Contributing Factors to Poor Patient Satisfaction

The ED faces some unique challenges when it comes to improving patient satisfaction:

  • Lack of an established provider-patient relationship
  • Long wait times due to high volume and ED overcrowding
  • Patient volume increases while resources to manage remain the same
  • Deprioritization of low acuity patients who make up 25-45 percent of ED visits
  • Communication issues, such as failure to inform patients about wait times, inadequate explanations of diagnoses and test results, when to resume normal activities, and when to return to the ED
  • Provider attitudes that emphasize the quality of care rather than building rapport

If allowed to persist, these factors can multiply until the community holds a negative opinion of the ED and hospital, leading to loss of market share.

Patient Satisfaction and Malpractice Risk

Studies show that the risk of a malpractice suit is related to patients’ dissatisfaction with their providers’ ability to establish rapport, administer care and treatment consistent with expectations, and communicate effectively.

Providers who were frequently sued were most likely to be seen as hurried, uninterested, and unwilling to listen and answer questions. Conversely, good customer satisfaction results in fewer lawsuits and reduces other risk management issues. Anger, not injury, triggers most claims. Empathy and good interpersonal skills are its antidotes.

ED Benefits from Higher Patient Satisfaction Scores

Several benefits accompany an improved patient experience:

  1. Patient satisfaction leads to staff satisfaction.
    Excellent customer satisfaction creates an environment the staff can take pride in, resulting in higher morale and less turnover. It is a virtuous cycle: Improved staff satisfaction further improves patient satisfaction within the healthcare system.
  2. Patient satisfaction improves financial growth.
    Positive customer satisfaction and excellent care have the potential to produce a customer who is likely to remain loyal to that hospital long term.
  3. Statistical data shows a clear relationship between hospital profitability and customer satisfaction.
    Press Ganey estimates that improving patient satisfaction scores from fair/good to good/very good equal $2.3 million in annual revenue from repeat customers.
  4. Patient satisfaction leads to better patient compliance.
    Patients are more likely to comply favorably to instructions, which leads to a better response to treatment, improved safety, and lower readmission rates.
  5. Higher patient satisfaction can also lower the risk of lawsuits, increase patient loyalty and lifetime value, improve patient outcomes, and reduce readmissions.
Strategy 1: Recruit and Retain the Right Providers

Clarity about your ED’s goals to provide exceptional quality care and an outstanding patient experience is essential from the start. Also essential is giving providers something valuable in return.

The simple secret to attracting (and retaining) exceptional providers is to treat them exceptionally well.

Demonstrate that you value your clinicians by recognizing and respecting their needs as practicing physicians. Promise and deliver things like:

  • Reasonable scheduling to allow for a life outside the ED • Worthy clinical leadership
  • A stable, supportive practice environment
  • Growth, education, and leadership opportunities
  • Access to healthcare and retirement plans
  • Continuous feedback and communication, making them feel like part of a larger whole

Offerings like these will help your Emergency Department attract and retain the kind of providers who share your ED’s values for people and their experience.

Remember, as necessary as high-quality emergency medicine providers are to the ED patient experience, they cannot be expected to affect significant change without support. You must also equip them with the proper tools.

Strategy 2: Recognize Compensation Inspiration

Also instrumental in boosting satisfaction: incentives. Time and again, financial incentives prove to be tremendous motivators for high-quality providers.

When providers have a hand in shaping the goals to which their incentives are tied, they’re more motivated to achieve them.

When tying goals to incentives, be on the lookout for opportunities to create shared goals and incentives for ED providers and the non-ED providers upon whom they rely (Radiologists, Hospitalists, etc.). Shared, incentivized goals build collaborative processes and reinforce teamwork between the groups, which in turn boost the entire hospital’s overall efficiency, communication, and ultimately, the patient experience.

Strategy 3: Involve Medical Director Training and Coaches

Another tool providers need to elevate patient satisfaction in your ED is a Medical Director who is trained to both manage and lead. While a clinically gifted Medical Director is certainly a worthwhile part of any ED, if you want to excel at patient satisfaction, a Medical Director that understands how to build and sustain a stable, supportive practice environment is crucial. If providers are to thrive, they must work in a practice environment that is well managed, both financially and operationally, so they are free to focus on caring for their patients.

A strong Medical Director is one who makes the initiative to share the skills they possess, but also makes the effort to learn from his or her entire team. Courses and coaching in conflict management and resolution, documentation management, quality and risk management, and of course, patient satisfaction are a must. Give your Medical Director support and encourage their efforts. That positive reinforcement will foster the entire ED’s teamwork, and those processes of positive reinforcement will be passed from Medical Director to provider to ultimately the patient.

Once the underpinnings of great care— excellent, well-equipped, goal-directed providers and a strong Medical Director— are in place, you’ve laid the foundation for outstanding customer service. Now, you’re ready to impact not just patient satisfaction, but to excel at patient experience.

Strategy 4: Set Measurable, Realistic Goals

Abstract goals like “improve patient satisfaction” or “communicate better with patients” offer minimal specific insights to bring a team together to impact change. However, defined targets with measurable goals, such as “reduce door-to-doctor time from 45 minutes to 30 minutes within six months,” gives the entire ED team a clear, quantifiable, attainable goal.

Be aware however: No matter how specific, measurable, and realistic, goals that simply come down from above rarely inspire or motivate.

It’s important for administration to work collaboratively with ED providers, whose voices and daily on-the-ground experience are vital to identifying appropriate, impactful goals, as well as potential obstacles and ideas for overcoming them. Using every team member’s input also cultivates a sense of ownership of the process, encouraging buy-in.

Strategy 5: Follow Metrics

1. Monitor trends quickly and provide access to real-time data. A high- functioning ED needs to make real-time adjustments—adjustments built upon knowledge from service recovery and real-time positive behaviors which promote excellent patient experience. This allows an ED to improve weaknesses, monitor improvement trends, and build upon excellence already being delivered.

Collecting a high volume of patient feedback while the patient is in the ED and immediately sharing it with the ED team is most important. Teams should receive positive feedback and have the ability to perform service recovery in a timely manner, so every patient’s ED experience is exceptional.

2. Gather specific operational metrics. Identify areas of impediment to patient flow and where process improvement could affect change in the overall patient experience by measuring:

  • Trends in patient arrival and departure information
  • Turnaround times
  • Patient acuity statistics
  • Provider productivity
  • CPT and diagnostic codes
  • Ancillary service utilization

3. Track daily, weekly, and monthly trends for individuals and teams. Providers, Nurses, and all ED team members must receive continuous feedback about both team and individual progress. As naturally competitive achievers, providers respond especially well to data that enables them to compete against their own day-to-day performance and that of their colleagues.

Strategy 6: Tidy Up the Place

You never get a second chance to make a first impression. The good news: You can make a good first impression just by ensuring you keep the ED environment neat, clean, and tidy.

Take a look around your ED.

  • Is the waiting area cluttered or clean?
  • Are patient rooms clean or in disarray?
  • Are the chairs old, frayed, or broken?
  • Have windows been washed and cleared of cobwebs?
  • Is the bulletin board organized with up-to-date, relevant information or covered over with old posters and notices?
  • Is the Nurse’s station messy and clamorous or orderly and quiet?

The fixes are easy enough: Brighten up dingy and dark areas with a fresh coat of paint and better lighting. Remove clutter and empty the trash. Keep bathrooms clean and well stocked with soap and towels.

If the overall scene presents a professional appearance, you will positively influence the perceptions of patients and their families from the moment they enter your doors.

Strategy 7: Pay Personal Attention

You never get a second chance to make a good second impression either. Assuming you’ve taken the first step—presenting a professional appearance—making a good second impression comes through paying personal attention.

That means having appropriate staffing ratios for peak times and ensuring your ED runs at maximum efficiency at all times. Plan for contingencies by having both full-time and part-time physicians available (and part-time NPs and PAs as well).

As a rule, we recommend maintaining one to two part-time doctors credentialed for every full-time Physician.

While increasing the provider-to-patient ratio certainly allows for more personalized care and attention, it’s also an expensive option that few EDs can readily afford. If budget is tight, pair physicians with scribes so they can focus on patient care and communication rather than administrative functions and documentation.

The improved interaction between physicians and their patients (and patients’ families) will translate into a significantly improved patient encounter.

Strategy 8: Communicate Effectively

Communication can make or break a patient’s experience. However, more communication doesn’t necessarily equate to better communication. Rather, content and delivery influence patient perception far more than time alone.

Two tips for improving content and delivery are:

  1. Get rid of “doctor speak.” Medical terminology, though second nature to physicians, is in direct opposition with the health literacy of the average patient. Doctors should, therefore, simplify their vocabulary and shorten sentence lengths to a level that an average sixth-to-eighth-grade student could easily comprehend.
  2. Show compassion and empathy. Content is one thing; delivery is another. To that end, doctors should clothe their content with compassion and empathy, qualities associated with better outcomes, greater patient safety, fewer malpractice claims, and a better patient experience.

Expressing these qualities, however, can prove challenging in a busy ED environment. So, just like doctors are trained to think analytically, they should also be trained to communicate with compassion and empathy.

Offer providers tools and techniques, such as video instruction, a Medical Director who leads by example, and hands-on training, to teach them how to communicate more effectively under pressure.

Strategy 9: Ask For Feedback

Maximize the opportunity to shape patient perception by capping off every encounter with a visit from a patient advocate. Akin to a relief pitcher who takes the mound to nab the final outs when his team is in the lead, a patient advocate acts as a closer in your ED. Filled by a Nurse, scribe, or well-trained volunteer, the role of this “designated patient satisfaction officer” is to make rounds every day, asking each patient questions related to his or her stay in the ED.

The questions should be designed to identify any concerns or needs the patient (or family) might have and to determine if any gaps in service, care, or understanding exist. As a practical matter, ask questions that reflect those found in your existing ED patient satisfaction survey.

A few examples:

  • Do you have any questions about your stay/tests/diagnosis?
  • Do you understand what you need to do next?
  • Are you/were you comfortable during your stay?
  • Do you feel we did a good job managing your pain/responding to your needs?
  • Did the Physician(s) and Nurse(s) who treated you identify themselves?

If the patient advocate detects a verifiable lack of service or comprehension, the ED staff now has the chance to remedy that before discharging the patient—an outcome that can lead to better patient satisfaction scores.

Positive Performance Metrics Yield Increased Patient Satisfaction

See how SCP Health helped implement change for positive metric improvement and patient satisfaction in a university health system facility.

Challenge

A 14-bed university health system facility with 30K annual ED volume hired SCP Health to help improve operational metrics in the Emergency Department.

The ED faced three primary challenges:

  1. LWOTs exceeding 8% monthly
  2. Prolonged door-to-provider time
  3. Throughput

Approach

In just seven weeks, SCP Health hired a new provider team, educated the team, and prepared the facility so that our established process could go live on day one. We also launched a multidisciplinary team to observe the ED and ancillary departments in order to formalize a strategy to expand collaboration and enhancements.

Performance-enhancing initiatives included:

  • Recruitment of new providers for the start date
  • Implementation of a new NP/PA program
  • See-Order-Treat (SOrT) process implementation
  • Monthly ED provider and NP/PA conference calls

Departmental changes came out of this process improvement team, which consisted of members of the hospital’s administration, the Chief Medical Officer, ED and departmental leadership, and representatives from SCP. They met monthly and focused on identifying key areas where changes could be made to increase patient volume, lower LWOTs, and reduce arrival-to-provider times.

Not only did we address changes in the ED itself but also all related departments, recognizing that if one part failed to meet benchmarks, it would adversely affect the overall functioning of the ED relative to improving the performance metrics.

Examples of departmental changes included:

Radiology

  • Established transport service to improve efficiency and turnaround time
  • Addressed ultrasound process
  • Extended ultrasound hours
  • Changed procedure for OB ultrasound to include over read

Laboratory

  • Laboratory culture follow-up process improved
  • Implemented performance improvement initiative for mislabeled specimens
  • Developed performance improvement initiative to address turnaround time

Outpatient and Specialty Clinics

  • Opened discharge clinic for expediting follow-up care for ED discharge patients
  • Relocated walk-in clinic to facilitate easier patient access

Case Management

  • Added a designated Case Manager for ED
  • Designated an ED Social Worker (utilized primarily to facilitate psychiatric patient disposition)

Other improvements included communication with system partners to establish more efficient patient transfers, the creation of an ED-specific code team, and enhancing quality measures.

Results

Due to these changes and the partnership of the facility’s staff and administration, performance metrics improved significantly within a short period (some within 30 days from the start date). These consistently positive performance metrics have led to other beneficial outcomes, such as increased patient satisfaction, greater interest among providers to work at the facility, and a better work environment overall.

“This clinical partner for a major university system was ready for change. Even though we presented the ideas for improvement, it was the hospital’s willingness to partner with us that made such transformation possible and that led to the remarkable success we continue to see.”

Beverly Gladney, MD, Group Medical Officer, SCP Health

 

Improvements in ED Throughput Drive Better Patient Experience

See how SCP Health helped drastically improve core measures to ultimately affect patient satisfaction in a for-profit facility.

Challenge

A national for-profit Southeastern health system facility with 20K annual ED volume hired SCP Health to improve quality core measures in the ED.

The ED faced three primary challenges:

  • Left without being seen numbers (LWOTs) exceeding 10% monthly
  • Arrival-to-triage time over 14 minutes
  • Door-to-Provider time approaching 80 minutes
  • Patient satisfaction scores at less than 65% satisfaction
  • Inefficient patient throughput
  • High length of stay
Approach

The key to success was aligning goals and driving better flow between work teams. SCP quickly collaborated with the client to set strong benchmark goals for performance metrics and to understand and support the long-term objectives of both the client and their parent system.

We coordinated with the Medical Director to establish goals, define success measures, implement improved communication and accountability with providers, and offered leadership development. With action items for improving throughput, and the facility’s hire of a new Nursing Director to remedy their nursing shortage, the team was prepared for success.

Notable initiatives that produced meaningful metric improvements included:

  • Implementation of action flow teams—analyzing and interpreting metrics with radiology and lab teams to improve performance. (To ensure movement and prevent reporting meetings, action items were determined with each team member.)
  • Monthly on-site visits and virtual meetings between SCP leadership and the facility’s team.
  • Supported Medical Director with leadership development and consistent leadership meetings with Group Medical Officer.
  • Set benchmarks of less than 2% for LWOTs, 10 minutes or less for arrival-to-triage, 30 minutes or less for Door-to-Provider time, and a patient satisfaction score of greater than 87%.
  • Implemented EM/HM admission protocols as well as nursing protocols, and reviewed the entire admissions process for opportunities for enhancement.
  • Regularly scheduled provider meetings and communication to engage EM protocols, quality measures, and overall improved patient flow techniques.
Results

With the strategic initiatives and the partnership of the facility’s staff and administration, performance metrics improved considerably within one year:

“This partnership has delivered substantial results, not only in core quality measures, but also in the overall improvement of the team. The collaborative atmosphere with the hospital, and our alignment of strategic goals and initiatives, has led to much success. Starting this contract on Thanksgiving Day was tough, but everyone persevered and it has been a wonderful journey in teamwork with excellent results.”

Dr. Daniel Newhaller, Group Medical Officer, SCP Health

Conclusion

Many EDs excel in delivering quality care but fail to provide a patient-centered experience that earns satisfaction scores on par with their clinical performance. And when it comes to patient experience within the ED, perception is everything. It isn’t always the actual quality of care patients receive that impacts patient satisfaction scores. Instead, it’s their perception of the care.

By pairing performance improvements with key aspects of the patient experience—the appearance of the practice environment, communication style of providers, and impression upon exit—your ED can make each encounter more consistently positive both clinically and in terms of patient perception.

Using these methods, you can ensure each patient recognizes the high level of care they receive and rewards you with higher satisfaction scores as a result. We hope you find these approaches helpful in boosting patient satisfaction and perception of care. To learn how SCP Health can help your team improve patient satisfaction, contact our team at business_development@scp-health.com, or call 800.893.9698.

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