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Wowing Them
Hopkins Hospital will receive a prestigious national award for improving its patient satisfaction scores. Still, there's room for improvement. Where do we go from here?

Some of the staff from Nelson 6, this year's winners of a Best Practice Award are, left to right, Lynn Desrosiers, Monica Darland, Sharon Owens, Tina Cafeo, Deb Sedlander, Stephanie Meredith, Betty Stewart and Susan Rush.
Some of the staff from Nelson 6, this year's winners of a Best Practice Award are, left to right, Lynn Desrosiers, Monica Darland, Sharon Owens, Tina Cafeo, Deb Sedlander, Stephanie Meredith, Betty Stewart and Susan Rush.

During the nearly five years that Tina Cafeo has been nurse manager of the cardiac progressive care unit, she has overhauled Nelson 6. First, Cafeo reassigned jobs on the unit, delegating the duties that were spilling over onto nursing's workload—cleaning rooms, passing out trays or tracking down supplies—back to the experts in their respective areas. Next, inefficient pharmacy practices were fixed, the CPCU's supply and equipment issues were put to rest, and new computer systems to cut down on paper were introduced. "The unit completely turned around," says Cafeo, who notes that feelings of discontent have been quelled by the license to solve problems and that there's now a better sense of teamwork on the floor.

Over time, Cafeo observed that something notable yet not unintended had happened. "We went from receiving a lot of patient complaints to getting thank-you notes," she says. By addressing employee morale, she watched patient satisfaction scores on Nelson 6 shoot up from the 38th to the 87th percentile in the space of a year, a feat that's being recognized with a Best Practice Award at this month's Celebration of Service Excellence event.

The CPCU is just one of many success stories throughout Hopkins Hospital. In fact, patient satisfaction scores have risen so dramatically in the past two years (2.5 points on a scale where the average improvement is 0.1 point) that the medical center will receive the prestigious Compass Award from its survey vendor, Press Ganey, next month. The award is given to the top three most improved organizations in Press Ganey's database.

Patient satisfaction data is more important than ever to hospitals across the nation, says Becky Zuccarelli, senior director of service excellence for the Health System. Foremost, "it's the way our patients tell us how we're doing," she says. "It's a measure of our mission." Secondly, good data gives hospitals a competitive edge in an era of consumer-driven health care. Lastly, beginning in 2008, the federal government is making public the patient satisfaction data from all hospitals that participate in Medicare and Medicaid programs. "Patients will be able to go online and compare us side by side with any other hospital in Maryland and in the country," says Zuccarelli.

Similarly, to ramp up awareness of service scores, Zuccarelli has stressed accountability since she arrived at Hopkins. Since February, she has published a quarterly scorecard, complete with names, of percentile rankings for every hospital unit. It's a method she used successfully at her last job at OhioHealth, a system of eight hospitals and 15 affiliates, where she propelled patient satisfaction scores from the 10th percentile to the 75th percentile (and, for more than half the hospitals, to the 90th percentile).

Zuccarelli, who has a master's degree in public health, also uses a scientific approach to surveying patients that has improved scores. Now it takes Hopkins five days to get surveys into patients' hands, not six weeks ("the sooner, the better because it's fresher in patients' minds"). She also discovered that years ago Hopkins had decided to exclude all patient stays of two days or less. "It was about 20,000 people who were never getting surveys," says Zuccarelli, "and they were probably some of our happiest people—new moms, cardiac patients who weren't that sick."

Still, when Zuccarelli examined the numbers, not all of Hopkins' improvement could be attributed to the inclusion of short-stay patients. "Part of me was skeptical," says Zuccarelli. "I thought the numbers can't be this good. But they are. There's been true change here." A lot of the credit goes to the surgical units, like the CPCU, that have introduced patient-centered care to include 24/7 visiting hours and comfortable family lounges. "You can't imagine how important that is to families, even if they don't stay," says Zuccarelli.

Yet Hopkins' service scores are not where she thinks they should be. Although the hospital currently ranks slightly below the 84th percentile (up from the 30th eight years ago), "the best hospitals in the country are up around 89 and the top hospitals are above 90," says Zuccarelli.

Part of the gap is attributable to widely ranging satisfiers and dissatisfiers. Hopkins' physicians, for example, have some of the highest scores in the nation; a few even reach the 99th percentile. But patients are sometimes unhappy with how the staff responds to their concerns and complaints. Zuccarelli thinks that's because often in big organizations, staff can feel powerless about things they don't control, such as when radiology will call or a medication will arrive. Then they avoid the situation and patients feel unheard.

To remedy that, hospital leadership and staff will receive classroom training in a skill called "service recovery" sometime during this fiscal year. It consists of listening to patients, acknowledging their complaints, empathizing with them and practicing blameless apology, "when you apologize for delays and mishaps without owning it," explains Zuccarelli.

Another part of the plan is to give patients something—meal coupons, gift shop coupons, even gas cards—when things go awry. "The key here will be empowering the frontline staff to use it," she continues.

Most of Hopkins' patients, says Zuccarelli, "are OK with us; they're not wild. They don't go home and tell their neighbors, Boy, that Hopkins is the best. That's what we want people to understand. What we really want to do is wow them."




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