Patients Demanding More Hospital Satisfaction

Hospitals seek survey, advisory-group feedback to improve their scores

If hospitals are looking for an honest appraisal of their service shortfalls, all they have to do is ask patients to rate their satisfaction -- and increasingly they're doing just that.

As the government and private health insurers look to tie providers' pay to their performance and as health-care quality and safety initiatives play greater roles in the effort to reduce costs, hospitals are more interested in improving patients' experiences. Young to middle-age patients and those with chronic medical conditions may prove particularly germane.

"When you slice it by age, patients 35 to 49 tend to be much more critical of their care and much less satisfied," said Matt Mulherin, a spokesman for Press Ganey Associates, a South Bend, Ind.-based company that provides about a third of U.S. hospitals with patient-satisfaction research and quality-improvement consulting.

What exactly makes for a good hospital experience? It can vary by specialty but generally includes everything from admission to discharge and such specifics as nurse interaction, noise levels, meals and staff responsiveness.

"When we look at what are some of the most important things to patients, it tends to be hands-on," Mulherin said. "It's communication, sensitivity to needs, responsiveness to concerns and complaints. Those are the things that really make or break a stay."

As patient satisfaction becomes more of a competitive issue, patients can expect to see more hospitals make high-profile efforts to address needs they may not even know they have, whether it's help being transported from the parking lot or better internal signage, said Susan Keane Baker, author of "Managing Patient Expectations," in New Canaan, Conn.

"By letting people know, 'Here are the questions we're going to ask you and here's what we're doing,' the patient should be satisfied," she said. "It's the same thing a hotel does when they ask 'Did the bellman offer to get you ice?'"

"The more that hospitals can tie those survey questions to specific actions and specific behaviors, the more likely they are to be rated high by patients receiving the surveys," Baker said. "I believe that managing expectations is helping people know how to be right and when to be satisfied."

Overall satisfaction rates among inpatients have been fluctuating in the low- to mid-80% range since 2001, according to Press Ganey data. Satisfaction tends to dip in the first quarter of the year during the winter months.

Medical specialties within hospitals see different satisfaction rates, with obstetrics and intensive care receiving high marks in 2005 while gastrointestinal and psychiatric units got a less positive reception.

Younger patients were the least impressed of any group with their care in emergency departments during 2005, according to the most recent Press Ganey report. Generations X and Y, those 18 to 34, were the most disgruntled, with only 76% saying they were satisfied with their experience compared with a high of 87.6% among those 56 to 79. The 35-to-49 age group was the second least satisfied in the ER, with a rate of 84.6%.

Wait times are the biggest offender in emergency departments, though satisfaction is higher if patients are regularly updated on the status of the delay even if it ends up being a long time, Mulherin said. Younger people may have higher expectations than their older counterparts because they grew up information-savvy.

"Each subsequent generation has different and usually higher expectations in terms of what kinds of information they should have and what kind of service they should get," Mulherin said. "Some of the Generation X folks might be less satisfied than even the boomers."

A gender gap showed up in the ER surveys as well. At 81.9%, women were less satisfied with their emergency-room experience than men, who had an 83.2% rate. That may sound like a small matter but amounts to a difference of 1.5 million patients, he said.

Targeting success

Spectrum Health in Grand Rapids, Mich., a Press Ganey client, was shocked to find it scored low in patient satisfaction in 2004, said Matt Van Vranken, its president. The regional health system quickly developed a plan for a broad-based turnaround, especially in one of its hospital emergency departments, which gets more than 130,000 annual visits, he said.

"It's been a top-down-driven approach but one that's engaged the entire organization," Van Vranken said.

Kris White, vice president of patient affairs for Spectrum Health, said change was imperative because the scores reflected facilities that weren't caring, coordinated or efficient enough. Hospitals often wrongly assume that giving patients what they want is costly and time-consuming, she said.

"We know that compassion can be the differentiator in the experience of care," White said. "We expect politeness, we expect courtesy, we expect helpfulness, but we're trying to take it up to the next level -- even in an organization of our complexity."

In the ER, the staff re-engineered the triage process so patients got to see doctors faster, among other changes, White said.

"They dropped the door-to-doctor time to 23 minutes vs. the four to six hours [patients] were spending in the emergency department, up to eight hours sometimes. They had to radically rethink how they did business."

In a little over a year, the emergency department on Spectrum Health's Butterworth Campus saw its patient satisfaction rank jump from the 13th percentile to the 74th percentile when measured against other hospitals of all sizes. It's a dramatic improvement in which the staff takes pride, Van Vranken said.

Another area that vastly improved was meal delivery. While few patients expect a five-star meal at a hospital, many were dissatisfied with how they were left to fend for themselves when the food came, White said.

After having the kitchen staff simulate a patient's experience, Spectrum soon assigned a "prompter" to go ahead of meal delivery to help patients prepare to receive their food. That can involve helping them sit up or get washed up and ensuring that the tray is placed within easy reach.

"Patients were happy," White said. "Nurses were thrilled." And the numbers followed: satisfaction with Spectrum Health's food and nutrition department moved from the 11th percentile to the 76th percentile.

Working with former patients and their families in an advisory council also helped direct revisions such as making sure a new mother has a view of and ongoing reports about her newborn, White said. Visiting hours also were eliminated in favor of changing the culture to value families as part of the care team.

Improvements in patient satisfaction have not just paid off in higher morale but in the bottom line as well, Van Vranken said.

"It has had a huge impact," he said. "Within the state of Michigan alone I know of only two or three other organizations that have seen growth year over year. Admissions are up 5.5% over 2005 through 2006."

Changing expectations

Twenty years ago, patients were more resigned to long waits or substandard hospital care but that's no longer the case, Baker said.

Dentists often ask new patients to describe their prior dental experiences and whether they feel nervous about treatment, a move some hospitals are now copying, she said. "Right up front before you're in the chair they're starting to find out what's most important to you."

In fact, patient satisfaction surveys help some patients develop new expectations, she said. For example, if patients are asked whether their doctor took the time to explain the side effects of the medication prescribed for them, they're likely to look for that conversation to come up in the next visit.