Two Clinics, Turned Around
Grim comments appeared regularly on the 2006 satisfaction surveys for Johns Hopkins Bayview Medical Center’s outpatient cardiology clinic:
“You have one sourpuss who sits at the front desk.”
“Walked in—IGNORED BY STAFF—Never looked up from computers.”
“The doctor acted as if he was in a hurry to get away from me, like something else was more important.”
Comments on this past spring’s satisfaction surveys showed an astonishing turn-around:
“All personnel exceptionally friendly.”
“Best service I ever have gotten in any hospital or doctor’s office.”
“I find the staff and my doctor to be responsive and allow me all the time I need and have all my questions/concerns fully addressed.”
Similar, startling improvement appears in overall patient satisfaction numbers that compare the medical center’s outpatient cardiology and echo/stress clinics to those around the country.
Now, new policies ensure that all patients requesting an appointment get one within 24 to 48 hours, if they wish to be seen that promptly. To do this, schedulers are given the power to decide when and with which physician to assign a new patient for an appointment. At first, this created tension with some physicians, who prefer to maintain control of their schedules.
“It took about a year for them to completely buy into this,” says Michael Cole, assistant administrator in the Division of Cardiology, but now “they’re saying, ‘I’m not seeing enough patients. I had an open spot yesterday; how come I didn’t have a patient in that spot?’ This is a team effort in terms of faculty, staff and management.”
In 2006, patient satisfaction with the outpatient cardiology clinic was in the 40th percentile, as measured in surveys by Press Ganey Associates, an Indiana-based health care quality control company. That means 60 percent of hospitals nationwide did better. By the end of fiscal year 2008, however, satisfaction with the clinic had doubled, reaching the 81st percentile, say Cole and Mark Miley, manager of noninvasive cardiology.
While less dramatic, the patient satisfaction scores for the echo/stress clinic, in the low 50s when first measured in October, 2007, are now in the 58th percentile and moving in the right direction, Cole says.
Cole and Miley are pleased by the improvements—but far from satisfied.
“To me, 50 percent isn’t good enough for us,” says Cole. “Sixty percent is not good enough. We have to shoot for 90 percent. We need to be the best that we can be, and we cannot settle for anything less.”
Patient satisfaction has become a significant measurement of quality care in recent years. Because prospective patients now can comparison shop for health care on the Web, hospitals everywhere have become intent on boosting the results they receive in patient satisfaction surveys conducted by such firms as Press Ganey.
Located on the third floor of the Francis Scott Key Pavilion, the outpatient cardiology and echo/stress clinics handled approximately 13,800 patient visits last year.
To improve patient satisfaction scores, Cole and Miley launched a series of initiatives two years ago to improve the efficiency and demeanor of the clinics’ scheduling, check-in and patient-care procedures. Initially the effort prompted some staff changes and at times annoyed the clinics’ physicians, Cole says, but ultimately “everyone worked together to get this done.
“They realized that if this wasn’t done, the program wouldn’t accelerate. We’d just sit and spin our wheels.”
At the check-in desk, receptionists now make prompt, direct eye contact with incoming patients, ask what can be done to help them, and remain uniformly upbeat. “The push has been to make every visit memorable,” says Miley.
Support staff and physicians also have been encouraged to explain what they’re doing to ensure that patients know that their concerns are being met, Miley adds. Instead of quietly closing an exam room door so a patient can disrobe, staffers now say, “I’m going to close the door for your privacy.” Instead of reviewing a patient’s medications in silence, a physician now will say, “Let me review your medications and see if you have any questions about them.”
A new television, upgraded coffee and vending machines, and some new furniture have been installed in the waiting room. A “courtesy competition” now exists between the schedulers, front desk and technicians to determine “who can be the nicest to everyone,” Miley notes. Scores are posted monthly on a staff bulletin board that is displayed where all—including the patients—can see it.
Tammy Oldaker, front desk supervisor and repeat winner of in-house service excellence awards, says she tells her staff “to treat every patient who walks through this front door like it’s a family member of theirs—or themselves.”
Reminded of the unfavorable Press Ganey results from 2006, Oldaker says, “The sourpuss is no longer with us. Need I say any more?”
— Neil A. Grauer