1 EP35: The structure(s) and process(es) used to identify significant findings and trends in overall patient satisfaction with nursing as compared to benchmarked sources The structure used to identify significant findings and trends in overall patient satisfaction with nursing as compared to national trends is our Press Ganey patient satisfaction survey results. We utilize Press Ganey s Infoturn process to provide the surveys to our patients by downloading a daily file to Press Ganey with patient administrative information. Press Ganey sends the Patient Satisfaction survey to the patient and if the patient does not respond within 3 weeks, Press Ganey sends a followup survey. This is part of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) requirements set by Centers for Medicare and Medicaid Services (CMS). The patient satisfaction surveys are returned directly to Press Ganey and they tabulate our results and provide the results to us online in a standardized format. We use Press Ganey s Solution Starters and information from The Studer Group as other structures for patient satisfaction. We currently survey our inpatient, Emergency Department (ED) and our Home Health Care (HHC) patients. We use our ED and HCC surveys as indicators of outpatient satisfaction. In 2008, we also surveyed our Outpatient Surgery and Outpatient Services patients but it was determined with budgetary constraints to drop those surveys in 2009. We have also conducted an outpatient survey of Cardiac Cath Lab and Outpatient Surgery patients in 2010 to obtain an overview of outpatient results from patients receiving care in hospital departments. The economic crisis of 2009 and our reallocation of funding to support our new building were factors that leaders considered when deciding to drop the outpatient survey in 2009. Inclusion in Press Ganey allows us to write reports to provide information on patient satisfaction based on a number of parameters that we choose. It is important to note that Press Ganey provides scores for units with more than 7 responses in a quarter. We find that the 2ICU will not have more than 7 responses in a quarter because the patient is not discharged from 2ICU and the questions usu reference the unit from which the patient is discharged. The structure and process we use to identify significant findings and trends in overall patient satisfaction with nursing is our Patient Satisfaction Team. We have a combined Patient Satisfaction Team for inpatient and Emergency Department. Home Health Care has their own team so the Director and Manager of Home Health Care review their results. (Home Health Care is not part of the hospital, but is part of the Riverside system.) The Patient Satisfaction Team meets bi-monthly and nursing representatives include the Director of OB, Director of ED, Director of Nursing, Team Leader of 2 Medical/Surgical, Manager of 2ICU, Manager of 3 rd Med/Tele, Manager of 3 rd Ortho/Neuro, Manager of 4 th Medical/Pediatrics, Manager of 5 Telemetry, and she is often accompanied by the 5 Telemetry Team Leaders, 5 ICU Team Leader and Vice President of Nursing and Vice President of Peri-operative and Procedural Services. Team leaders are direct care givers who supervise nurses by shift (no 24-hour
2 accountability). This interdisciplinary team also includes the Director of Environmental Services, Director and Manager of Coordination Center, the Director and Manager of Maintenance, the Operations Manager of the Laboratory, Manager of Radiology, Director of Education, and the Patient Food Services Manager. A weekly dashboard is provided for each inpatient department and displ the mean scores and percentile rankings for each patient satisfaction question. The dashboard is sent out ahead of time with the agenda so the data can be reviewed before the meeting. Emphasis is based on the priority index and process or systemic questions. The committee reviews numerical data, patient comments, follow-up phone calls and results from rounding on a daily basis to determine what is working well and what could be an opportunity for improvement. The data sheet provides the mean scores for the quarter to date, response rates and the percentage of very goods. The committee members look at last week s mean scores compared to this week s mean scores for each unit. They also review organization data to identify the gap for each question to address so we can work at achieving the 90 th percentile ranking. They review all of the comments received and the results of daily rounds and follow-up phone calls. There is a roundtable conducted when each department can discuss what has been done in their department to emphasize patient satisfaction and what could be improved. In this collaborative approach, ideas are shared. Follow-up phone calls are a key tactic that was implemented to improve patient satisfaction scores. A follow-up phone call is made to every discharged patient within 1 week of discharge with questions that were developed to determine if they were satisfied with the care they received. These follow-up phone calls are completed by a nurse in the patient care services office or by the team leader or manager of the unit. The same questions are asked of each discharged patient so we can evaluate patterns or trends to improve service to our patients. One example of an opportunity for improvement in patient satisfaction is noise levels. Our HCAHPS survey results for the question Quietness of the environment has been below state and national levels for Second Quarter 2008 through First Quarter 2009 Discharges as noted in the table below. HCAHPS Composite Hospital Environment Items Q9 Quietness of the Hospital Environment Your Hospital s Adjusted Score State Average U.S. Average 18 37 45 15 32 53 13 31 56
3 Nursing leadership has disseminated the survey results to staff and spoken with them about decreasing the noise levels. We installed carpeting in the hallw to decrease noise and purchased and offered ear plugs to our patients. This past summer, Riverside began a modernization project that entails erecting a 3 story building attached on the river side of the hospital. As with any construction project, there is a lot of noise produced from jackhammers, cranes and trucks and all of these noises are right outside the windows of many of our patients. This has been an issue of discussion during the Inpatient Satisfaction meetings. We have had multiple complaints on our survey results regarding noise, particularly from our OB patients who are housed on the first floor right next to the construction site. OB has purchased quiet noise machines for patient use and provided treat bags to their patients. The Director of OB is making daily rounds and apologizing for the noise from the construction. Signs have been posted to inform patients and families that we apologize for any inconvenience and noise due to our construction project. The Patient Satisfaction Team developed targeted action plans to deal with noise and defined who is responsible and target dates were assigned. On 2 nd Medical Surgical, a noise ear has been purchased and placed in the nurse s station. There are lights on the ear that range from green for an acceptable noise level and red for an unacceptable noise level. The lights provide a visual cue for the staff for the level of noise being produced at any given moment. On 3 rd Ortho/Neuro, the staff closes the door to the nurse s station so there is less noise in the back hallway that is closest to the nurse s station. A script has been drafted for the staff to use with our patients to apologize for the construction noise. This script has been distributed to staff with instructions for using with each patient admission. A recent development in our attempt to apologize for construction noise and inconvenience is the implementation of the process for the patient to dial the operator with a noise complaint and a hospital administrator will be called to address the noise concern with the patient face-to-face. This process has worked. One example was a phone call to the CNO in the fall of 2009, which was routed to him by the hospital operator. The CNO called the construction company and asked them to immediately stop using the jackhammer. The company rescheduled use of the jackhammer for a different time. For 2010, one of the daily dashboard measures is quietness of the environment for 2 nd Medical/Surgical and 5 th Medical/Telemetry. The Nurse Manager will ask 5 patients each day if they experienced any noise over the previous 24 hours above what the patient considers normal and if the noise was related to the staff or the environment. If the noise is related to staff, the Nurse Manager will address this with her staff members. If it is related to the environment, the Nurse Manager will follow up with Maintenance or Housekeeping staff. This daily measure will ensure enculturation of patient satisfaction with quietness in the environment for the staff on 2 nd Medical Surgical and 5 th Telemetry. The Patient Satisfaction Team has also discussed another action put into place to improve our outcomes for patient satisfaction, hourly rounding. Hourly rounding was
4 implemented at the end of 2008. This process involves all staff members and they are to round on each patient every hour to ask the patient the 3 P s: potty, pain, and position. The nursing staff ask the patient if they need to use the bathroom and assist them if they do, provide pain management if they have pain and re-position the patient. We looked at our specific patient satisfaction question results for Amount of Attention Paid to Your Personal/Special Needs and Promptness in Response to the Call Light to determine whether hourly rounding was making a difference. We decided to look at these patient satisfaction results by nursing unit to correlate whether there was an increase in scores for the nursing units that had initiated and were regularly completing hourly rounding. First it was decided to educate the staff again on the hourly rounding process and have a contest for the nursing unit that made the greatest gain in patient satisfaction scores during Quarter 2, 2009. We noticed that the nursing units that sent their staff to the educational sessions had the greatest gains in the Quarter 2, 2009 results. 3 rd Med Telemetry scores were above the 90 th percentile ranking and the nursing staff won the sundae contest. Ice cream was served to staff by the Vice President of Nursing, Deena Layton. 5 Telemetry and 2 nd Medical Surgical saw the greatest gains in their patient satisfaction scores after re-educating the hourly rounding concepts. Correlating employee satisfaction results with patient satisfaction results has also been a focus of the Patient Satisfaction Team. If we have unhappy employees, we will have unhappy patients. Our staff members have pride in Riverside. The question from our employee opinion survey of Taking everything into account, I would say this is a great place to work with an overall score of 76 correlates to the HCAHPS question Overall Rating of this Hospital score of 69 from our patients rating this question a 9 or 10 (best hospital), as opposed to 63 in Illinois and 65 nation. However, with other survey questions our results are only average. The Patient Satisfaction Team implemented a script for providing very good care and we found that using this script made a positive difference in our patient satisfaction scores. This action supports that the right thing to do to improve patient satisfaction is have our staff use key words and standards when working with our patients. Key words and standards were created in 2006 and authored by our nursing staff. Our unit based councils have also been involved in patient satisfaction. The Nurse Manager for 2 nd Medical/Surgical asked her staff how to partner and create ownership on their patient satisfaction commitment for what patients and staff could expect on their unit. A campaign entitled Strive for five was started as an outcome of their LEAN project. They developed a bulletin board in the hallway to create peer-to-peer accountability. Staff can recognize one of their peers by posting a note of appreciation for another staff member. The patients and families saw the bulletin board and asked if they could also recognize staff members they appreciate. The Nurse Manager trains all of her new staff on the patient satisfaction reports and how to read and interpret the reports. They discuss the difference between the trending questions and the priority index questions and how they can leverage these questions to impact patient satisfaction results. The Nurse Manager trains them to practice key words.
It is evident in the process of disseminating ongoing biweekly patient satisfaction scores and weekly follow-up phone calls that Riverside is committed to Patient Satisfaction. Patient satisfaction is enculturated by the nursing staff at Riverside as they practice vigilance on a daily basis. Nursing strives on a daily basis to meet and exceed the expectations of the patients. Recent staff surveys have shown that Riverside is a great place to work and that correlates to the improvements being completed for patient satisfaction. 5