In this Q&A, Deirdre Mylod, PhD, vice president of public policy at Press Ganey Associates, Inc., discusses trends in patient satisfaction with nursing care--and what nurse leaders can do to boost their scores.
What are some of the trends that you’ve seen in patient satisfaction?
Mylod: Over the last few years, hospitals have shown a slow but steady improvement in their patient satisfaction scores. Part of that has to do with the movement toward more transparency and treating patients as consumers. And part of it has to do with hospitals realizing that service is a component of quality. We have actually done a number of studies linking service quality to overall quality in hospital care.
What about the impact on an organizations’ bottom line?
Mylod: In Press Ganey’s 2008 national survey of hospital executives, the three major reasons for organizations’ focus on patient satisfaction were to improve the quality of care, to measure loyalty, and to increase market share. The fact that hospitals with consistently high levels of patient satisfaction are also consistently among the most fiscally successful is not a coincidence. The most profitable hospitals have the highest levels of patient satisfaction.
Patient loyalty also translates into serious revenue gains. By improving patient satisfaction, providers increase future patient volumes through existing patients and their personal networks.
All facets of satisfaction work together. Improving patient satisfaction increases loyalty, which increases utilization. Likewise, attending to physician concerns and improving physician satisfaction increases referrals and patient volumes. Improving employee satisfaction increases employee engagement, which increases staff retention and decreases turnover cost.
What about patient satisfaction with nursing? Where does that stand?
Mylod: Nurses definitely play a key role in the patient’s view of service quality. We know from Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) that specific questions that relate to nurse interaction drive outcomes. So nurses play an absolutely pivotal role.
That said, often times, the highest scoring areas for hospitals are those related to nurses. So nurses are already doing a fantastic job.
Are most hospitals sharing patient satisfaction data at the unit level?
Mylod: Hospitals definitely vary in terms of how much transparency they provide to their organization. But we find that hospitals that are high performers or that are improving rapidly tend to share more data with their staff.
What are the best performing hospitals doing?
Mylod: The hospitals that are doing it right are good at communication--with patients and with other staff within the hospital. From the patient perspective, just meeting patient information needs is vital for their satisfaction. One of our client hospitals mandated what they call “therapeutic time,” which is five minutes at the beginning of a shift doing nothing but talking with the patient. What they found was that patient satisfaction went up. Nurses were also more satisfied with their jobs. Nurses had less stress and less turnover because they were reengaged in their work. Nurses who are themselves satisfied and engaged, and who can spend sufficient time at the bedside, know their patients better, learn their patients’ vulnerabilities, and are better able to ward off potential harms and safety threats.
Regarding communication among staff, hospitals rated as having good practices surrounding the facets of safety culture--such as handoffs or transitions from one shift or unit to another--also see high levels of patient satisfaction.
What else are the best hospitals doing?
Mylod: The best hospitals are looking at individual patient comments on satisfaction surveys. Specifically, they are using them to follow up with high-performing areas as well as the low-performing areas. Often, the comments help you see that patient satisfaction and quality are often linked with safety. For example, you might see a lot of comments related to delays in call button response.
But the big thing is using positive comments for reward and recognition. When it comes to nurses, 71 percent of patient comments are positive. Patient satisfaction surveys can be a huge repository for reward and recognition efforts. For example, a nurse manager might send a handwritten thank-you note to an employee who was mentioned in a patient comment.
In addition to reward and recognition, research shows significant associations between positive leadership behaviors and both increased patient satisfaction and reduced adverse events.
Where else can nurses improve?
Mylod: Response to concerns and complaints is usually the No. 1 area that hospitals can improve, even though it is not exclusively a nurse area. Having a service recovery plan or being able to triage complaints should be a priority for hospitals.
Keeping patients in the loop on their treatment is also an area where nurses can make a difference. Often, patients don’t understand what they are being told and are reluctant to ask. Having nurses role-play common patient interactions can help. Additionally, patients associate quality and safety, so by addressing concerns and complaints, and keeping the patient informed, nurses are essentially impacting both.
Deirdre Mylod is vice president of public policy at Press Ganey Associates, Inc. (DMylod@pressganey.com).