior to surgery and makes sure that all history and physical information, lab work, and other diagnostic tests ordered by the physician are on the chart," Sherman adds.
This move has made cancellations of surgery almost nonexistent, she says.
"We have called physicians’ offices to get power of attorney forms for children when their grandparents are bringing them in for surgery prior to the day of surgery because the pre-admission nurse found out in her initial call that parents would not be bringing the child," Sherman says.
The changes at the same-day surgery program at Sacred Heart Medical Center in Spokane, WA, were not as drastic as adding staff and moving the pre-op area, but they were effective, says Denise Dominik, RN, BSN, CPHQ, director of performance improvement at the hospital.
"Our first step was to send our performance improvement team throughout all areas of the hospital to observe how we communicate with patients, visitors, and family members," she says.
Smiles improve overall attitudes
One of the things the team noticed was that employees throughout the hospital, including those in same-day surgery, hurried from place to place without making eye contact with visitors or other employees, Dominik notes.
That discovery, as well as other examples of poor communication, were used to develop staff education programs that addressed the importance of making visitors feel comfortable, she adds.
The first step in educating staff members to make others feel welcome was to institute the "10-foot rule," Dominik says.
Whenever staff members are within 10 feet of another person, they are to smile and say hello, she explains. "The person can be a visitor, another staff member, a physician, or anyone," Dominik adds.
Smiles are contagious, she continues. "I’ve seen greetings put smiles on people’s faces, and then they’ve gone on to greet the next person," says Dominik.
If a staff member notices someone who appears to be lost, it is that staff member’s responsibility to stop and help the person find the way, she notes.
In addition to feeling welcome, privacy also is a significant issue for patients, says Connie Wechtenhiser, RN, manager of outpatient surgery at San Jacinto Methodist Hospital in Baytown, TX.
For that reason, same-day surgery staff members always keep the sliding doors in the pre-op and recovery areas closed, she says.
"We also respect privacy of patients in different cultures," Wechtenhiser says. "For example, we allow Indian women to keep pants on to maintain their sense of modesty until right before we take them into the operating room."
At Sacred Heart Medical Center, staff members throughout the hospital are required to knock on a patient’s door before entering the room, but the same-day surgery department has curtains separating patients rather than doors, Dominik notes.
Knock first
Curtains, however, don’t change a nurse’s responsibility for knocking, she adds. "Our staff members stop at a closed curtain and say knock, knock’ before entering," Dominik says with a laugh.
Sometimes improving patient satisfaction is as simple as letting patients know who cared for them during their visit, Wechtenhiser points out.
Perhaps the most successful activity implemented at San Jacinto is the greeting card that the same-day surgery department prepares for each patient.
The card thanks the patient for entrusting San Jacinto with their care and wishes them a speedy recovery, she explains. The card is placed on the chart and as the patient moves from area to area, the staff members, including the physicians, sign the card.
"Not only does this increase the sense of accountability for staff members, but patients have mentioned the card in follow-up phone calls made by staff members as a highlight of their experience," Wechtenhiser says.
A bonus to having all staff members sign the card is that the patient now knows everyone who provided care, she says.
"We’ve always had patients send thank-you letters that named their pre-op nurse, but now patients thank every person who cared for them because they know who cared for them, even when they were under anesthesia or drowsy in recovery," Wechtenhiser says.
[For more information about patient satisfaction improvement tips, contact:
- Denise Dominik, RN, BSN, CPHQ, Director, Performance Improvement, Sacred Heart Medical Center, 101 W. Eighth Ave., Spokane, WA 99220-2555. Phone: (509) 474-3733. E-mail: [email protected].
- Connie Wechtenhiser, RN, Manager, Outpatient Surgery, San Jacinto Methodist Hospital, 4401 Garth Road, Baytown, TX 77521. Phone: (281) 420-8908. E-mail: [email protected].]
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