Six Steps to Improving Patient Satisfaction

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Patient satisfaction is often misunderstood by health-care providers, according to William R. Johnson, CRA, MBA, RT, system director of patient experience with Memorial Health System (Springfield, Illinois). In Los Angeles, California, on April 10, at the 2013 spring meeting of AHRA: The Association for Medical Imaging Management, he presented “Patient Satisfaction: What It Isn’t, What It Is, and How to Do It Better.” He says, “It’s all about the patients’ experience of how they were treated as human beings. It’s about their perceptions of the caring they received during their clinical journeys.” Terms such as experience and perception might not sound conducive to strategic development, but Johnson stresses that patient experience, like any other aspect of care, can be improved using an action plan that sets specific goals and defines the tactics that will be used to achieve them. “There are business strategies and operational techniques to improve patient satisfaction,” he says. Approaches that include experience mapping, reinforced communication with staff, and tracking survey results from Press Ganey Associates Inc all contribute to deepening caregivers’ understanding of how to improve patient satisfaction. Johnson observes that initiatives like these are becoming more vital than ever before, as consumerism drives patients to compare their health-care experiences with their experiences in other environments. “Patients do not compare hospital A to hospital B,” he says. “They have a mental picture of how they should be treated, and the standard is the best they have been treated anywhere, not the best they have been treated in health care.” With that in mind, he outlines seven steps that facilities can undertake to improve patients’ experiences of care. Step 1: Identify drivers of satisfaction. Johnson recommends using surveys (such as those performed by Press Ganey and other professional research consultancies) to zero in on drivers of patient loyalty. Press Ganey’s 2011 Pulse Report,1 for instance, recommended that facilities prioritize, in this order, response to concerns/complaints expressed during patient visits, sensitivity to patients’ needs, staff concern for patients’ questions and worries, and how well staff members work together to provide care. “Response to concerns is a really strong influencer of the patients’ perception of caring,” Johnson notes. “For us, it became a strong center of focus.” Step 2: Create an action plan for the identified drivers. Johnson recommends using survey results to identify both the current state of performance and the goal, quantifying them as mean scores. Next, identify the key stakeholders who are accountable for execution of the action plan and make sure that they are aware of both the goal and the plan for reaching it. Step 3: Educate staff on the action plan. “We train on the action plan for 30 days,” Johnson says, adding that handouts, emails, staff meetings, and more are used for reinforcement. The goal should be to hardwire key behaviors, such as responding appropriately and sympathetically to complaints at the time that they are lodged. “Ultimately, what we want to be able to achieve is narrowing the knowing–doing gap,” he says. “Results come from the behaviors of the staff members who touch the patient.” Step 4: Audit staff knowledge and responsiveness. At Memorial Health System, audits are conducted spontaneously, in the form of informal interviews. Johnson says, “Five minutes or less: They can happen in the hallway.” Staff members might be quizzed on the goals that they are trying to reach or on specific language choices that they have been encouraged to make. “We can go through the whole process of making sure the staff members know what to do, but getting them to do it is another thing,” Johnson notes. Step 5: Observe staff behavior and provide feedback. This process can be somewhat informal; Johnson says, “We observe staff members’ behavior and give counseling, coaching, and (sometimes) corrective action.” To quantify when counseling should give way to consequences, Johnson recommends creating a culpability map of behaviors and consequences; increased culpability—and corrective action—should occur when staff members purposely do not do what is expected, not when established processes cause them to fail. Step 6: Monitor results over time. Using Press Ganey surveys or another tracking method, see whether patient-satisfaction scores are trending toward the target mean score. Johnson cautions us that looking for results over longer periods of time will yield a more accurate sense of your progress (or lack thereof). He says, “Peaks and valleys in performance are normal variability. Ultimately, we want to see improvement from year to year, because when you start looking at small datasets, you’re going to chase ghosts.” Johnson adds that engaging already-busy physicians in patient-satisfaction initiatives can be particularly challenging, especially when it comes to the radiology department, where physicians might not have a lot of contact with their patients. “My focus, with our radiologists, is getting the interpretations done as quickly as possible—that’s how they have an impact on the patient experience,” he says. “For those physicians who do have direct patient contact, it’s helping them understand that they could be the most clinically competent physicians in the world, but if they’re rude, patients don’t care.” At Memorial Health System, Johnson’s action plan has yielded big results, in terms of improving patient satisfaction: Between 2008 and 2013, the organization’s mean satisfaction score rose from 91.6 to 94, exceeding the set goal of 93.9. “Patients’ perceptions of caring include their beliefs and expectations that the clinical-care providers, technologists, and radiologists were competent in their skills, and their belief that all the representatives they encountered truly cared about them as human beings, not as diagnoses, diseases, or procedures,” he says. “Many of us come to the hospital every day with the best of intentions, but where we fall short is making sure those intentions are interpreted correctly.” Cat Vasko is editor of and associate editor of Radiology Business Journal.