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Moving the needle on patient satisfaction scores

It takes a top-to-bottom effort to improve patients' experience

March 2011

Published in the March 2011 issue of Today’s Hospitalist.

When it comes to patient satisfaction scores, hospitalists like to complain that they’re being unfairly singled out. To bolster that argument, they point to all the factors involved in satisfaction that physicians can’t control, from lousy food and non-private rooms to paging systems that make sleep impossible.

Ned Jaleel, DO, MMM, the director of the hospitalist program at Seton Health St. Mary’s Hospital in Troy, N.Y., has heard all of those complaints, and he admits that assessing patient satisfaction is a flawed science.

“But the reality,” Dr. Jaleel says, “is that hospitalists’ scores are fairly consistent from quarter to quarter to quarter.” The hospitalists who get great marks for communication from nursing staff and other physicians, for instance, are the ones who also have the highest patient satisfaction scores. And doctors who routinely get not-so-good feedback from other providers consistently place lower with patients.

“You have to have a formal process to give physicians the education and tools they need.” 

nedjaleel~ Ned Jaleel, DO, MMM
Seton Health

Although Dr. Jaleel says that patient satisfaction scores are “a really hard needle to move,” his group has had major success in doing just that. The program has seen its “excellent” ratings rise dramatically, in part by linking physician compensation to satisfaction ratings.

Even with those successes, Dr. Jaleel says, he agrees with the sentiment that patient satisfaction can’t be laid on doctors alone, but has to be part of a hospital-wide effort.

“It can’t be about, ‘Hey, our score’s low this month. Let’s get the score up,’ ” he notes. “You have to have a formal process to give physicians the education and tools they need to really improve patient satisfaction.”

Pick the right source
As part of the hospital’s push to improve patient satisfaction, Dr. Jaleel credits the facility’s choice of satisfaction-assessment companies. Several years ago, the hospital decided to go with Professional Research Consultants Inc. (PRC).

The consulting group makes phone calls to patients, rather than mailing questionnaires. “People motivated to fill out a questionnaire are typically on the extreme of being really upset or really happy,” Dr. Jaleel explains. “With phone calls, PRC is able to ask more specific questions, and I believe we get a broader sample of patients and information.” That broader sample helps with physician buy-in. (PRC also, he points out, has “specific doctor-related questions, which is another advantage over other formats.”)

In the past year, Dr. Jaleel’s group has done two things with those assessments: First, all hospitalists receive quarterly reports with feedback on their patient satisfaction scores. And to really hold their interest, hospitalists are receiving financial incentives.

As in many hospitalist programs, physician compensation at St. Mary’s breaks down into 80% salary and 20% incentives. While half the incentive pool is based on productivity, the other half consists of four quality incentives: citizenship, core-measure compliance, medical record completion and patient satisfaction scores.

The program is aiming for a higher percentage of “excellent” scores. When improvement efforts began a year ago, Dr. Jaleel says, physicians’ percentage of excellent scores hovered under 20%. They’ve now jumped to about 45%, he says, which still leaves room for improvement.

Comprehensive effort
Dr. Jaleel makes clear, however, that the quarterly feedback began only after physicians took part in an educational program designed to improve patients’ experience at the hospital. Part of that campaign included instructing all hospital personnel in how to utilize AIDET principles (acknowledge/introduce/duration/explanation/thank) in all patient interactions.

The principles advocate some simple techniques, like remembering to smile when speaking to patients and sitting down instead of standing by the bedside, giving patients the sense that doctors are spending more time with them. But the bulk of AIDET training, Dr. Jaleel explains, is “a bare-bones education on communication, using a scripting method when interacting with patients.”

Most physicians assume, he adds, that “we can go see patients and they know who we are and what service we’re from “and that’s really not the case.” Instead, hospitalists have been instructed to repeat “I am the hospitalist” and give patients some personal background.

Physicians don’t feel singled out by the educational program, says Dr. Jaleel, because it’s hospital-wide and given to everyone from the nurses and physical therapists to the maintenance crews. As part of that campaign, everyone in the hospital has been charged with improving what the hospital calls its “net promoter score.”

That score “which isn’t tied to individual hospitalists’ incentives “reflects the percentage of patients surveyed who respond “excellent” to the question of how they would recommend the hospital to others. It’s another indication, says Dr. Jaleel, of how serious hospital administration is about enhancing the patients’ experience.

Taking it further
Another recent innovation “post-discharge calls “has had “an immediate impact in improving our scores,” says Dr. Jaleel. In its current iteration, hospitalists don’t make those phone calls.

However, the calls have had such a dramatic effect on patient satisfaction scoring that hospitalist post-discharge calls will soon be implemented. Under that program, which will be voluntary for the doctors, each hospitalist will receive a list of patients he or she discharged in the previous week. The group will also assign a certain number of RVUs to each call.

“Our computer system will be able to monitor how many calls are made and documented in the medical record,” says Dr. Jaleel. “The calls will count toward physicians’ productivity bonus at the end of each quarter.”

And another phase of the AIDET campaign is about to begin: Physicians (along with every other hospital employee) will be shadowed by members of the education department to see how well they’re putting the principles of improving patient interaction into practice.

While that may take some getting used to for some hospitalists, says Dr. Jaleel, he notes that the physicians now respond much more positively to the feedback they get on their efforts to boost patient satisfaction.

“I’ve seen a shift in their general willingness to focus on satisfaction scores,” he notes. Some hospitalists may have started with the belief that “their primary goal was to provide good quality medical care, and their job ended there.” Now, however, physicians appreciate that the quality of care is tied to physicians’ ability to effectively communicate.

“Your interaction with patients does influence whether they take the medication you’re prescribing or do what you’re telling them to do,” Dr. Jaleel says. “If they trust you, that has an impact on the quality of your care.”

Phyllis Maguire is Executive Editor of Today’s Hospitalist.