How to Improve Patient Satisfaction

SINCE THE Centers for Medicare and Medicaid Services’ implementation of pay-for-performance programs and financial incentives, increasing patient satisfaction has become a main priority among healthcare providers. But, avoiding financial penalties for falling below in the Hospital Consumer Assessment of Healthcare Providers and Systems qualityof-service survey is only one benefit to boosting patient satisfaction ratings. Healthcare providers also stand to benefit from an improved reputation, reduced malpractice costs and being chosen by patients over other facilities.

How can facilities improve patient satisfaction? Aside from providing customer service training to staff or hiring patient experience consultants, some relatively simple techniques can put a smile on patients’ faces and keep them coming back.

Understand What Patients Want

Recognizing patients have choices for their care, then-Cleveland Clinic Health System’s Chief Experience Officer James Merlino, MD, hired an outside firm to address the health system’s low patient satisfaction scores, which ranked among the lowest for physician communication with patients. The firm found patients’ top concerns were far from what staff perceived (Table):¹

1) Respect. According to Dr. Merlino, “Respect is important to patients because they want providers to treat them like individuals and engage with them personally,” which goes against everything providers have learned, since they are taught to be objective and unemotional. Yet, having a personal experience with their doctors and nurses makes patients feel providers will make fewer mistakes.

2) Communication between caregivers. Patients use proxy measures (indirect measures of desired outcomes) such as communication between physicians and nurses to assess the type of care they receive, says Dr. Merlino. For example, a doctor comes into a patient’s room to speak with the patient, and later a nurse is asked by the patient to repeat what the doctor said, but the nurse doesn’t know. Such an unmet expectation, he explains, is perceived as a lack of communication between the doctor and nurse, causing some patients to believe they are receiving substandard care.

3) Happy providers. Providers who appear happy are perceived by patients as more approachable. Patients are less likely to engage or ask questions of doctors or nurses who appear to be angry or in a hurry because patients don’t want to contribute to whatever the providers are dealing with or make the providers more angry.

Treat Patients with Care and Concern

The best way providers can give patients what they want is by treating them with care and concern. Here are some suggestions for how to accomplish just that:

• Smile and say hello when patients arrive. People want to be acknowledged, so this should be an expectation by all staff.²
• Spend time with patients. Even if visits are shorter than what patients expect, a study found that “perceived” visit lengths create the highest satisfaction levels. The study also found patients’ expectations of visit lengths predicted their satisfaction.³
• Sit down during the visit. One study found 52 percent of patients want their doctor to be seated versus 8 percent who want their doctor to stand and 40 percent who don’t care. The study also found sitting translates into a perception of the visit lasting nearly 25 percent longer.³
• Dress the part. A review of clothing for healthcare personnel found patients express preferences for certain types of attire, including a white coat and no jeans.³
• Be an expert communicator. This can be accomplished by 1) using patients’ names at least once during each conversation to emphasize they are viewed as individuals; 2) listening to patients without interrupting them, and looking for cues that may indicate they are not satisfied or are concerned about something; 3) expressing empathy by observing patients’ communication style and responding in a manner that makes them feel comfortable;² and 4) meeting patients’ expectations for why they came to the appointment, including explaining why symptoms are occurring and what is causing them (patients are looking for answers), and providing guidance on the possible length of the condition and outcome (if possible).³

Embrace Technology

With more than 79 percent of the U.S. population using social media,⁴ healthcare personnel have an opportunity for two-way communication and interaction with patients. Providers can use social media platforms to post health education videos, share new and relevant studies and statistics, answer general questions from patients, and advertise and promote upcoming events.

Online patient portals are another way patients prefer to access personal health information and communicate with their physicians. These allow patients to view notes from office visits, lab results and lists of medications and immunizations. And, most portals allow patients to email physicians or nurses, request prescription refills, schedule appointments, complete medical forms, read educational material and make payments.⁵

Similar to patient portals are smartphone apps. Known as mHealth, these apps are designed to ease clinical communication between providers and patients and allow for 24/7 management of patients’ conditions along with the ability to personalize healthcare with patients. A few examples are:⁶

• AirStrip, a mobile, interoperable platform that allows care coordination between multiple devices and multiple care settings;
• Ambulatory EHR, which allows providers to access complete web charts, giving them instant access to patient records across healthcare organizations on a single mobile device; and
• MyChart, which allows patients to download health data from previous in-office visits, including test results, immunizations, medication and health conditions indicated by a provider.

Create a ‘Halo Effect’

What all this comes down to, says Michael Solomon, a customer service consultant, is creating an overall experience of caring that translates into a better individual assessment of the facility. In essence, this means leaving a generally positive impression even if, for example, wait times are long and physician visits are too short. This can be accomplished, Solomon explains, with these eight tips:⁷

1) Not giving off cues of indifference and caring such as failing to make eye contact with patients, or talking about non-work-related topics such as vacations;

2) Experiencing care the way patients do such as parking where patients park to see how easy it is or isn’t to get into the front door on crutches, and taking a tour of the facility to see if it’s easy or difficult to find where an appointment is located;

3) Ensuring employees understand the purpose of the practice and why their jobs exist such as “to create successful medical outcomes and hospitable human experiences for patients”;

4) Learning how to say “sorry,” without defensiveness or apathy, to resolve issues;

5) Teaching every employee how to handle patient complaints rather than having to find the “right” person to address them;

6) Striving to create a blame-free environment (if it happens once, it may be the employee’s fault, but if it happens twice, it is likely the fault of the system);

7) Understanding genuine warmth and smiles are of value; and 8) Benchmarking customer service on the best-in-service industries rather than just on other healthcare facilities.

Use Data to Put Patients First

When Dr. Merlino decided to tackle his facility’s patient satisfaction problem at Cleveland Clinic, he recognized that using patient satisfaction and outcome data was key. In his article “The Glaring Omission in Healthcare: Patient Satisfaction and Outcome Data,” Dr. Merlino talked about his experience at Toyota: “My Toyota maintenance guy sends me a customer satisfaction email automatically after each ‘clinical encounter’ with my cars. He asks me to rate the quality of the service he provided, as well as the quality of the outcome (Did we fix your problem?) and the cost effectiveness (Do you feel that our prices were fair, clearly explained beforehand and understandable?). Toyota corporate offices review these results in detail, and they hold those dealerships totally accountable, with consequences for bad numbers. You would think that the functionality of electronic medical records that cost millions of dollars could at least match my Toyota maintenance guy.”

Unfortunately, says Dr. Merlino, now serving as Cleveland Clinic’s first chief clinical transformation officer, the healthcare industry is different: “We’re afraid to ask the patient what they think of our services and treatments, and we veil that fear in false claims of complexity and scientific validity. In the words of Jack Nicholson in a Few Good Men, we can’t handle the truth, so we avoid the vulnerability.”¹