Daily monitoring of patient satisfaction hits a stumbling block

Improving the patient experience has been a long-standing priority for administrators at OSF HealthCare. Some of its 11 acute-care facilities had even won awards for this important marker of high-quality care.

In its efforts to continue boosting its patient satisfaction scores, the Peoria, Ill.-based health system in 2014 kicked off a bold new strategy. Its leadership began making daily rounds to gauge their patients' experiences.

Leadership rounding “is a way for our leaders to make connections with our patients and identify their problems while they're here, instead of hearing about bad food or room cleanliness through a mail survey six weeks later,” said Brandy Fisher, Vice President of Clinical Support Services at OSF HealthCare.

The idea behind leadership rounding was to have hospital administrators attempt a visit with every patient in the building during a set time on weekday mornings. The patient could use this opportunity to voice concerns about staff responsiveness, room cleanliness, their care plan or whatever else might be on their minds.

Previously, OSF HealthCare had been gathering patient satisfaction data using the traditional Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey sent to discharged patients through the mail. The system wanted to go a step further and address patients' issues in real-time, before they got a chance to grow into loud, booming complaints.

A lot is at stake for systems like OSF HealthCare. Poor patient satisfaction scores can lead to penalties from Medicare since they account for a quarter of a hospital's rewards or penalties under the government's value-based purchasing program.

Dissatisfied patients can also take a toll on a hospital's reputation. Patients now have the instant soapbox provided by the internet and social media. CMS now also publishes “star” ratings based on patient satisfaction scores.

Hospital leaders have long recognized the importance of patient satisfaction. Over half (52%) of respondents from U.S. hospitals ranked patient experience or satisfaction one of their organization's top three priorities for the next few years, according to a 2015 survey by the Beryl Institute.

OSF HealthCare, like a number of leading systems seeking to transform their internal processes to foster higher quality care, has turned to real-time monitoring of patients' experiences as a better way to tackle complaints as they occur. That's not possible with the traditional post-discharge surveys.

OSF launched its initiative at its St. Francis Medical Center in the summer of 2014. It was expanded to the system's other hospitals over the next several months.

The same hour each day was blocked out in the calendars of administrators—everyone from supervisors to hospital presidents—for rounding duties. Despite some initial pushback, they began to see the value of the extra work.

At first, some leaders resented tacking another duty onto their jam-packed days. The worried their rounds would interrupt ongoing patient care. But administrators quickly saw the value of connecting with patients face-to-face through rounding. Also, doctors and nurses appreciated leadership passing on positive feedback gathered from patients.

As leaders warmed up to the new initiative, Fisher and her colleagues realized the need for a technology upgrade. The pen-and-paper process meant senior leaders or their aides had to later input the data into a computer, manually look for trends, and then communicate patient concerns to other departments by phone.

“We needed a technology that would make the rounding process much more efficient, as well as allow us to understand the feedback our patients were giving us about how could we overall improve the patient experience,” said Fisher. “A paper process doesn't support an easy way to do all that.”

Providence Health & Services in the Pacific Northwest faced a similar situation when it sought out a better way to boost patient satisfaction scores. It was setting annual improvement goals at each of its 32 hospitals, but its scores had stagnated for several years.

Like OSF, Providence recognized its paper surveys slowed down the collection of patient experience data. Providence had the additional complication of being a large, sprawling health system operating across five states.

“In an organization as large as Providence, we want a standard solution and not have three different solutions that we're trying to support at once,” said Nancy Yates, Chief Nurse Informatics Officer at Providence Health & Services. “Having a standard solution allows us to benchmark our performance across the enterprise.”

So in 2012, the health system implemented nurse leader rounds in inpatient settings and emergency departments as a new standardized approach to improving the patient experience. Questions asked of patients during rounds covered areas like staff responsiveness, pain, medications, and plan of care.

A subsequent analysis of its HCAHPS survey results administered by Press Ganey revealed implementation of nurse leader rounds at Providence led directly to increased levels of patient satisfaction in both inpatient and emergency settings.

But while it had found a systemwide solution that appeared to work, a nagging problem remained—the pen-and-paper method used at each site. It killed valuable time and made finding trends in the data difficult.

“As we've done the rollout, we found that there is variation when you're using pen and paper, and not everyone does it the same way,” said Yates. “It's also a very cumbersome process to input the data into an Excel spreadsheet, which gets sent to someone else to aggregate and collate the results.”

Patient satisfaction scores were finally moving in the right direction. But the inefficiencies still dogged the process and delayed feedback. Providence needed a better tool to measure patient experience and engagement in real-time.

In part three, of the numerous solutions for patient monitoring, which works best?

Meeri Kim is a freelance healthcare writer based in Los Angeles.