Boosting Patient Satisfaction in the ED: What Hospitals Should and Shouldn't Do

In a Sept. 17 webinar hosted by Becker's Hospital Review, experts from Select International discussed steps for hospitals to boost their patient satisfaction scores, especially in the emergency department.

The webinar featured Bryan Warren, healthcare solutions manager for Select International, Paul Glatzhofer, consulting manager for Select International and an industrial psychologist, and Todd Hold, MD, president of Georgia Emergency Services and associate medical director of the emergency department at Gordon Hospital in Calhoun, Ga.

Each speaker agreed that any improvement to a patient satisfaction scores essentially comes down to human behavior, and customer service initiatives in the emergency department present a unique set of challenges. Higher patient satisfaction scores are not the ultimate goal. The goal is to improve the patient experience, in the context of improved clinical outcomes.

"Physicians and staff sometimes balk at efforts because they're presented in isolation and as the most important performance metric," said Mr. Warren. Instead, hospital leaders should emphasize the connection between satisfaction scores and other metrics, such as clinical outcomes, employee engagement, staff turnover and profitability.

From the 15th to 99th percentile
Dr. Hold helped Gordon Hospital's ED staff raise patient satisfaction scores from the 15th to 99th percentile in three quarters. When hospital management prioritized customer service, Dr. Gordon was responsible for leading physicians and mid-level providers through the initiative to boost scores.  

Skepticism was the largest obstacle Dr. Hold encountered while leading the improvement effort. "I can easily determine who is a good clinical provider, but when it comes to the softer side of medicine, that's where a lot of people struggle," he said.

Many physicians may already feel overwhelmed with high patient volumes, high acuity cases, stress, inconsistent documentation procedures, managing midlevel providers and pressures to avoid long wait times. In light of these demands, patient satisfaction can be seen as the straw that will break the camel's back.

The presentation included seven steps providers can take to avoid resistance to a culture of customer service:

1. Make the patient experience a provider priority
2. Make the patient experience a hospital priority
3. Create accountability
4. Appreciate the limitations of training
5. Lead by example
6. Balance persistence with patience
7. Build the right team

Understanding the roles of psychology
In addition to those seven best practices, Dr. Gordon pointed out a few common mistakes hospital leaders make in their satisfaction efforts. For leaders who have tried implementing customer service initiatives only to see substandard results, Dr. Hold highlighted two areas to focus on: human psychology and employee selection.

On the human psychology side, Dr. Hold recommended leaders balance persistence with patience. There is no quick fix, and isolated data isn't likely to motivate people to change their behavior. "One of the things you can't do is feed a provider with scores, stats and criticism," he said. "I've seen that fail so many times."

Instead, mnemonic devices can better help overburdened physicians and clinicians incorporate customer service behaviors in their daily routines. This way, a set of behaviors becomes a constant expectation. It's easier for physicians incorporate specific behaviors into their interactions with patients rather than percentages, statistics and pages of benchmarks.  

AIDET is one mnemonic framework that's gained a considerable amount of momentum in the customer service industry. It stands for Acknowledge, Introduce, Duration, Explanation and Thanks. It reminds physicians to warmly address patients and family members, tell them who they are, inform them of the duration of this visit ("This should only take a few minutes" or "This could take about an hour"), explain patients' results and finally, thank them. While these steps might seem basic on paper, Dr. Hold said it's remarkable how often providers can forget one without the mnemonic device or similar training.

In addition to creating a sense of consistency, Dr. Hold taps into physicians' competitive nature. He posts detailed satisfaction data in the physician lounge so everyone can see it. If patients submit comments about their experience, Dr. Hold posts those as well.

"This is a competitive group that doesn't want to look bad," he said. "Create complaint accountability. Complaints come in frequently, and in the past the director would handle them. Now we have a process where every complaint goes to the CEO. It's amazing how there's such an overlap between avoiding complaints and delivering customer service."

How selection and hiring fits in
Mr. Glatzhofer pointed to a few mistakes hospitals and managers make in employee selection and hiring. One error is caving into pressure to fill positions. "This is one we come up against all the time," said Mr. Glatzhofer. "You have an opening and you really just need a warm body in that role."

This sense of urgency, often driven by management's focus on metrics like "time-to-fill," can result in bad hires, which will affect the hospital's broader patient satisfaction effort. Dr. Hold said Gordon Hospital traced a decline in its patient satisfaction score to two newly hired employees, illustrating just how much influence a poor hire can wield on department-wide scores. "When you bring in a bad hire, it's a black eye and it's a strike," said Dr. Hold.

Another cultural and staffing mistake to avoid is devaluing frontline staff. Mr. Glatzhofer told a story about a high-level human resources executive who dressed in a patient transporter's uniform one day and went to work at her hospital. She noticed nobody made eye contact with her. "Everyone in the hospital needs to work across levels so people feel like a team," said Mr. Glatzhofer. He also said that, oftentimes, patients' interactions with frontline staff are some of their most memorable and likely to leave a lasting impression. When they complete a satisfaction survey, it may very well be an encounter with a patient transporter or technician that affects patients' feedback most.   

In closing, Mr. Glatzhofer recommended that hospitals reassess their hiring process so the interview, screening and professional development plan all reinforce patient satisfaction goals. These are the three keys to building the right team.

• Interview: Are interviewers trained adequately? Does the interview have a standard scoring process for responses?
• Screening: Will this person be a good fit within the organization, or should you move on?
• Development: Even if a person is hired, they still have some professional weaknesses — what are they? "Good interviews have identified these ahead of time and will work on them," said Mr. Glatzhofer.

View or download the webinar (wmv).

Download a copy of the presentation.

More Articles on Patient Satisfaction:

Study: PCMH Model Improves Patient Satisfaction
Improving Physician Mindfulness May Increase Patient Satisfaction
Patient Experience Roundtable: Raising and Maintaining Patient Satisfaction

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