news, views & ideas from the leader in healthcare satisfaction measurement Amazing Service Every 'Touch Point' Counts The Satisfaction Snapshot is a monthly electronic bulletin freely available to all those involved or interested in improving the patient/ client experience. Each month the Snapshot showcases issues and ideas which relate to improving patient satisfaction and customer service, improving workplace culture and improving the way we go about our work in the healthcare industry. The Satisfaction Snapshot features: «relevant articles from healthcare industry experts «case study success stories «tips and tools for quality improvement «patient satisfaction and other industry research findings «articles with ideas to help achieve success in your role If you would like your colleagues to receive the Satisfaction Snapshot please send us their names and email addresses. The Satisfaction Snapshot is published by Press Ganey Associates Pty Ltd. All material is copyright protected. Quotation is permitted with attribution. Subscribers are permitted and encouraged to distribute copies within their organisations. Subscription to the Satisfaction Snapshot is FREE! Please direct any comments, suggestions or article submissions to: Success Story Winner 2010 Manager of Client Relations snapshot@pressganey.com.au www.pressganey.com.au P: 07 5560 7400 F: 07 5560 7490
page 2 Introduction Hollywood Private Hospital, a member of the Ramsay Health Care group, is an acute-care private teaching hospital situated in the Perth suburb of Nedlands, in Western Australia. It has 522 inpatient beds and 137 day beds making it one of Australia s largest private hospitals. Hollywood is recognised as a centre for excellence in surgery and medicine specialising in orthopaedics and urology, cardiology, oncology, palliative care, psychiatry and rehabilitation and is accredited with the Australian Council on Healthcare Standards. Values are an integral part of Hollywood s culture and express in clear terms the way we operate. These Ramsay Way values are: RESPECT FOR THE INDIVIDUAL TEAMWORK PURSUIT OF EXCELLENCE THE RAMSAY SPIRIT CONTRIBUTION TO THE COMMUNITY The Press Ganey Satisfaction Surveys have provided feedback from patients on a regular basis for over ten years. In order to gain confirmation that improvement strategies were effective, 365 days a year surveying of patients was introduced in 2006 enabling more immediate feedback. A target of reaching the 90th Percentile score in all categories was introduced supported by a traffic light feedback system to demonstrate progress. Initially progress in achieving the target was patchy and inconsistent. Hollywood embarked on a journey called Amazing Service. At our destination the hospital will be recognised as the leading provider of customer service in the private hospital sector. We identified 4 major objectives to get us there: create a simplified and more efficient booking and admission process for doctors and patients; provide more training for staff to support the delivery of our Amazing Service strategy; provide better strategic support, consistent and exciting information for staff through an ongoing communication strategy that reflects our unique culture; change daily work practices to simplify, de-clutter and desist in performing redundant tasks, making time in our work day to provide Amazing Service. Our driver on this journey is the Executive Director, Kevin Cass-Ryall. His personal vision and enthusiasm for finding a new approach to the way we deliver customer service to our patients and doctors, and his energy and passion is a critical factor in our success. During 2008, extensive research was undertaken by two external organisations which involved obtaining feedback from staff, doctors and patients. Tellingly, both external bodies drew similar conclusions from their research. The most important information generated from these independent studies was that currently no hospital in Perth is perceived by doctors as providing "an amazing overall patient experience", or providing administrative processes which are customer focused, streamlined and easy to use. This was an opportunity that Hollywood decided to grasp! Approach In recognition of the fact that Organisations don't provide amazing service, people provide amazing service Staff needed to be excited about this new approach to customer service and to take ownership of the changes required in their daily work life to get us to our destination. During early 2009 the Executive Director personally conducted one hour sessions with staff to explain the approach and gain their commitment. 728 staff attended over a 4-month period. These sessions were the first step in creating the environment to shift Hollywood from a care only, to a service and care culture.
page 3 A supportive framework was built to ensure that Amazing Service became a real part of daily life at Hollywood. Part of the framework was the Five Symptoms of Amazing Service that allowed us to relate what we were expecting of staff to the practical day to day work. The symptoms were the talking point for change. These Five Symptoms of Amazing Service are: Own, act and resolve is the ability to take ownership of a situation or problem regardless of its make-up and get it done. All tasks involved in the day-to-day running of a hospital rely upon everyone taking initiative and making things happen. It s the responsibility of everyone to work towards developing a culture where individuals have the confidence to find a solution to a problem. Simplify, make it efficient - is one of the first symptoms of amazing service that is considered in providing patient care. It not only improves the service provided, it allows more time to engage with patients, doctors and each other. In order to provide a seamless service to all customers it helps if the work environment is decluttered and the systems are logical and efficient. Often simplifying how things are done can also reduce the chance of error. Every 'Touch Point' counts - refers to any interaction a patient has with the hospital from pre admission to discharge. This may include clearly written pre admission patient information, easily finding a parking bay on arrival, a friendly welcome by the concierge, or a well presented hospital room. It only takes one negative interaction whilst in hospital to create an average experience, so each member of staff needs to be engaged and present in the moment of communication with a customer. Keep doing it better - is about continuous learning, improving and perfecting. There is always room for improvement, and by challenging processes some innovative solutions to everyday problems can be found. Work proud - pride in a job can be expressed at every opportunity whether that be in language, manner, appearance and surroundings. All staff are important to the smooth function of the hospital so the commitment and passion for doing a job well, and being aware of how they are perceived by others, in particular, patients is crucial. Even the small things count. Another key component of the supporting framework for Amazing Service is effective communication with patients, doctors and staff. The hospital s external marketing campaign involves bringing the Amazing Service message to patients and doctors in unique and exciting ways via billboards, bus strips and our website. The message is consistent and tells a story. Staff communication involves a number of components including an Amazing Service newsletter to publish the stories of staff achievements and a Winning Hearts for Hollywood campaign which seeks to recognise staff who give exemplary service. Rewards for staff include vouchers, movie tickets, certificates of recognition and inclusion in the newsletter. All wards and departments have Amazing Service as the first agenda item of their meetings. Managers encourage staff to contribute ideas and suggestions about improving their service. To help in driving change at the ward level, individual wards have their own Press Ganey top ten priorities for improvement that form part of the Quality/Risk Management plan. The monthly reports generated from Infoedge, Press Ganey s online analysis system, provide continuous feedback on strategies implemented to improve patient satisfaction. The monthly results are presented to the managers as Excel spreadsheets using a traffic light system, Red for 80th percentile or below, Yellow for scores between 80th and 90th percentile and Green for those at the 90th percentile or above. Wards that achieve the 90th percentile score in all categories, plus their top ten priorities, in any one month, receive a basket of gifts personally presented by members of the Executive. This consistent reinforcement of the message at every turn has been important in keeping up momentum. An example of results from one ward is provided on the following page.
page 4 Specific Projects Key projects have been undertaken to improve organisation wide processes for patients and staff. Two examples are discussed below. Patient booking and admission As said earlier a critical factor in changing the perception of patients and doctors to good service related to the administrative processes of booking and admission. To address this, a team of staff (Admissions/Booking project team) facilitated and supported by the Clinical Service Coordinator, a senior nurse, re-designed the whole process. In conjunction with Ramsay Health IT Services an on-line booking form has been implemented which enables patients to complete personal details and medical history via the Internet. Elective patients can complete the form on-line or alternatively phone a designated telephone number to give details to a staff member who then enters them on the patient s behalf. Currently over 90% of patients complete the form on-line. This has improved timeliness and accuracy of data provided. A system to allow specialists to book patients on-line is also being developed.
page 5 Human Resources Processes In support of providing Amazing Service to staff several Human Resource processes have been reviewed and innovative solutions implemented, including: on-line employment applications; e-mail notifications of the progress of job applications; electronic storage of Human Resources records; electronic delivery of payslips and staff memos/notifications to those with personal e-mail accounts. Currently 64.1% (932) of staff have chosen this option. Also the Training and Development Department have streamlined the achievement of mandatory training by the implementation of e-learning modules in orientation and annual staff update programs. These include Infection Control, Fire Safety, Occupational Safety & Health and Medication Administration. Amazing Service Outcomes Using this integrated approach of involving all staff in strategies based on our values, the benefits were seen to be: For patients: personalised service, where they are acknowledged as individuals, and their physical, emotional and spiritual needs are anticipated and proactively addressed; ease of the admission process within an appropriate timeframe, as well as express admission to ward or to theatre; minimisation of repetition and re-checking of information; For staff: increased personal satisfaction, with streamlining of workloads and the elimination of duplication; well documented processes and training resources; For Doctors and their staff: Results The quarterly reports provided by Press Ganey contain in-depth analysis including updated top ten priorities and target scores. It should be noted that target scores vary from year to year as all hospitals using Press Ganey are trying to improve patient satisfaction scores. The continuous surveying by Press Ganey provides an important feedback mechanism to evaluate the effectiveness of improvement strategies that are implemented. When continuous surveying commenced at Hollywood in January 2006 the Overall Rating mean score was 83.0 A target score of 88.2. was set to achieve the 90 th percentile in the benchmark. In 2007 Ramsay Health Care commenced benchmarking between its facilities according to their peer group. In the latest quarterly report to May 2010 Hollywood achieved the 99 percentile rank in both the Ramsay Peer Group and the Private 300 bed+ peer group. This results have been achieved at a time of massive change including the opening of new wards and additional operating theatres and the expansion of services such as rehabilitation and oncology services. ease of booking admission and procedures for their patients; clearer communication with Hollywood;
page 6 Examples of results for individual wards are provided below demonstrating steady improvement across all key areas: 1/3/2010-31/5/2010 No of pts responding 497 2010 Target All Facility Mean Rank All Facility Private Rank 300+be Private d 300+ Bed Rank RHC Peer Group Med/Sg Target Score Question HPH ICU G 1 = 90th%tile Overall Rating 84.1 83.9 53 82.3 99 81.8 99 83.7 Admission 85.5 85.2 49 82.6 89 82.2 99 86.2 Room 82.2 81.3 58 79.8 99 79.8 99 80.9 Meals 82.1 81 57 79.1 99 78.5 86 81.2 Nursing Care 85.8 86 49 83.7 99 82.9 86 84.7 Tests & Therapy 87.1 87.5 47 86.1 67 85.4 86 87.3 Visitors and Family 85.7 84.8 60 83.1 99 82.7 99 84.6 Doctor Care 85.8 84.6 57 84.4 78 84.5 71 85.1 Discharge 83.6 83.3 51 81.4 99 80.7 99 82.2 Personal Issues 80.1 80.2 51 78.8 89 77.8 99 81.6 Overall Assessment 85.8 86.5 41 85.1 56 84.4 71 87 Hospital Top 10 Priorities 2010 Special/restricted diet explained 80.8 79.1 58 75.1 99 74.5 99 78.7 Ext made aware of rights & responsibilities 75.3 77 41 74.4 89 74 71 77.3 Ext made aware how to voice a complaint 71.4 70.3 54 69.1 89 68.4 71 74.6 Nurses kept you informed 83.5 83.6 51 81.4 89 80.2 99 81.9 Staff address emotional/ spiritual needs 81.2 81.8 48 79.8 78 78.2 99 81.1 Staff concern for your privacy 84.6 85.2 44 82.8 99 82.9 86 84.4 Nurse effort to include you in decisions 83.8 84.8 41 82.1 89 81.6 86 83.3 Info family re condition/treatment 83.4 84.1 44 81.9 89 81.2 99 82.5 Comfort for visitors 85.4 81.5 75 79.4 99 80 99 83.1 Extent better understanding of med prob 81.2 82.7 33 81.4 39 81.4 43 82.5 In addition to the Amazing Service strategy there was a focus on improving the top ten priority scores in individual wards. The ten criteria for each ward have changed over time as improvement strategies have been successfully implemented. In June 2010, only 3 out of 10 criteria for the Cardiology Ward and 4 out of 10 for the Orthopaedic Ward were in the 2006 list. Cardiology Ward Jan Dec Oct Oct Oct March 2006 2006 2007 2008 2009 2010 Overall Rating 81.8 86.9 84.7 85.5 85.5 87.3 Orthopaedic Ward Jan Dec Dec Dec Dec March 2006 2006 2007 2008 2009 2010 Overall Rating 79.1 85.9 87.2 80.8 87 86.6 Press Ganey has helped in ensuring continuity of measurement by mapping services and care teams from old wards to new. An example is the Cardiology service originally located on Murray Ward and now in a new building on Gosse Ward. This has allowed continued evaluation of strategies implemented by staff. The table below shows the scores for Murray Ward in 2006 and for Gosse in June 2010.
page 7 On Wednesday 9 December 2009 On Wednesday 9
page 8 Staff Support Caring for staff and providing a supportive environment pays dividends. This was recognised in 2009 as the hospital was the proud recipient of the Department of Education and Training WA Employer of the Year 2009 award, which is part of the WA Training Awards; a State Government initiative that has been running for the past 15 years. Kevin Cass-Ryall stated that he was delighted that the hospital received the award. This is an acknowledgment of years of hard work by countless individuals at HPH in its commitment to training, he said. In October 2009 the hospital was awarded the Workforce Development in Health accolade at the inaugural National Accolades for Excellence Awards. These national awards are designed to promote a competent workforce that is able to meet the needs of Australia s population; showcasing and applauding health and community service organisations that demonstrate best practice in this area. The WA Employer of the Year Award recognises best practice in training, looking at the organisation s whole philosophy and approach to education As Nola Cruickshank Hollywood s Director of Clinical Services stated Unlike many organisations that outsource their training, we have a dedicated Training and Development Department. We have also developed an ethos of shared learning so every staff member views education as their responsibility. This means training does not happen sporadically its happening all the time. In the recent 2009 Press Ganey Staff Satisfaction Survey Hollywood Private Hospital achieved the highest ranking for hospitals over 300 beds. Contact Information Jackie Bullock RN BA (Government Studies) ECU Quality Improvement Manager Telephone (08) 93466110 Fax (08) 93898470 bullockj@ramsayhealth.com.au One of nine accolades, the Workforce Development in Health category, recognises outstanding achievement in sustainable growth through the use of workforce skills strategies. staff satisfaction is directly related to providing Amazing Service and this has been endorsed by our success in both Press Ganey surveys. The Amazing Service program combined with continuous surveying of patient satisfaction in an environment of support, reward and recognition, within a values based culture has ensured Hollywood is on the road to success. The goal of being the leading provider of customer service in the private hospital sector is now within reach Kevin Cass-Ryall