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Improving patient feedback can dramatically increase engagement levels with caregivers and decrease turnover, leading to an overall improvement in the quality of care, one hospital reports.
Those results at Methodist Hospital of Southern California, in Arcadia, came from improving patient satisfaction and engagement by providing patients and family members an anonymous, real-time way to review the care received. The system also provides caregivers an opportunity to receive that feedback immediately and improve service delivery when possible.
The hospital adopted the system in June 2017, first employing it to gather baseline data on patient reviews before making that information available to staff in the form of individual scorecards in September 2017, says Darlene Burge, director of service excellence/volunteer services. Patient satisfaction scores spiked in October and December, she says.
“We also started getting positive letters from patients and families praising specific employees, and they started mentioning names we hadn’t seen in the past, people we didn’t necessarily consider our ‘A’ players,” Burge says. “It was interesting to see how the system is transitioning employee behavior. We know our data is very young, but the numbers are sustaining and improving every month.”
The same methodology at the Florida’s Special Care Unit at North Broward Hospital in Ft. Lauderdale doubled the unit’s engagement levels among its caregivers, showing a 39% improvement in Net Promoter Score, a proprietary metric that can be used to measure patient satisfaction. The unit also experienced a decrease of 18% in care provider turnover.
Methodist Hospital uses a software system with three major portals. One is “Patient/Family,” where reviews on individual providers are taken during the time of their care. Another is “Employee,” with an individual dashboard, and the last is “Admin,” where managers get real-time visibility into employee performance and patient satisfaction.
Volunteers ask five questions of patients and family members, such as whether the employee was kind to them, entering those data into the system with the names of any individual hospital employees mentioned. All surveys by patients and families are anonymous unless they self-identify for follow-up.
The employee dashboard allows individual employees to see how they are performing on a per-question basis in real time so that they are empowered to make behavioral change while being recognized for their strengths. (Methodist Hospital uses a system from Wambi in Los Angeles. Other patient feedback systems are available from RL in Cambridge, MA; RepuGen in Irvine, CA; and several other companies.)
Employees receive ongoing recognition through the dashboard, where they can see their overall patient satisfaction scores, compare their performance vs. the unit (but not other individual employees), and provide encouraging feedback to their peers. Employees accumulate points called PECKs, which stands for Providers Empowered by Compassion and Kindness.
Employees work to reach Silver, Gold, Rose Gold, and then Diamond levels after earning a defined accumulation of PECKs. When they hit their first level, Silver, they receive a silver pin to wear to work to share their achievement. They receive another pin for each level achieved.
“The caregivers are now aware that the attribution is coming to them individually. They can’t hide behind a score for the whole floor,” Burge says. “They can’t say the floor’s score is because of someone else’s behavior and not theirs.”
The system works in part because it includes a “gaming” component, notes Bobbie McCaffrey, RN, vice president and chief nursing officer. Also called gamification, this is an increasingly common element in many feedback systems. It applies features familiar from game playing, such as scoring points, competing with others or against your own past scores, rules of play, and trophies.
“To be perfectly honest, I was a little skeptical because I’ve always believed that if you work in healthcare it’s almost a sacred calling for you. That may not be the case for everyone, though, so you do have to reward people for doing a good job,” McCaffrey says. “Everywhere you look everyone is doing something on their phones these days, and we have a ton of millennial employees who are sometimes more comfortable texting someone than engaging them personally. So we’re taking advantage of their comfort level with technology, but at the same time encouraging them to engage with people more.”
Employees can sign on to the hospital’s webpage for the system and see a real-time update of their reviews and the points accumulated. In addition to recognition pins and praise, employees reaching certain point levels earn gift cards, starting at $5, that can be used in the hospital cafeteria or gift shop.
The hospital determined that any monetary rewards for gamification would be taxable income, which complicates accounting and diminishes the value for recipients. So, instead of providing cash, Methodist Hospital created its own internal dollars that can be spent in-house. The dollars can be spent immediately or accumulated, Burge explains.
“It’s a competitive thing, which people seem to enjoy, and there is a tangible reward as well. Praise and recognition are very important, but people also like to receive an actual gift of some sort for doing well,” McCaffrey says. “This all draws on people’s natural tendencies to be rewarded for working hard.”
However, the system was not immediately welcomed by staff. Employees saw it as a rating that could be held against them, so they were waiting to see the negative repercussions from poor scores, Burge says. She and other hospital leaders wanted to focus more on rewarding positive behavior, so they celebrate positive feedback and high scores from the reviews, and they look for other opportunities to praise employees, such as articles in the hospital newsletter.
Employees soon accepted the review system and how it created individual accountability, Burge says.
“From a caregiver’s perspective, it makes sense for them to do the right thing now because it is attributable to them instead of their good work being lost in a collective score for the entire unit or floor,” Burge says. “People who provide the best customer service may not be the most popular with their co-workers because they’re spending more time with the patient and less time getting tasks done. It rewards the behavior we’re seeking, which is interaction with the patients.”
McCaffrey notes that, though the hospital tries to focus on positive reinforcement, poor reviews from patients and families can be instructive for individual employees.
“The employee can look at the score from a patient interaction and wonder what caused the patient to give such a low score. What caused that person to have such a negative impression of my interaction with them?” McCaffrey says. “It can lead the employee to be a little more reflective and consider how they are actually engaging the patient, how they can correct some of their performance to score higher.”
Burge, McCaffrey, and their staff monitor individual employee scores, looking for opportunities to intervene if the surveys show an employee is falling short in a particular area.
“I might see that one person is doing poorly in communication and that the concerns are all about how he or she communicates discharge instructions. We can go to that person and say, ‘We want to help you get better scores in this area,’” Burge says. “That might mean asking the employee to go through the discharge process with us and help them hone their skills to get the maximum number of points. Previously, we might have known that this person wasn’t considered a great communicator, but we wouldn’t know where to start with coaching.”
Each employee’s performance dashboard breaks down the accumulated points, how close they are to getting a reward, and how they compare to other employees. The hospital originally set the threshold for rewards too high, at 2,000 points for the first gift card, and recently reduced it to 1,500, McCaffrey notes.
“We didn’t want to start so low that it just seemed like a giveaway, but we found that it was a bit harder than we intended for them to reach that first $5 gift card,” she says. “We lowered the points needed so that it’s still a stretch and they feel like they earned it, but they get the positive reinforcement from the reward without waiting so long that it becomes counterproductive.”
In addition to individual scores and rewards, the system compiles an overall score for the unit or floor, which can be rewarded for achievements like having no falls or infections during the month, Burge says. Each member of the team receives points for the unit’s achievement, such as 150 points if the unit had no falls that month. The goal is to encourage a sense of teamwork and shared responsibility at the same time individuals are recognized for their particular work, she says.
Administrators monitor scores for each unit or floor, looking for correlation between positive feedback Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores.
“If I see that 5 North historically has not done very well in HCAHPS but it’s now seeing positive comments in our surveys, I expect to see that same trend in HCAHPS,” Burge says. “If we see a conflict there, we have to dig deeper to find out what is registering on one but not in the other, and which is more accurate. We do a lot of analysis on the back end to make sure what we’re seeing is really valid.”
The first three months with the system produced positive trends, but McCaffrey notes that a six-month trend is considered necessary to be statistically valid.
The review system engages employees in a way that is different from the routine encouragement to improve HCAHPS scores, says Jason Sydenham, RN, BSN, MBA, 4 North Unit manager. Staff become accustomed to hearing about the importance of patient satisfaction and HCAHPS scores, he says, but a system providing feedback on a microscopic level gets them involved in a different way, he says.
“People may have the best intentions and still become numb to the constant talk about HCAHPS. With this, I have people coming up to me and actively engaged, wanting to know more about how they can earn more points, whether they’re going to get points for having no falls this month,” Sydenham says. “They come to me on the 29 of the month, asking about scores because they want to achieve a good score before the end of the month.”
Financial Disclosure: Author Greg Freeman, Editor Jesse Saffron, Editor Jill Drachenberg, Nurse Planner Amy M. Johnson, Editorial Group Manager Terrey L. Hatcher, and Consulting Editor Patrice Spath report no consultant, stockholder, speaker’s bureau, research, or other financial relationships with companies having ties to this field of study.