At Gundersen Lutheran Health System, the culprits behind a nighttime noise problem were not things that go bump in the night but rather things that go beep.
Small details, big impact
Providers find little things can make big difference in patient satisfaction
Specifically: infusion pumps. The service excellence department reached this conclusion in October 2008 after an employee spent several nights on numerous inpatient units listening to noises. The infusion pumps are always beeping and making funny noises, says Gale Kreibich, director of service excellence at Gundersen Lutheran, a 100 Top hospital in La Crosse, Wis.
While hospital staff cant stop the noise, they can warn patients. We found that by preparing patients for the infusion pump noise, they were less surprised by hearing it, especially during the quiet evening hours, Kreibich says.
To spread the word, the service excellence department included information about noise and infusion pumps in a monthly newsletter on patient satisfaction. In addition, nursing staff attended in-service meetings on patient satisfaction and noise.
The effort was worth it. The hospitals score on the nighttime noise question on the Hospital Consumer Assessment of Healthcare Providers and Systems, or HCAHPS, survey, increased. During the first quarter of 2009, 53.1% of patients said that the hospital was always quiet at night, up from 50.4% during the last quarter of 2008.
Gundersen isnt the only Wisconsin hospital focused on patients perceptions of quality care. Wisconsin ranked in seventh place in patient satisfaction in a new analysis from Thomson Reuters on hospitals performance on the HCAHPS survey.
Thomson Reuters, which produces the 100 Top Hospitals annual rankings, released the study exclusively to Modern Healthcare. The study ranked 50 states and Washington, D.C., based on the average performance of hospitals within a state on the HCAHPS survey. Thomson Reuters then grouped states into five quintiles based on how their performance compared with other states. (See map accompanying this story.)
The average score of each of 2,999 hospitals was calculated based on a composite score of the 10 survey items reported on the Hospital Compare Web site. Thomson Reuters used 2007 HCAHPS data.
Among the findings:
The Midwest performed well as a region. South Dakota (4th), Nebraska (6th), Wisconsin (7th) and Iowa (9th) scored in the top quintile. Minnesota (11th), Indiana (15th) and North Dakota (18th) scored in the second quintile.
The upper Northeast also did well. Maine (2nd), New Hampshire (3rd) and Vermont (5th) were ranked in the top quintile. Massachusetts (17th) scored in the second quintile.
The mid-Atlantic region did poorly. New Jersey (43rd), Maryland (44th), New York (46th) and Washington (49th) scored in the bottom quintile. Delaware (25th) scored in the third quintile.
Some large and urban states also did poorly. In addition to New York and New Jersey, California (47th) and Florida (50th) also scored in the bottom quintile. Pennsylvania (35th), Ohio (37th), Texas (38th) and Illinois (39th) scored in the fourth quintile.
Rural states did well, dominating the top quintile. Rankings were: Alabama (1st), Maine (2nd), New Hampshire (3rd), South Dakota (4th), Vermont (5th), Nebraska (6th), Wisconsin (7th), Utah (8th), Iowa (9th), and North Carolina (10th).
Experts familiar with the HCAHPS survey results arent surprised that predominately rural states did well in Thomson Reuters analysis. Why? Patients in small or rural communities are more likely to know their caregivers personally or to have seen them in the grocery store or in church or the PTA, notes Nancy Foster, vice president for quality and patient safety for the American Hospital Association, a partner in the Hospital Compare Web site.
Caregivers and patients who have at least seen each other around town are probably more comfortable talking to each other than those who havent, in Fosters opinion. Because many of the HCAHPS questions revolve around effective communication between caregiver and patient, hospitals in small communities are more likely than their peers in large metropolitan areas to score well, Foster says.
HCAHPS success in Minnesota and Wisconsin may go beyond the concentration of small-town hospitals: both states were early adopters of public reporting of facility-level data, notes Jean Chenoweth, senior vice president of performance improvement and the 100 Top Hospitals programs at Thomson Reuters.
California hospitals, which contend with many state-government regulations, may be at a disadvantage in HCAHPS performance, speculates Steve Moreau, president and CEO of San Antonio Community Hospital, Upland, Calif., which made the list of the 100 Top Hospitals published by Thomson Reuters. Executives can get bogged down in regulatory compliance, leaving less time to focus on business fundamentals, such as customer satisfaction, Moreau says.
Nonetheless, changes to improve HCAHPS scores dont have to be complicated or expensive. For example, Gundersens surgery department decided to check on patients waiting in an exam room every 10 minutes. Once staff members check on a patient, they add the time and their initials to a white board on the door of the exam room. The white board allows the staff to keep track of how long each patient has been waiting in a room. The check-ins last only a minute; usually the staff tells patients how much longer they will wait. The patients know they havent been forgotten, Kreibich says.
Employees at San Antonio Community Hospital also have found that simple measures can have a big impact on patients opinions about the hospital. For example, the hospitals 13 transporters are taught that they play an important role in soothing patients nerves because they are with patients during periods of high anxietysuch as when being wheeled to surgery.
Explains transporter Ian Donahue in a recent employee newsletter called the Fountain, I have held patients hands, hugged them, whatever it takes to be a calming influence and let them know I understand.
Also like Gundersen, San Antonio Community Hospital has focused on noise issues. Nurses have been taught to be vigilant about noise reduction, such as encouraging patients to wear earphones if they watch television at night. And the hospitals ongoing training and annual competency tests for nursing staff include material on noise and its impact on patients well-being and healing.
We have taken the position that if it matters to our patients, it needs to matter to us, Moreau says.
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