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A worried patient entering a hospital doesn’t want to struggle to find the place where he or she needs to go. Nor should someone who is already under stress have to spend an hour trying to figure out how to work the television, lights, or bed in the room. Yet these small irritations can create a lasting negative impression on patients. That’s why Brockton (MA) Hospital targeted such little nuisances and their elimination through its Removal of Patient Irritants Team (RPI). The team — part of an overall effort to reverse a downward trend in patient satisfaction scores — won accolades last year from Press Ganey Associates, which made the hospital one of its finalists in the annual Client Success Stories competition. More importantly, patients are noticing the change, says Carol Martin, RN, director of cardiopulmonary rehabilitation at the 290-bed hospital and leader of the RPI team.
The idea immediately was to resolve as many issues that bother patients as possible, while making sure that those that are more complex are quickly brought to the attention of the appropriate person for development of an action plan.
The RPI team is one of five that the hospital implemented four years ago, explains Martin. The others are the measurement team, which keeps track of data and provides weekly updates on patient satisfaction scores; the communication team, which is in charge of all patient communications, including hospital room bulletins; the reward and recognition team, accountable for applauding the efforts of staff members who perform above and beyond the call of duty; and the standards and values team, which makes sure that hospital values are known, understood, and are part of the hospital staffs’ performance evaluations.
Initially, the team members were unsure what they should do, so they concentrated on reading every single patient satisfaction survey that was returned. Martin says of particular import was the comment section. "Patients don’t usually write any comments," she notes. "If they do, you know it is something that is important to them." Positive comments immediately were e-mailed around the hospital, and negative notations were listed and systematically attacked by team members.
One of the first items they noted was that emergency department (ED) patients complained that they couldn’t get pillows. "We asked the staff in the ED why they didn’t have pillows, and they said it was because if they had them, the emergency medical technicians would walk out with them, or the patients would take them to the floor with them when they were admitted and the department would never see them again."
The simple solution was to purchase green pillowcases. "Any time you saw a green pillow, you knew it belonged to the emergency department," Martin says. It was a quick and easy benefit to provide to patients. "We still lose a few pillows, but patient comfort is more important."
The team did some mystery shopping at the facility and noticed that it often was difficult to find someone who could provide a patient with directions. "So we started a greeter program where every manager has to pick an hour and work as a greeter at our main entrances," she says. "I got a lot of grief for it, but the program is still working."
The impact of the greeter program goes beyond patients, too, adds Martin. "It makes it clear to the staff that managers are interested in patient satisfaction. In addition, the visible presence of managers means that some problems can be addressed much more quickly than they might have been otherwise."
Another program involves patient rounding, in which patient advocates, nonclinical managers, and maintenance personnel make rounds to all new patients. During the week, patient advocates make the visits. On the weekend, clinical and nonclinical managers volunteer for the shifts. Maintenance associates visit every new patient within 24 hours of admission to ask about their accommodations and provide basic instructions for the television, lights, call button, and bed.
To ensure that there is wide participation in and knowledge of the RPI team activities, Martin holds meetings on different units every week. "It was hard to get staff nurse involvement, because their shifts aren’t predictable," she says. "But by having a meeting on different units each week, we can get nurses to come in for a few minutes, even if it’s just to grab a bagel. It’s often long enough for them to provide good ideas or hear what we are doing."
In one instance, a nurse said there weren’t enough intrevenous pumps available. "If you tell a nurse manager that, they might say you are using them on too many patients. But we stepped back and looked more in depth. We called other hospitals to see what their use was and found we used them 50% less than other hospitals. We ordered more pumps right away."
If a problem is brought up — either by patients or by staff — it is addressed. If it can’t be fixed immediately, staff is apprised of the situation so they know where it stands.
When a complaint comes in, it is brought to the attention of the person in charge of that area. For instance, if a patient complains that a room is too warm, the complaint goes to maintenance. Since rooms don’t have individual heating systems, the maintenance staff might recommend using fans. The manager who can best deal with the problem is in charge of making rounds to patients who have made such a complaint and is given two weeks to work on the problem. "Then they come to a weekly meeting and report on what they have done and what they couldn’t do." Only once has the manager in charge failed to come up with an action plan in the two-week time frame, says Martin.
The overall goal, she says, was to improve patient satisfaction scores from the 38th percentile to the 98th percentile. It’s a high goal, and Martin says that since there are 650 hospitals in the Press Ganey database, she’d be happy with any score in the 90s. Initially, she succeeded. "We had a full year where we were over the 90th percentile," she notes. Then a nursing strike hit the hospital last fall. Upon the return to work, the scores were once again very low. "But we went right back to work, addressing patient and staff issues and the scores started going up again." By the start of May, the scores had been in the 90s for about a month.
With good support from the CEO and other senior management, Martin says no one doubts the importance of patient satisfaction. "It is the No. 1 item on the senior staff agenda every single week," she says. "I have my own budget, and every week the CEO asks what I need to make this all work."
Not that money is the only answer. "It’s not even about the big things, but about the small ones," says Martin. "It’s acknowledging a problem, asking how you can fix it. It’s often a lot less than you think."
The staff takes great pride in the achievements, which even were noted on paychecks, with a banner that said the hospital was in the top 10% for patient satisfaction in the country. But Martin does have a word of warning. "Don’t waste your time on the 1% of people who you can never make happy," she says. "Put your efforts on exceeding the expectations of the others and on swaying the feelings of those fence sitters."
[For more information, contact:
• Carol A. Martin, RN, Director of Cardiopulmonary Rehabilitation Services, Brockton Hospital, 680 Centre St., Brockton, MA 02402. Telephone: (508) 941-7231.]