14 Best Practices to Improve Patient Satisfaction in an Orthopedic Unit

The Orthopaedic Joint Reconstruction Program at 250-bed Gottlieb Memorial Hospital in Melrose Park, Ill., achieved an outstanding score in the 99th percentile range in the first quarter of 2009 on CMS' patient satisfaction survey, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS).

A lot of planning went into this achievement, according to the two leaders of the new program — Paul Gorski is administrative director of orthopaedic and rehabilitation services at Loyola University Health System, which acquired Gottlieb last year and directed the changes, and Mary Romano, RN, nurse manager of orthopaedic unit at Gottlieb, was a key participant is each step of the process.

Here are 14 best practices from Mr. Gorski and Ms. Romano for success with patient satisfaction, based on their experiences.

1. Think like your patients. "When designing operations, think in terms of the patient's perspective, not your own," Mr. Gorski says. Orthopedic patients have problems with mobility and pain after surgery, which can make it difficult navigating the comparatively large campus of 570-bed Loyola University Medical Center. When Loyola acquired Gottlieb last year, Loyola planners realized that the smaller community hospital would be easier for orthopedic patients to visit. Patients with five of Loyola's orthopedic surgeons would be sent to Gottlieb, along with the patients of Gottlieb's five orthopedic surgeons. Altogether, some 300 patients have come through the new Gottlieb orthopedics unit since it opened in July 2008.

2. Plan well and early. When Mr. Gorski and others at Loyola began planning a new orthopedic program at Gottlieb, they looked at the big picture and asked: What is the vision of the program and the mission that will serve as your guide? The Loyola planners decided it would be: "We are dedicated to providing high quality, patient-centered care in a comfortable, attractive state-of-the-art facility." They aimed for outstanding customer service and superior clinical outcomes.

3. Focus on a few key indicators.
"In a surgical program, there are an overwhelming amount processes and data metrics to review," Mr. Gorski says. "You can get dizzy keeping all of them in mind and it then it becomes impossible to focus on any one of them." He recommends selecting a few key indicators. He says the Gottlieb orthopedic team focuses on three processes: 1) the HCAHPS score on the patient's likelihood of recommending the hospital to a friend; 2) the HCAHPS score for "pain control"; and 3) CMS non-payment events such as falls, pressure ulcers and mortality.

4. It helps to be brand-new.
Gottlieb refurbished a 21-bed oncology unit to create the new orthopedics unit. The unit has new flooring, new wall coverings and new furniture. Research shows that patients feel more satisfied when care is delivered in new facilities. "The patients are more comfortable and the rooms are more welcoming to visitors," Ms. Romano says.

5. Incorporate patient-friendly design elements. The new unit has all single-occupancy patient rooms, which Mr. Gorski says patients prefer because they afford privacy, are less noisy and encourage visitors. The rooms also have large windows, bringing in extra sunlight, which patients prefer. Six of the rooms have couches that convert into beds and the rest have sleeper chairs. This encourages family to stay for long visits, which not only improves satisfaction but also improves healing, according to several research studies.

6. Make sure the patient feels comfortable. "What is best for the patient is best for the program," Mr. Gorski says. Making sure that the patient feels at home starts in the pre-op stage, when patients attend classes showing them what to expect in surgery and on the unit. When they arrive at the hospital, patient transportation is available at the door. "The patient does not even have to ask for transportation," Mr. Gorski says. "It's right there."

7. Keep everything clean.
The HCAHPS survey specifically asks whether the patient's room was clean. One housekeeper is assigned to clean the orthopedic unit, so that she can become familiar with requirements. The housekeeper's knowledge of the unit translates into high efficiency, which is crucial when rooms need to be promptly cleaned and ready for new occupants during the high turnover period for orthopedic surgeries from Monday through Wednesday.

8. Bring together a skilled staff. Ms. Romano was able to bring together experienced nurses for the unit without going outside the hospital. The nurses came from a previous Gottlieb unit that combined orthopedic, cardiac and pediatrics patients. Ms. Romano says the nurses' EKG skills have come in handy for orthopedic patients with cardiac problems. "A highly skilled staff, focused on the customer, is crucial in achieving excellent patient satisfaction scores," Mr. Gorski says.

9. Make sure staff is motivated.
"The nursing staff was really very positive about this collaboration with Loyola," Ms. Romano says. "They were very, very motivated. They were very accepting of the changes and an expansion of the orthopedic program at Gottlieb."

Because she had worked at Loyola before, Ms. Romano was able to prepare the Gottlieb nurses to deal with the Loyola processes and the specific goals of the program.

10. Work closely with physical therapists. In addition to nursing care, immediate attention from physical therapists has the most impact on positive patient outcomes, Ms. Romano says. Physical therapists see the patients the same day of surgery. "This is very important for recovery," she says.

11. Get everyone involved. "The bottom line is, when reviewing satisfaction scores, include all staff," Mr. Gorski says. Even non-clinical personnel, such as housekeeping staff and patient transporters, can have a positive effect on patients. "Make sure everyone involved understands the hallmarks of the program," he adds.

12. Be available.
Patients need to know that someone is paying attention to them. In the Gottlieb unit, a nurse checks in on each patient every one to two hours. "There is quite a bit of monitoring," Ms. Romano says. "We constantly ask, 'How is your pain?' Pain control is very important for patients who have had orthopedic surgery."

13. Take satisfaction scores seriously. The HCAHPS survey is now a requirement for all hospitals and the results are posted on Hospital Compare, a Web site that the public can access to compare hospitals' patient satisfaction scores. In addition, the hospital voluntarily uses Press Ganey surveys that are more detailed and report scores weekly. The Press Ganey survey asks questions such as whether nurses were courteous, responded promptly to call lights and had a positive attitude toward requests. The survey also asks the patient to evaluate the nurse's skills.

At monthly meetings, Ms. Romano and her nursing staff on the unit review HCAHPS scores and identify how services can be improved. Ms. Romano also refers to the Press Ganey and HCAHPS scores when making periodic evaluations of nurses.

14. Check out patient complaints.
"Listen to what patients say," Mr. Gorski says. "Never brush off a complaint that may not appear to be factual." You may be missing an underlying issue that is has been active under the surface and is ready to bubble up.

Learn more about Gottlieb Memorial Hospital.

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