1. Learn from the hospitality industry. According to Dr. Teuber, the hospital and healthcare industry sits on the opposite end of the spectrum from the hospitality industry. Instead of catering every aspect of a facility to the customer, as a hotel would, hospitals often prioritize quality clinical care without considering the importance of customer service. “Hospitals often enjoy monopolies, and the attitude of the staff members becomes, ‘Hey, where else are you going to go? We didn’t ask you to come here,'” Dr. Teuber says. “I think that attitude comes from that market protection.”
Dr. Teuber says in order to achieve high patient satisfaction scores as well as high technical quality scores, hospitals should send their staff members to hospitality training programs. “We attend Ritz-Carlton training programs and Four Seasons training programs to learn from the hospitality industry,” he says. “We have a zero-tolerance policy for the ‘we don’t care if you’re here’ attitude.”
Press Ganey’s Pulse Report 2009 on patient perspectives in healthcare revealed the top five items that would prompt patients to recommend the hospital to others as:
• Response to concerns and complaints made during the hospital stay
• Degree to which hospital staff addressed patient emotional needs
• Staff effort to include patient in decisions about treatment
• How well nurses kept the patient informed
• Promptness in responding to the call button
Dr. Teuber says many hospitals underestimate the effect that patient-provider relationships have on patient satisfaction and recommendations. He says the issues that decrease patient satisfaction are usually based on “day-to-day contact,” including conversations between nurses and the way nurses greet patients. “I’d compare [nurse rudeness] to flying first class and having a drink that’s empty and seeing two stewardesses talking about something that happened last week,” he says.
2. Improve provider attitudes by eliminating wasted time. Dr. Teuber says wasted time is one of the main causes of surgeon dissatisfaction, and that dissatisfaction can trigger hostility between nurses, physicians and anesthesiologists that will affect patient satisfaction. He says surgeons can waste up to two hours a day waiting for other providers and waiting for room turnover. “If you do the math, if a surgeon is operating four days a week, that’s an eight-hour day they’re losing every week. If you extrapolate that, they’re losing a few days a month and then twelve weeks a year, which can add up to [hundreds of thousands of dollars],” he says.
In Dr. Teuber’s experience, the choke points in hospital processes generally occur in pre-op and anesthesia. Medical issues that will prevent surgery are often apparent several weeks before surgery in an office visit. Unless the patient presents on the day of surgery with unpredictable conditions — such as lesions on the surgical site, oxygen abnormality, blood pressure abnormality or glucose abnormality — surgical cancellations should be low.
Cancellations can happen similarly through problems with anesthesia. “Anesthesia has got to review the medical record a few days before the scheduled surgery,” he says. “Somebody has got to take responsibility for the cancellation and the failure to advance, and if anesthesia cancels a surgery in the pre-op area, that stops the whole [process].”
Because cancellations are a major cause of surgeon dissatisfaction, Dr. Teuber recommends making it very clear to anesthesia providers and pre-operative nurses that necessary checks have to be done several days before surgery — while there is still time to cancel the case without angering the surgeon.
3. Respond to every patient complaint with a phone call and a letter. Both The Joint Commission and CMS require hospitals to provide patients with specific instructions about how to register complaints, and 2010 requirements say hospitals must provide the following to all patients who submit a grievance within seven days of the complaint:
• Written notice of the hospital’s decision
• Name of the hospital contact person
• Steps taken on behalf of the patient to investigate the grievance
• Results of grievance process
• Date of completion
Dr. Teuber recommends that every patient complaint be handled with an initial phone call and a follow-up letter. Not every patient complaint can be solved within a seven-day time frame, but patients need to know that their complaints are taken seriously. “Every negative response gets a phone call from the staff member to the person who generated the negative response, and the patient gets a hand-written letter,” he says. He adds that every negative response is written up into a report that Dr. Teuber receives to review the issue and the providers involved. He says he tries not to look at positive responses from patients in order to prevent the hospital from resting on its laurels.
4. Give physicians information on patient responses to their work. According to Dr. Teuber, one of the best ways to improve interactions between physicians and patients is to inform physicians of positive and negative comments. He says hospital administrators can deal with negative responses by calling the provider or staff member into the office to talk the issue over. The problem might be resolved through a simple notification, training or disciplinary action, but it won’t be solved if the provider never hears about it.
He says positive responses can be distributed to physicians regularly by listing positive feedback for each physician in a packet distributed every few weeks. Dr. Teuber says he distributes the compiled feedback to each physician and highlights his or her specific responses. That way, providers can see how they compare to their colleagues without disseminating negative information and encouraging hostility.
5. Make your facility an attractive place to work and visit. An attractive facility doesn’t have to mean state-of-the-art equipment or million-dollar expansions — Dr. Teuber says Medical Facilities Corp.’s facilities promote patient satisfaction through small touches throughout the hospitals. “We have a lot of reading materials and big coffee table books, which everybody likes to look at,” he says. “We live in the west, so everyone likes to look at pictures of tractors, wildlife, spurs and saddles, things like that.” He says the hospitals are equipped with wireless internet and internet stations, and patients who request laptops are provided them in their rooms. He says seemingly small issues like dirty bathrooms can have a big negative impact on patient satisfaction, so involving maintenance and housekeeping staff in pushes toward improved patient satisfaction is key.
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