Patient satisfaction became a much more important issue earlier in 2008 when hospitals began reporting their performance on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. The 18-item survey was developed by the Centers for Medicare and Medicaid Services (CMS) and the Agency for Healthcare Research and Quality, and is completed by patients to record their level of satisfaction with the hospital and the care they received.
If you don’t know your hospital’s publicly reported HCAHPS scores, you should make it your business to become familiar with them. Survey results from participating hospitals are updated periodically and available at www.hospitalcompare.hhs.gov.
I regularly hear hospitalists say they could more effectively direct their energy and resources in ways consistent with their hospital CEO’s goals, if they only knew what those goals were. If you find yourself in the same category, then you should know there is a really good chance the upper-level hospital leadership has a salary bonus in place for achieving certain patient safety and satisfaction goals. A recent survey in the Journal of Patient Safety showed this is the case for more than half of the nation’s hospital executives.1 Therefore, learning more about your hospital’s patient satisfaction scores, and your group’s contribution to the score, is worth the effort.
The publicly reported HCAHPS data does not address hospitalists’ effect on patient satisfaction separately from other doctors and hospital attributes. As a result, some hospitalist groups conduct their own survey. This may range from a very brief series of written questions, or a more-involved survey administered via phone. Since it is difficult to drill down to patient satisfaction with individual hospitalists, data from these surveys often times are collected for the entire hospitalist practice in aggregate, rather than by the individual doctor.
Investigate both internal and external resources, if you believe your group could benefit from an intervention (e.g., education or training to improve patient satisfaction). Many hospitals have someone on staff to provide employee training in this area; the trainer probably would be impressed and pleased if you initiate contact to learn more about available training. Resources external to your hospital include survey companies (e.g., Press Ganey, NCR Picker, among others). These companies can provide training and guidance, or put you in contact with firms with whom they work. I have seen something as simple as a one- or two-hour online or DVD course be a valuable tool for some practices.
I know some very efficient hospitalists who maintain incredibly high levels of patient satisfaction despite very high workloads. I think these doctors probably are outliers, and most of us will see satisfaction scores decline as workloads become unreasonably high. Each group should challenge itself continually to find the optimal point between patient volume and important outcomes like patient satisfaction.
Here are some strategies hospitalist groups could use to improve patient satisfaction:
- Call patients after discharge. This is a potent way to improve patient satisfaction. It is a valuable clinical encounter, since it offers a chance to reinforce discharge instructions (e.g, the value of smoking cessation, or the need to have ongoing INR monitoring), and to address any issues arising in the interim. The calls are most effective if done by the doctor who discharged the patient, but can be of some value if made by a nurse or other person connected to the practice. Note, it is best not to inform patients you will be making this call, since it will reduce the surprise and pleasure when the call comes, and could lead to frustration if a patient never gets the call they were told to expect.
- Provide referring doctors, emergency room doctors, and nurses at the hospital with a “script” to use when introducing or describing the hospitalist practice to patients. Without coaching, most of these people likely will say to the patient something like “your doctor [primary care physician] doesn’t come to the hospital anymore, so the hospitalist will see you.” Such a description may make the patient feel like they’re getting a second-class doctor. Instead, encourage these workers to say something like “Your doctor has decided to focus her practice on the office, to be more available to you there. As a result, she has decided to refer you to Dr. McCartney, a doctor who specializes in the care of hospitalized patients with problems like yours. Dr. McCartney will communicate with your primary doctor, and you should plan to follow up with her when you are discharged.”
- Communicate regularly, even daily, with family members of patients who have dementia or other cognitive impairment. This usually means calling the family.
- During initial and subsequent visits with a patient, shake hands or gently touch the patient in some way. Sit down and, while still sitting, conclude the conversation by asking if the patient has any questions and asking “Is there anything special I can do for you today?”
- Provide patients with a copy of their discharge summary. It can serve as a valuable education tool for the patient, their loved ones, visiting nurses, etc. Ideally, the summary should be transcribed on a stat basis, so it can be available for the nurse to give to the patient on the way out of the hospital. Alternatively, it could be mailed to the patient later.
- Track your ongoing satisfaction performance by regularly including available data from HCAHPS and/or other sources in the practice dashboard or report card.
- Ensure patients and their families are provided a copy of your group’s brochure. Brochures delivered to primary care offices rarely find their way into the hands of the patients, and often times are forgotten or misplaced by the time hospital care is needed. It usually is more effective to ensure hospital staff provides the brochure. This could be done via a standing protocol stating that a clerical person will provide all patients with a hospitalist as attending or consultant will get a copy. Or, ensure an order to this effect is written on every one of your patients. It’s best to do this via pre-printed order sets.
If you don’t have a group brochure, develop one. It should include the name of the group with a one- or two-line biography and photograph for each hospitalist (e.g., where they attended medical school and residency), and other key information about the practice. If you’d like a sample brochure, visit www.hospitalmedicine.org and search “sample brochure for hospitalist program.”
Each hospitalist in your group could carry business cards with the doctor’s picture next to their name and key info. One small study showed this enhanced patients’ ability to correctly identify their hospitalist and presumably increased their satisfaction, as well.
- Maximize hospitalist-patient continuity. Each group should adjust their work schedule to maximize continuity between patient and hospitalist while still providing a sustainable lifestyle. TH
Dr. Nelson has been a practicing hospitalist since 1988 and is co-founder and past president of SHM. He is a principal in Nelson/Flores Associates, a national hospitalist practice management consulting firm. He is part of the faculty for SHM’s “Best Practices in Managing a Hospital Medicine Program” course. This column represents his views and is not intended to reflect an official SHM position..
1. Vaughn T, Koepke M, Kroch E, et al. Engagement of leadership in quality improvement initiatives: executive quality improvement survey results. J Patient Saf. 2006;2(1):2-9.