Patient satisfaction rises in importance for hospitalists
It takes a team
But large-scale training and simulation efforts take resources and that requires buy-in from the hospital leadership, experts said.
Take the chair example. One of the common tactics for improving patient satisfaction is to sit down when in the patient’s room. Studies show that sitting down makes the patient feel like you’ve given them more time than if you were standing, even when the encounter is actually shorter. It also allows the physician and patient to be at the same eye level.
But what if there isn’t a chair in the room? Or the chair is filled with linens? That’s exactly what happened several years ago at Baystate Medical Center when they first tried to implement a set of behaviors aimed at improving patient satisfaction. To move forward, the physicians had to work with housekeeping to get a free, open chair in every room, Dr. Whitcomb said.
To be effective, patient satisfaction efforts have to include not just physicians and nurses but environmental services, transport, clinical associates, administrative associates, and the hospital board, Dr. Short said.
"You can’t do it alone. You shouldn’t do it alone. You won’t be able to do it alone," he said.
Dr. Short recommended starting with the hospital board because if they buy in, everyone else has to follow. And he said hospitalists shouldn’t be afraid to ask for the resources they need to get this done. Maybe the money goes to compensation incentives or to investments in improved technology in the department. Either way, if it’s important to the hospital leadership, they should provide some extra funding.
"Make it a partnership and not a one way," he said.
Another key element for success is measurement. And HCAHPS scores alone are probably not going to be adequate to advance improvements, said Dr. Richard Slataper, medical director of the hospital medicine service at Our Lady of the Lake Regional Medical Center in Baton Rouge, La. While HCAHPS scores are good for aggregate hospitalwide data, it’s difficult to impossible to relate the scores to specific physicians, he said.
At Our Lady of the Lake, they got around this issue by creating their own simple patient feedback form. The short questionnaire is mailed out to patients after discharge and includes the names of the physicians involved in that patient’s care. Dr. Slataper said they use the homegrown survey to judge if their patient satisfaction initiatives have been successful. Sharing the results is also a good motivator for the providers, he said.
They share all of the positive feedback from the surveys at a staff meeting and then review negative feedback during one-on-one meetings.
If developing your own survey is too complex, Dr. Whitcomb said most of the big vendors have or are developing surveys that can be used to gauge individual physician performance more accurately than HCAHPS.
Hurdles remain
Despite all the talk about patient satisfaction and the increasingly aligned financial incentives, physicians and hospitals are still struggling to make improvements. One problem is that hospitalists practice all over the hospital – from the observation unit to the ICU – and it can be difficult to take the tactics available and practice them consistently, said Dr. Steven B. Deitelzweig, vice president of medical affairs and chair of hospital medicine at Ochsner Health System in New Orleans.
Co-location, where physicians work consistently with the same team of providers, could help alleviate part of the problem, Dr. Deitelzweig said. Another possible solution is increased coaching and mentoring among hospitalists, he said. As a result of the high volume of patient handoffs, hospitalists have a greater opportunity to see each other at work. That’s also an opportunity to share effective tactics when it comes to patient satisfaction, he said.
A tougher hurdle may be that patient satisfaction is being added to a long list of requirements for hospitalists from core measures to hospital-acquired infections to improved documentation.
"They are kind of inundated, and I think some hospitalists are a little bewildered," Dr. Whitcomb said.
His best advice to hospitalists is to remember to "keep the patient at the center" and patient satisfaction will follow.
Dos and don’ts for improving patient satisfaction
Wondering how to get started on improving patient satisfaction? Dr. Peter Short of Northeast Hospital Corporation in Beverly, Mass., suggests that hospitalists get started by choosing three tactics, implementing them, and then measuring their impact. Once those items are hard-wired in the program, move on to other strategies for connecting with patients, he said.
