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POWER OF THE PATIENT: Defining and Measuring Patient Satisfaction

Published: Synapse 2011, Vol. 2

The term "patient satisfaction" is heard regularly in today's healthcare environment. But what does it mean exactly? In a hospital setting, it should mean a lot. At The Chester County Hospital, it does. At The Chester County Hospital, patient satisfaction is the lynchpin in the overall healthcare experience.

"We have the philosophy that every single patient experience matters. Of course, we want every patient to be pleased with his or her medical care, but we also want each patient's stay with us to be satisfying in every way possible, both medically and personally," says Carli Meister, Director of Customer Relations and Risk. "And we believe that our patient's positive memories of us are built at every step along the way... from when they come in until they return home." How does the Hospital go about making sure that patients - inpatients and outpatients alike - leave the Hospital with positive memories about their Hospital experience? They are asked, and their answers are heard. According to Meister, listening to patient feedback is the most valuable way to gauge how the Hospital is doing.

Checking in One-to-One

Power of the PatientChester County's nursing staff visits patient rooms at least once every hour to perform what is called "Hourly Rounding," a room check for safety and service issues. They enter the room to make sure that nothing is amiss that could possibly cause any risk to patients, checking electrical cords and ensuring clear pathways. They make sure the patient's call bell and water are within easy reach. They ask a variety of questions to make sure each patient's specific needs are being met. Questions like... How are you feeling? Can I get you anything for your pain? Can I help you to the bathroom? Do you have any questions about your medication? Is there anything I can do for you before I leave?

Patients always have the comfort of knowing that someone will soon be in to check on them. "Studies show that call bell usage goes down with hourly rounding, because patients know someone will always be back in less than an hour, and they feel like they don't have to use their call bell to get the attention they need," said Meister. "It creates an incredible sense of trust and safety in patients."

And, at Chester County, nurses are not the only ones checking in with patients via rounding. Hospital volunteers also visit patients to collect their feedback and to make sure patients are happy with their care. These volunteers each come equipped with an electronic clipboard that sends a signal out to inform nursing staff, or the appropriate department, if a patient's expectations are not being met. The Hospital can take immediate measures to rectify the patient's concern. In addition, members of the Hospital Senior Administration also stop in routinely to talk with and get input from patients. Leaders introduce themselves to patients, ask questions, gather feedback, and make sure any issues are addressed right then and there with the patient's whole clinical team.

Random Patient Surveys

Power of the PatientThe Chester County Hospital also uses external patient satisfaction surveys to hear the voices of its inpatients and learn about the Hospital experience from their perspective. The Hospital uses patient feedback from the surveys to continuously focus on performance improvement and enhancing existing services and programs.

"If you are a patient here, you could receive a survey at home within two weeks of your visit. It doesn't matter why you were here or how old or how young you might be, we want your feedback," says Meister. "The questionnaire touches on everything from how you personally respond to the patient experience to whether the staff did everything possible to respond to your concerns and lessen the impact of hospitalization."

For many years, patient satisfaction has been measured through a formal survey independently administered by Press Ganey Associates, a satisfaction measurement firm. Chester County also uses patient input collected through another assessment tool called HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems), the first national, standardized, publicly reported data of patients' perspectives of hospital care.

The Press Ganey survey, which is mailed to random patients' homes, asks patients to rate various aspects of their visit on a scale of very good (100%) to poor (0%). Alternatively, the HCAHPS survey asks patients of all ages to rate their care in eight key areas by answering questions asked in terms of behavior. For example, "How often was my call bell responded to?" is one inquiry. Patients choose from "never, sometimes, usually, and always." HCAHPS also measures patients' overall rating of the Hospital, along with their willingness to recommend the Hospital to others.

For the past few years, The Centers for Medicare and Medicaid Services (CMS) has required all hospitals across the country to participate in HCAHPS. Beginning in 2012, CMS will start using the HCAHPS patient experience data to determine the level of funds it will reimburse hospitals for services, based on the percentage of "always" answers each hospital receives. With this Value- Based Purchasing program, CMS will financially reward or penalize hospitals with Medicare reimbursement based on performance as noted by patients who fill out their questionnaire. This means it is important for satisfied patients to take the time to complete the survey too.

"Value-Based Purchasing is forcing some hospitals to re-examine how really critical it is to do the right thing for their patients and families. For us, it just serves to underscore a mission we have always held firmly in place," says Meister. "We have always been dedicated to making sure that our patients know we will do everything possible to make their entire patient experience of the highest quality."

Sharing and Applying Information

Power of the PatientPatient satisfaction data is shared throughout the Hospital. Press Ganey and HCAHPS results are distributed to staff at every level across the Hospital, via formal reports, management/ department meetings, and the Hospital's intranet. Staff can also go directly to a website to look at Hospital data in real time and even calculate the financial impact of what the current scores might mean to the Hospital.

To Chester County, this data is not just numbers. It represents real people - members of the community who were cared for by its team within the past few weeks - telling what they think about their experience at the Hospital. For this reason, it is important to Hospital leadership that all staff has access to the information. Patient satisfaction data is never seen as belonging to a certain department. At The Chester County Hospital, everyone is in the patient satisfaction business and everyone shares in the responsibility.

"We live and breathe this all the time. It's not just about percentages or scores, it's about someone's personal experience," explains Meister. "Someone we know is opening up her mail at home, maybe with a cup of coffee at her kitchen table, and thinking about us while she fills out the survey. She is thinking about our staff, our Hospital, and the memories of the care we provided."

One area where Chester County has seen a lot of improvement noted in its patient survey data is the subject of noise at night - a real challenge for all hospitals nationwide. One question from HCAHPs asks patients to rate the statement "The area around my room was quiet at night" with a response of "never, sometimes, usually, and always." According to Meister, the national percentage of "always" answers usually fluctuates at about 50 to 60 percent at the very best hospitals across the nation. Data can easily ebb and flow; however, The Chester County Hospital has recently attained that same percentage range as the best hospitals in the nation.

The satisfaction increase seems to be a direct response to a few new initiatives at the Hospital, designed to help make a positive impact on the noise level for patients. Every patient admitted now receives a special sleep aid packet, which includes an eye mask and ear plugs with a message from the Hospital asking to be informed if patients experience any difficulty sleeping. The Hospital also observes "quiet time" in the late afternoon and evening, when lights are turned down and quiet is encouraged.

"We are all excited to see positive patient satisfaction numbers, because they reflect happy patients and that is our goal," said Meister. "We will continue to work hard to ensure that our patients and their families know that their positive Hospital experience is our goal, and that we are constantly striving to create a comfortable, healing environment for them."

By Beth Eburn

Last Updated: 12/1/2011