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Dome - A Solution Oh So Simple

May 2010

A Solution Oh So Simple

Date: May 7, 2010

Surgery tackles patient satisfaction.


PACU nurse Elenita Masiglat
Just one of the simple yet effective ways Surgery helps keep patients satisfied is a bag of overnight niceties. Here Weinberg PACU nurse Elenita Masiglat hands one of the bags to patient Delbert Chastain.

Even the country’s best hospital can’t please everyone all the time.

There are uncontrollable events and frustrating circumstances. One patient waits too long for an open bed, another receives the wrong meal, a doctor misses an appointment or a test result is confused. Perhaps there’s a disagreement about medication or just a simple personality conflict.

But that doesn’t mean a patient’s entire experience has to be doomed to misery.

When a situation isn’t ideal—whether it’s the fault of the hospital or of circumstances— saving patient satisfaction falls to the hands of physicians, nurses and other staff. It’s a skill Hopkins Hospital’s Department of Surgery has committed to mastering, and its efforts are starting to show. In the latest nationwide Press Ganey patient satisfaction survey, the department scored in the 81st percentile overall, up from the 39th percentile in late 2005, and in the 81st for the question Response to Concerns and Complaints, up from the 15th.

Becky Zuccarelli, senior director of Johns Hopkins’ Office of Service Excellence, attributes the score to two factors. One is the patient- and family-centered model that Surgery instituted six years ago. Second is the department’s adoption of a service recovery model developed by Service Excellence a few years ago. The model provides departments with tips on effectively making changes when addressing patient complaints or less than ideal situations. 

One of the simpler (but not always obvious) ideas behind the model is that dissatisfied patients need a sympathetic ear. For example, imagine a patient’s frustration should he encounter a long delay while waiting to be transferred from a post-anesthesia care unit to a private room. Sometimes, for reasons beyond anyone’s control—it’s a high-volume time, or patients stay longer than expected—there isn’t an available bed elsewhere.

Deb Baker, Surgery’s director of nursing, has taken steps to improve the situation. She tells the department’s nurses to explain situations to patients and reassure them. So far, their techniques are working. Baker notes that she gets such comments as I’m almost happy I had to stay [in the PACU] because I felt so well cared for. One man wrote about his nurse, “Never can I remember such competency and insight. Hopkins is number one.”

Baker or anesthesia administrator Christina Lundquist talk to patients and family members, letting them know they can contact them if there are problems. PACU staff also give a small tote bag filled with overnight niceties—accompanied by a note of apology—when things go wrong or a situation isn’t ideal. A joint present from the departments of Surgery and Anesthesiology, the bag contains a surgery department blanket and items like a toothbrush and lip balm. 

“It’s gone over tremendously well,” says Peggy Hood, the surgery department’s nursing program coordinator, who came up with the idea after noticing the unexpected PACU stays. Since this specific patient satisfaction project began in fall 2008, over 600 bags have been distributed, and the idea has extended to patients across the department who’ve been inconvenienced in any way.

Also successful are parking reimbursements, meal tickets for families with long waits and, in extreme cases, free overnight stays in local hotels for out-of-town families.

Aside from soothing a dissatisfied patient, another primary goal for surgery staff has been to learn from their service recovery efforts.

During weekly meetings, staffers discuss things that went wrong and how they addressed them. For instance, in the department’s Marburg Pavilion, a patient was angry and upset after his cardiac surgery was cancelled twice. Refusing to have the operation rescheduled, he demanded to be discharged. Carole Blakely, Marburg’s nurse manager, intervened.

“He hadn’t eaten in two days,” she recalls. “I calmed him down, and arranged for him to meet his surgeon.” Blakely also provided him and his wife with a free meal from the Marburg kitchen. “It was something I could do,” she said of the gesture. “He still left, but he left with a good feeling.”                    —Barbara Pash and Lauren Manfuso

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