patient satisfaction

Bucket list leadership lessons

By Thomas Davis, DNAP, MAE, CRNA

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I am an avid cyclist to the point of being suspected of having a personal relationship with my bicycle; after all, we have spent over 40K miles together on the road. In addition, I have a deep interest in healthcare leadership development and last weekend my two major interests collided while doing a bucket list bike ride on the 150-mile Great Allegheny Passage bicycle trail from Pittsburgh, PA to Cumberland, MD.

As our group of 10 loaded the shuttle van to transport us from Cumberland to Pittsburgh, it was evident that Greg, owner of 2wheel escapes and coordinator for the trip had his act together. Assisted by his wife Rhona and paid helper Lynn, each new person arriving for the trip received a warm welcome and, with efficiency, luggage, bicycles and passengers were loaded onto the trailer and van, respectively. In short order, anxiety of the unknown challenge ahead turned into lively conversation among the new group of friends.

As we traveled toward Pittsburgh, Greg openly shared his vision with our group explaining that the trail is beautiful, but it is the support provided for the riders that converts the ride into a memorable experience worth repeating. He explained that his goal is to be the number one GAP trail tour organizer and create an experience that people would want to repeat and that they would recommend to friends. Everything from that point forward was designed to bring his vision to life. We were told up front that his services were intended to be second to none and that it was up to us to make him even better…please offer suggestions.

Greg put words to action and delivered on the pledge that he made to the group. Every aspect of the trip was on time and as promised, often exceeding expectation. The format for our journey included camping overnight; Greg set a high standard and only stayed at campgrounds with flush toilets and hot showers. Because COVID has closed many restaurants, 2wheel escapes provide an exceptional dinner on site every evening followed by an ample hot breakfast in the morning. Each day started with a briefing and a printed list of landmarks along the way. The scenery was different every day and particularly magnificent in the Ohiopyle area, however, riding into the campground each day consistently found Greg and Rhona set up and ready with afternoon snacks for the hungry riders. They aimed to please and hit the bull’s eye.

As I pedaled toward the Eastern Continental divide, I could not help thinking about the importance of creating a positive and memorable experience and then extrapolated the concept to healthcare. The outcome of my amazing weekend was much more than rolling along a wooded trail, it was having an experience that I am eager to repeat. Likewise, a positive healthcare encounter requires more than a nice facility and creates a responsibility on healthcare workers to deliver a positive and memorable experience for each patient.

Having a positive experience is important in healthcare and this is why

Builds trust Creating a positive experience requires healthcare workers to connect one on one with each patient and learn about what is important to them. Taking Greg’s attitude of “make us better” sends the message that what is important to the patient is also important to the provider. The experience of feeling valued creates trust that the other person has your back.

Enhances confidence Most patients do not have a medical background and do not fully understand best practice guidelines; they are at the mercy of the healthcare provider. Those who have a positive experience and trust the provider are more likely be compliant with treatment protocols and achieve a better overall outcome.

Improves patient safety A solid, trusting relationship between patient and provider creates a bond where both are more vigilant, communicate more frequently and ward off problems before they arise. Writing in BMJ, Authors Doyle et. al. affirm the connection between the patient’s experience, safety and ultimate outcome.

Job security Greg knows that to earn a profit in a competitive market, he must deliver the goods reliably and in a manner that generates repeat business. Similarly, in the past, patients were tied to their local community for healthcare, however, our digital world has broken geographical barriers and opened the door to shop anywhere for medical services. Healthcare is a competitive market and by creating a positive experience, a loyal customer base is developed. Patients share their experiences, both good and bad, on social media so the environment that we create will be revealed to the world. Ultimately, those who create the positive experience for the patient will thrive and those who do not, will not survive.

My weekend ride did a lot more than check off an item on my bucket list, it opened my eyes to the importance of creating a dynamic and memorable experience. Taking an interest in a patient and placing value on the feedback that you receive is the first step in creating a culture that knows the importance of the patient’s overall experience. Be bold and create a bucket list experience for each of your patients.

Tom is an experienced leader, author, and requested speaker. Click here for a video introduction to Tom’s talk topics.

2019 Best Airline ranking; Lessons for ambulatory surgery centers

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

Four decades ago, I was a neophyte embarking on the challenge of learning to safely administer anesthesia, earn certification, and become a productive member of the profession. I recall being told several times that delivering anesthesia is like flying a plane; chaotic and high risk at takeoff and landing with hours of boredom in between.

Throughout the span of my career, other analogies have compared aviation to anesthesia. For example, as the patient safety movement gained momentum, John Nance’s book, Why hospitals should fly: The ultimate flight plan to patient safety, took the principles that vastly improved airline safety and applied them to healthcare. The book made a strong case for collaborative teamwork in the operating room to match that required of the flight crew in the cockpit.

An article by Scott McCartney published in the Wall Street Journal on January 15, 2020 ranked US airlines from the perspective of customer satisfaction. At the top of the list was Delta Airlines with a spectacular on-time record, few flight cancellations, low incidence of bumping customers and efficient baggage handling. Following closely were Alaska and Southwest with American Airlines at the bottom of the list of 9 companies vying for riders.

As an airline passenger, the article caught my eye and reading it triggered me to consider parallels between aviation and healthcare in terms of customer satisfaction. Re-reading the article, I noted the criteria used to separate the wheat from the chaff. Below are the standards that were used to rank the air carriers and thoughts on how they would manifest if applied to the healthcare setting.

On time arrivals. When buying a ticket, passengers are given a specific time for the anticipated arrival at the destination. Likewise, when patients are scheduled for surgery, they are given a specific time to arrive the day of surgery as well as a time for the procedure to begin. Like travelers, patients have arranged to be dropped off and picked up based on the timeline that they were given to them prior to surgery. For the patient to have an on-time arrival, equipment, personnel and documentation must all be in place prior to the patient’s arrival. Once the patient has arrived, every effort must be made to keep the person informed and move him/her through the system as flawlessly as possible. Those receiving care in outpatient surgery centers must be ready to depart at the predicted time.
Cancelled flights. Airline flights are not cancelled on a whim, but rather only when the system breaks down and it is not safe to proceed. Broken planes are grounded, and crew rest mandates are strictly enforced. In healthcare, cancelled surgery is the outward manifestation of a defective system. Broken equipment, inadequate pre-op workup, and failure to follow NPO guidelines are common causes for cancellation of surgery. On rare occasions, a conflict in the surgeon’s schedule may lead to cancellation. Regardless, proactively improving communication with both suppliers and patients will reduce the incidence of cancelled cases. Equipment requirements must be anticipated, and patients must be informed regarding pre-op expectations.
Extreme delays. Being left to sit for hours (or days) in the waiting area of the airport can be as bad or worse than having a flight cancel. Weather, maintenance or crew rest may delay a flight; however, in healthcare unrealistic scheduling is a common culprit for delays. Overbooking creates unrealistic expectations and ensures that patients will experience delays. Procedures must be scheduled based on historical time averages rather than best case scenarios.
Mishandled baggage. I remember many years ago when a disgruntled friend had a bad experience with Delta Airlines and said, “Delta stands for don’t expect luggage to arrive.” They have come a long way and are now at the top of the industry when it comes to baggage handling. In healthcare, patient belongings are as important as the airline traveler’s bags. When you lose a pair of glasses or hearing aid and the patient will tell the story for the next 10 years. In addition, the patient’s driver or family can be considered baggage that deserves to be handled respectfully. Provide a comfortable waiting area and offer frequent updates to show your regard for their tie to the patient.
Bumping. There is nothing worse than buying the ticket, arriving on time at the airport, surviving the security check and then being told that your seat was given to another person. The plane takes off, but you are not on it. In healthcare, emergencies arise and sometimes the surgeon is not available to do the case. All effort should be made to keep commitments and make reasonable accommodation where needed. Scheduled cases should not be cancelled at the last minute to accommodate short notice vacation. A case cancelled because of lack of equipment represents a total breakdown in the system.
Complaints. In both the airline and healthcare industries complaints come with the territory. Having a smoothly functioning system and engaged, customer-oriented employees will reduce but not eliminate complaints. The question is not whether complaints will be lodged but rather how you react to them. Client centered organizations will welcome complaints as a source of insight that will lead to improved service in the future. Lesser organizations will simply track numbers and learn nothing about their failures in delivering the promised service.

Earning a top rating for customer service requires employees at all levels to be fully engaged in their work and be committed to creating a positive experience for the client. Although cause and effect have not been claimed, Scott McCartney noted that while being rated 2019, American Airlines was in contract negotiation with maintenance and baggage workers. It was implied that employees were not fully engaged in their job and that worker sabotage was tied to the low satisfaction scores.

Customer satisfaction is driven by the front line, not by the front office. The Board of Directors can build a solid corporate structure, but the passenger/patient remembers the attitude of those they encounter during the journey and whether promises were kept. Delta’s number one ranking was no fluke and employees at all levels worked diligently to provide the promised service and deliver it with a positive friendly demeanor. When the rankings were announced, Delta executives were pleased; however, rather than taking personal credit, the Board of Directors showed appreciation for their workers and posted the following: “There’s no higher honor for Delta when our employees are recognized for the work that they do to take care of our customers.” Clearly, passengers can expect a smooth ride on Delta Airlines.

Tom is an experienced leader, author and requested speaker.

What the patient wants

By Thomas Davis, DNAP, MAE, CRNA

Recently we were discussing patient satisfaction at the desk in the pre-op area. One of the physicians noted that patients assume they will receive top-notch medical care, so the care itself is not notable. What the patient does remember, he suggested, is their impression of the facility, the workflow process and whether they were respected as individuals.

My colleague’s comments triggered personal memories of a recent encounter with the healthcare system. Last year I accompanied my wife to a medical appointment. The waiting room was filled with heavily worn furniture, magazines were scattered on empty chairs and there was a generally unkempt appearance. We were moved to an exam room that appeared to need more than a good cleaning. When the physician arrived, she did a quick assessment and ended the appointment by dictating a plan that did not work for us. As you can imagine, all the way home we talked about the importance of patient satisfaction. Having had a negative experience, my wife did not follow-up with their organization nor solicit contact with the physician again.

Because “overall experience of the patient” has become a meaningful component of quality care that is demanded by those who pay the healthcare bill, simple conformance with regulations and standards is no longer enough. Elevating patient satisfaction, while simultaneously dealing with shrinking healthcare budgets, requires payors to insist that medical providers deliver state of the art treatments that will be remembered positively.

The Center for Medicare and Medicaid Services (CMS) has reinforced this idea by implementing the Hospital Consumer Assessment of Healthcare Providers and Systems (H-CAPS) which ties reimbursement to patient satisfaction. Simply put, full reimbursement for healthcare services is being tied to the overall patient experience and his/her level of satisfaction with both the individual healthcare provider and the organization offering the care.

Improve patient satisfaction scores

Moving from the obsolete mindset of “doctor knows best” to the new paradigm of “shared decision-making,” in which doctors and patients work as a collaborative team, requires that healthcare providers learn what patients really want and then commit to meeting their expectations. Learning about the preferences of the patient requires observing, questioning and listening during every patient encounter. Discovered through discussions with patients and a review of literature related to client satisfaction, here are a few ways to improve your patient’s overall experience.

Patients want to feel respected. The red-carpet treatment is not necessary but common courtesy is essential. Timetables that are designed to run behind schedule do not respect or value the commitment made by the patient who arranged child care, hasn’t eaten since midnight, has provided the requisite driver and arrived on time. When patients follow the rules and do as told, they expect to receive care as promised. Likewise, a one size fits all approach to prescribing patient care does not respect the individual needs of each client.
Patients want information conveyed in a manner that they can understand. We work in an environment that has its own language and acronyms. Terms that are common to us are foreign to many of our patients. I recently overheard a patient interview. Nurse: Do you have A-fib? Patient: What’s that? Nurse: Do you have GERD? Patient: What’s that? Nurse: Do you take ACE inhibitors? Patient: What are those? Always communicate on the level of the listener and ask follow-on questions to ensure that the person fully understands you.
Patients want open communication with every provider. Hospitalized patients see their doctor once or twice a day and then spend the other 23 hours with nurses and assistants. Patients expect and need honest, transparent answers from the nursing staff. The cop-out reply, “Ask your doctor,” is a sure-fire way to kill trust between the patient and the nursing staff and is a trigger for dissatisfaction.
Patients want the staff to be collaborative with one another. Disagreements between staff in a location where patients can observe and overhear must be taboo in the workplace. Discord between staff members creates anxiety in the patient population and kills satisfaction scores. When conflicts arise, make sure that they are discussed privately and behind closed doors.
Patients want to be included in the decision-making. The best-practice treatment plan is one that is described rather than prescribed. The patient must know what is recommended and why; only then are the patient and provider positioned to agree on a plan to provide the recommended treatment in a manner that affirms the patient and his/her family.
Patients want a response to concerns and complaints. Receiving healthcare can spark anxiety in an otherwise intelligent and relaxed individual. A glitch that’s the size of a pebble to the worker can be viewed as a boulder to the patient. When a patient expresses concern, listen attentively, immediately fix what you can and follow-up on items that require additional resources. Leaving the patient with the impression that he/she was not heard will elevate anxiety and increase dissatisfaction.

Assessing patient satisfaction

Your organization sends a survey to every patient and your workgroup consistently scores above the benchmark of 90%. Does that mean everything is OK?

Conducting an ongoing survey is an accepted way to gather information and is required in order to obtain full reimbursement under the H-CAPS system. Surveys are necessary; however, those who truly seek to improve the patient’s experience constantly dig deeper in search of concerns that may not be exposed by the survey. Rather than boasting about achieving 90% or 92% on the satisfaction survey, focus additional attention on the 8% who were not satisfied. Seek common themes that generally fuel dissatisfaction such as lack of privacy or excessive wait times and then solicit patients to suggest ways to address the issues.

The best way to learn about the weaknesses in your system is through the eyes of those who use it.

After working for a year as an anesthesia provider at a busy GI center, it was my turn to be on the receiving end of a colonoscopy. Wanting to have the same experience as any other patient, I kept things low-key, and it turned out to be an eye-opener. After following completing a bowel prep and arriving on time, I sat in the waiting room a full hour past my scheduled time. The room had nice furniture and a TV; however, the room temperature was so cold that I entered the pre-op area shivering. Despite receiving top-notch care, I felt as if I was on an assembly line and that neither my time nor comfort mattered. Based on my feedback, the temperature in the waiting area was adjusted. However, the manager was not brave enough to tackle the sticky issue of intentional overbooking. In the end, overbooking was not addressed and excessive waiting times continued to be the top complaint expressed by patients at that center.

The key to improving the overall experience for the patient and family is to engage them in a non-threatening discussion. Asking pointed questions puts people on the defensive and seldom generates useful information. Instead, first engage in a friendly conversation and then ask open- ended questions about their experience. Rather than asking, “What do we need to do in order to improve?” ask, “If your friends were coming for this procedure, what advice would you give them?” Instead of, “Where did we fail?” ask, “What was your greatest surprise while in our care?” Finally, ask the patient, “In retrospect, what do you wish that you (or we) had done differently?” Ice the cake by asking the patient to identify one or two people on the staff who made a positive impact on their experience, and to follow-up by describing the behaviors that made the worker outstanding.

Patient satisfaction IS notable; and it’s not difficult to achieve. Design a system that values the patient’s time, one that recognizes the patient’s anxiety, that openly communicates information, that develops a collaborative treatment plan and solicits suggestions for improvement; then your satisfaction scores will take care of themselves.

Patient satisfaction is transforming healthcare

By Thomas Davis, CRNA, MAE, DNAP candidate

One hundred years ago, American culture was in a time of rapid change with an influx of new technology changing the way people lived their lives. Being phased out, the horse and buggy, kerosene lamps and outdoor privy were quickly replaced by autos, electric lights and flush toilets. In the hundred years that followed, the shift in healthcare delivery has affected our lives to the same extent as the technology changes of a century ago. In the 1960s, healthcare was physician-centric with little concern for the needs or desires of the patient. It was a time in which “the doctor knows best” governed healthcare and patients were lucky that the doctor agreed to provide treatment. Moving forward another fifty years to the 21^st century we find a system in which patients manage their own health records and have mobility to seek care wherever they desire. Role reversal has put the patient in the driver’s seat leaving doctors and healthcare organizations to compete for the patient’s business. In today’s medical marketplace, patients select doctors and hospitals based on both the quality of care delivered and their memory of how they were treated. Healthcare providers who survive are those who are sensitive to patient satisfaction while providing state of the art treatment.

Patient satisfaction is the person’s perception of their overall experience with you and your organization. A patient’s perception is his/her reality so the impression that you make is the memory that they will share with others, sometimes for years after receiving treatment. Toma Kulbytė, content marketing specialist at SuperOffice, says “If they like you and continue to like you, they are going to do business with you and recommend you ….” Does satisfaction count in a patient’s assessment? According to Kulbytė, a positive customer experience creates a 42% increase in loyalty (likelihood for repeat business) and a 33% increase in satisfaction scores.

Loyalty is earned

Regardless of whether the need is for a car, computer or colonoscopy, today’s consumer demands a quality product at a fair price, delivered by people who understand their specific need and treat them with respect and dignity. To build a loyal base of satisfied customers, three factors are foundational: People, product and presentation.

People

It can be argued that the most important person in a healthcare facility is the first person a patient encounters at the point of entry desk. The congeniality with which a person is greeted, and the expertise shown by the attendant when entering the patient into the system create a lasting impression. Ciotti, blog author and marketing strategist, confirms the importance of customer service skills and recommends that those delivering health care, master this list.

Patience	Attentiveness	Clear communication skills
Clinical competence	Positive attitude/language	Acting skills
Calming presence	Ability to sense patient’s mood	Tenacity
Persuasion skills	Empathy	Willingness to learn

Patients moving through the healthcare system encounter many people along the way and feel reassured by being introduced to the next person by name and their role in the treatment process. With the patient’s wellbeing as your top priority, always use a positive language and an undistracted, welcoming attitude when providing care

“Nobody cares how much you know until they know how much you care.”

~Theodore Roosevelt

Product

People expect those delivering a service are competent, capable and committed to excellence. It doesn’t matter if you’re delivering a double cheese pizza, or an anesthetic, in order to earn your customer’s satisfaction, you must be skilled at your job and create expectations that are realistic. In the healthcare arena, connect with your patients pre-operatively, clearly describe what can and can not be done, and then deliver on the service as described. The bottom line is that your patients want you to be good at what you do, and they expect to receive the product and experience the outcome that they have been promised.

Presentation

Healthcare delivery is a competitive business and people are free to seek treatment wherever they desire. Marketing analysis by Keona Health reveals that 77% of patients use online reviews to find and select a physician. The physician compare area of the CMS web site makes rating healthcare providers quick and easy. Likewise, when a physician uses more than one hospital, patients rely on online reviews when requesting their hospital of choice. Once a provider has been selected, patients use mobile devices to schedule appointments and judge the organization by the degree of user-friendliness of their web site. When online sites are difficult to navigate, patients move on to another provider with a more user-friendly online presence.

Indiana University Orthopedic surgeon, James Rickett, links patient satisfaction to outcome by documenting that reduced hospital stay, reduced readmission rates, and overall better quality of care all correlate to high patient satisfaction scores. Dr. Rickett’s observation underscores the importance of delivering healthcare services in a manner that ensures patient satisfaction. The physician driven hierarchy for patient treatment that existed several decades ago no longer applies in our web-based, patient-centric world. The healthcare marketplace is becoming more and more competitive and patient satisfaction may be the key factor separating those who lead the industry from those who are forced to close the doors and turn off the lights. Patient satisfaction does matter.

Thomas is a respected author, speaker and clinical anesthetist.

The Satisfaction Connection

By Thomas Davis, CRNA, MAE, Lt. Col (ret)

Follow @procrnatom on Twitter

In 2013 the Centers for Medicare and Medicaid Services published a report that stated 6 in 10 patients were not respected or heard during their hospitalizations.

Throughout the country, healthcare providers are using evidence based practice to deliver the highest quality of care to an aging population with a growing list of coexisting diseases. At the same time, reimbursement is being reigned in requiring providers to see more patients and provide greater service with fewer resources. To that end, healthcare providers focus on completing tasks efficiently and the simple act of connecting one on one drops through the cracks.

Last week I made a quick trip to the grocery store for a few items and was in the express checkout with two ahead of me. The clerk was efficiently scanning and bagging when she noticed that the person in line behind me was her personal friend. Immediately, the clerk engaged her friend in an animated conversation about their children, vacations, holiday plans and a number of other things. She was so engaged with her friend that she did not acknowledge me or the person in front of me. When I stepped up to check out, she scanned the items and pointed to the credit card machine without a breath of interruption in her ongoing conversation. I accepted the receipt and left without ever being acknowledged as having been in line. My only positive memory of the trip to the store was the product, not the experience.

We work in hospitals and not grocery stores and we treat patients rather than scanning items.

In another personal experience last week, at the end of a long day a case was added for a brain biopsy on a 30-year-old with a suspected tumor. The woman was visibly frightened when I met her and though I didn’t have magic words to give her, I listened and heard her fears and concerns. By the time we rolled back, having been heard made her much more relaxed and as I rolled her into the room, I told her about the amazing OR team who were there just for her. As we entered the room I said, “Hi everybody, this is Karen.” Silence. The nurse and scrub tech were reviewing instruments and did not look up. A second OR nurse was on a computer and did not respond. Karen got a stressed look on her face so I turned to the team and enthusiastically announced, “Let’s do this again.” We backed out the door into the hall, re entered the OR and again I said, “Hi everybody, this is Karen.” The second entry generated a warm welcome from the team, Karen relaxed and we quickly got the patient settled and off to sleep.

Connecting with patients matters. The current literature documents a strong link between patient satisfaction and patient outcome, and CMS is no longer willing to reimburse at the full rate when patient satisfaction is lacking. Here is what we know.

When patients are satisfied with their experience, they are more likely to be compliant with instructions and to keep follow up appointments, both of which affect outcome.
Patients do not have the technical knowledge to know whether or not they received the best possible treatment, however, they do know how they were treated.
Healthcare teams committed to giving patients a positive experience have a common goal and tend to work more collaboratively.
As patient outcomes improve, the morale of the healthcare team also improves making the workplace more attractive to those seeking a great job.

Introducing yourself and reviewing a medical history can be like scanning items at the store – robotically, without ever going below the surface to acknowledge the patient as a unique individual. Or, you can easily connect to the patient on a personal level by simply adding this question, “Tell me something about yourself that is not on your medical record.” Humanizing the process opens a window into the patient’s life and the things that interest them. When entering the OR, introduce the patient and let the team know something about them. Others in the room will join the conversation and soon the patient will feel a connection to the entire team.

As healthcare workers, many things are beyond our personal control. One thing that is completely within our control is the way we interact with our patients. In 2013, 6 in 10 patients reported that they were not respected or heard. If we surveyed your patients from last week, what would they say? Connecting is quick, easy, fun and rewarding. Go beyond the medical record and start treating whole patients.

My wife mailed a registered package at the US Post Office last week and came home saying, “The place was really busy, the man who waited on me took forever, but he knew all the forms needed, the kind of tape to use, the reasons behind the new security regulations and kept up a cheerful chatter with me while he worked, including his two coworkers and even two other customers who were filling out forms and waiting for service. Everyone was smiling and you’d think we had all just had a biscotti and latte with our best friend.” Now that’s a 10 out of 10!

Coming soon: Values based Leadership Webinar series.