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Agency decides it is time to drop homegrown tool
Home care clients of Watertown (WI) Memorial Hospital Home Health consistently rated the agency high on the agency’s homegrown patient satisfaction survey.
On a scale of 1 to 5 with five being the highest rating, most of the responses fell in the 4.5 to 5 rating, recalls Sandy Roberts, RN, BSN, manager of home health for the hospital-based agency. "So it was kind of like, What do you do with this information?" Roberts says. "Everybody is rating us good’ or excellent,’ and it seemed like there was something missing."
For one thing, the agency had no way of putting its "excellent" ratings into perspective. Would every other agency rate as high, or were there problems that were not showing up on the survey? "It was hard to make a quality assurance project out of the survey information," Roberts adds.
For example, there was one small trend of therapists being rated "poor" during two quarters. On the surface, this would appear to be a good place to start a quality improvement project. But upon closer examination, Roberts realized that this lower rating was due to one or two complaints about therapists not being as receptive to patients’ complaints about discomfort as the patients wanted them to be. Since there was such a small sampling size of surveys, one or two complaints could drastically affect a satisfaction rating.
Also, they realized that the complaints came from patients who were covered by private insurance and their coverage allowed few visits.
Nonetheless, managers asked therapists to be more sensitive to patients’ needs, particularly when patients had limited visits. "We worked with therapists to change how they presented this to patients," Roberts says. "They can say, You haven’t met your goals yet, but we’re limited by what your insurance will pay for, and so we need to look at some other options for you.’"
While the homegrown survey did produce at least one positive change, it was limited in its scope and managers decided they needed more and better information about patient satisfaction.
Watertown Memorial Hospital had begun using a satisfaction survey from Press, Ganey Associates of South Bend, IN. The hospital recently was named a finalist in the Press, Ganey client success stories. But the home care agency was too small to obtain benchmarking data using that survey.
Instead, the agency turned to the VHA South-west Inc. of Dallas for a home care survey that could be benchmarked against home care agencies in the Upper Midwest. VHA Southwest is a nonprofit organization. The agency began to use the survey in January 2000, and managers quickly found that it provided them with more detailed satisfaction information. (See comparison of homemade survey and VHA survey, right.)
When the first benchmarking data returned, the agency’s score was in the 81st percentile for timeliness, but higher for other categories. The agency scored in the 100th percentile for the question asking whether the staff member treated the patient with respect. "That’s going to be the area we will focus on," Roberts says. "We’ll work on improving our responses as far as timeliness, both for visits scheduled and timeliness of the on-call response."
The quality improvement (QI) project focused on staff education about admission visits.
"We told staff we’d like them to take extra time with patients at the admission visit and explain to patients what the home care visit would be, when we would be there, and what they can expect for a response if they call in," Roberts says.
Staff were also told to give patients a range of times when the patient might anticipate a visit, such as saying "before 10 a.m.," instead of promising to be there at 9 a.m. "Patients understand that emergencies come up," Roberts explains. "And the staff felt it would be difficult for them to get there at specific times."
The next phase of the QI process is to monitor the time frames for on-call responses. The agency will track those from the time the nurse is paged to the time the nurse calls the patient. The goal is to have a 15-minute response time.
The home care agency’s switchboard is capable of logging the time a patient calls and the time the nurse returns the call; this is how the agency will track the response time. "We plan to monitor all on-call times for a month," Roberts says. "Then we’ll look to see if our patient satisfaction improves."