The high bar of 'always'
In HCAHPS, most of the questions offer four response choices: never, sometimes, usually, and always. But healthcare organizations only receive credit for the "always" responses. "The patient has to feel every single interaction has been correct and there is a right interaction, and that's a high bar," Maione says. "It's a challenge and we're looking for ways to make an impression for patients to have a great experience."
To that end, Stony Brook isn't just playacting its way toward better performance for its patients. It also has taken steps to improve educational programs for physicians and nurses, with hopes of making them more sensitive to the needs of patients and more aware of their concerns. The hospital initiated weekly rounds when hospital leadership visits patients' rooms, asks patients questions, and evaluates the responses in internal reporting and committee meetings. The effort is to continually improve the process.
Hospitals want to give patients that one-on-one feeling whenever they can. They are improving bedside reporting by increasing how frequently nurses relay updates to each other on patients' progress throughout the day; adding time to nurses' visits in patients' rooms; and encouraging physicians to sit down near patients' beds, possibly holding the hand of older patients, and definitely looking them in the eye. Hospitals call patients or write to them—within hours after discharge. An oncology patient recalls just returning from the hospital, still sorting out the prescriptions on the kitchen table when the phone rang. It was the hospital, asking, "How did we treat you?" Hospitals tell the frontline staff, "Be nice. Be friendly." And, they hope, the patients will notice their outstanding efforts to care.
"We really have to put ourselves in the same area as hotels. Patients expect hotel-like service, with the food and people responding to their calls. We have to be able to do that," says Wendy H. Solberg, FACHE, CPHQ, vice president of quality and patient safety at Baptist Health System in San Antonio, Texas, which has 1,674 beds at five acute-care hospitals. But it's not really a hotel, and that's a big issue for hospital leaders, Solberg acknowledges. One of the problems is that "you are dealing with perception," she says. "You can treat [patients] great, but if you aren't nice to them, it takes some of the shine off a great thing you've provided in healthcare."
Hospitals tackle dealing with patient satisfaction in different ways. Some evaluate job applicants with an eye on the prospective hire's personality and possible relationship with patients. Others are continually evaluating how physicians and nurses interact with patients, taking steps to intervene to improve patients' perception of the professionals' care. Most hospitals have a steady stream of action plans and reports that flow to and from the C-suite on how they are doing with patient satisfaction.