Emergency department managers at Overlook Hospital in Summit, N.J., were shocked in 1996 when their facility scored in the bottom fifth of 460 hospitals in a customer satisfaction survey conducted by Press, Ganey Associates of South Bend, Ind., an independent polling firm.
The staff faced the facts and committed to rebuilding the hospital's image and performance. Three years later, after dramatically trimming patient-waiting times for various services, scores on the annual Press surveys have been consistently higher than the 95th percentile.
"We see patient satisfaction as a legitimate outcome of care," similar to medical outcomes, cost and quality of life, says James Espinosa, M.D., medical director of the emergency department.
For its Improving Emergency Department Patient Satisfaction project, 490-bed Overlook won this year's Sodexho Marriott award in the patient-service category.
Overlook held a patient-satisfaction summit, a mandatory meeting for all emergency department staff including physicians, nurses, technicians, registrars, secretaries and volunteers. After intense brainstorming, the department began benchmarking and studying customer service programs of such stalwarts as Walt Disney Co. and the Ritz-Carlton hotel chain.
It became clear that ER wait time determined satisfaction.
"Clinically we were very good, but patient satisfaction is not about that," says Linda Kosnik, the hospital's chief nursing officer. "They expect you to be clinically proficient. But people are impatient; they don't want to wait to be seen."
The department staff worked in various teams-up to 12 at one point-to identify and improve the processes that affected wait time. As a result, the department began a fast-track program, so that patients with problems such as sprained ankles could be seen and discharged within one hour. The length of stay in the emergency room for patients in the fast-track program decreased to an average 47 minutes from 97 minutes in the past two years. To make such a dramatic change, the department had to streamline many of its processes such as radiology and registration.
To speed the time for X-rays, the emergency department changed its protocol. Instead of sending people to the radiology department, it used its own X-rays machines more frequently.
The department also hired technicians dedicated to the emergency room instead of calling radiology for help.
Bedside registration, which allows patients to register while their medical needs are being met by nurses or physicians, increased to 70% from 20%.
With the improved wait time for X-rays and with bedside registration, patients made contact with physicians in 18 minutes on average, down from 35 minutes. Teams worked to reduce average patient admission time to 1.2 hours from 3 hours.
The department also reduced waits for clinical treatment such as pain management or antibiotic administration.
Additionally, the patient-satisfaction team added new flooring and wallpaper throughout the department; built a four-bed suite- equipped with supplies, a television and telephones-for patients under observation; and added a fish tank and a children's corner with a VCR and Disney movies in the waiting room.
The department also enhanced privacy in the registration area with soundproof barriers and encouraged physician and nurse eye contact with patients by placing stools in the patient rooms. The renovation cost $121,700.
Both Kosnik and Espinosa say that empowering the staff and recognizing their efforts fueled Overlook's comeback.
In addition, tracking patient movement allows staff to take action when expectations are not being met. If, for example, radiology cycle time exceeds 30 minutes, technicians can pull someone from another area or call in a technician from home.