Based on an annual sample of 65,000 people, the overall Customer Satisfaction Index created by ACSI was unchanged at 75.9 (out of 100) from the previous quarter, but results improved for all industries except health care and energy utilities. A sharp 5% drop in satisfaction for the hospital industry dragged on the overall index. The health care sector also fell 1.9% year-over-year. 

As lately as last November, Press Ganey showed continued increases in patient satisfaction.  These new results from the “American Customer Satisfaction” group may be a bellwether.  With so many hospitals being required to make “across the board” cuts in the past year, it does not come as a surprise that patients are less than satisfied with their care.

The leading hospitals, however, are not going for across the board cuts.  They are looking at more difficult, but more lasting and effective, transformations of clinical care.  Joan Moss, RN, MSN, Senior Vice President, Sg2, on June 21, 2010, commented on the blog (registration required to read entire posting) that the average proportion of costs that will need to be taken out by facilities may be 14% to 20% in order for facilities to reduce their direct costs to maintain current profitability at Medicare rates.   Using consultant-supplied full-time equivalent (FTE) ratios, Moss estimates that across-the-board workforce reductions might shave perhaps 5% off of the expense base. Over time, the headcount creeps back into the organization. Moss sees that what is different this time is the magnitude of the reductions faced and, therefore, how we must go about making them.

Moss outlined several approaches to making changes.  She included:

• imaging appropriateness criteria at Massachusetts General,
• fast-track asthma lounge at Highland Hospital in CA,
• remote monitoring of heart patients at Inova in VA, and
• repurposing an acute care facility at Henry Ford Health System (MI). 

Moss has it right, and documents leading edge hospitals.   The unintended consequences of across the board cuts includes creating disgruntled employees, and lower patient satisfaction scores.  Though it’s far more difficult to reengineer services rather than simply enforcing  an “everybody take 10% off their budget” directive, the results will be longer lasting.  These organizations will succeed in the long term under the health reform pay-for-performance standards.

I’m interested in hearing innovative approaches that hospitals have done to save costs. Feel free to post them here!

Highlights:

• Press Ganey calls “Response to concerns/complaints” the “Number 1 priority” for our nation’s hospitals.
• Highest correlated item between HCAHPS “Likelihood to recommend” was “staff worked together to care for you.”
• In April 2008, CMS began requiring all hospitals to publicly report HCAHPS data. Only seven months later (October), Press Ganey data showed inpatient satisfaction scores climbed more significantly than at any other point in the 24 year history of Press Ganey (see chart on page 2 of report). The study reports (p. 14), “In October 2008 alone, Press Ganey found a 1.53 percent jump in the overall rating of a hospital and a 1.96 percent increase in the likelihood to recommend a hospital to family and friends, both unprecedented increases in the more than two decades that such data has been collected. Typically, satisfaction follows seasonal ups and downs, with a modest upward trend being found in the past decade.”

What gets measured (and reported)…improves! Thoughts?

I read this article from CNN about hospital ED throughput, and thought of my earlier airline experience.

What if everyone who presents in the Emergency Department casually drops the name of their dear friend, the CEO, or their Uncle who is the Chair of the Board, or their Grandmother a major donor?  Imagine the stress on your staff!!!

Long waits in the ED have quality of care ramifications.  In April 2008, the Government Accountability Office, using 2006 data, found that the average waiting time nationally was twice that recommended for the most urgent cases. People who should have been treated in 1 to 14 minutes were being seen, on average, in 37 minutes.

Press Ganey found that the average ER waiting time last year was 4 hours, 2 minutes!  Yes, Press Ganey did report a slight improvement from the prior time period (2 minutes).  However, throughput was seen as an area which could significantly impact satisfaction. The report stated: “Improving the actual flow of patients through the hospital impacts the entire organization down to time spent in the emergency department. Most emergency department physicians and staff know that the emergency department is at the mercy of the inpatient capacity and census.”

The answer, like the airlines, is to develop a system for ensuring that patient throughput improves.  The answer is not as simple as saying to the staff “See patients quicker.”  It involves making sure that equipment is available when you need it, clean beds are available for transfer of ED patients, and even that patients might know that their EDs have capacity.

If you want to see an example of a hospital that alerts its community to approximate wait time in the Emergency Department, check out Mountain States Health Alliance, www.msha.com, which posts their wait times directly on the ED…and allows patients to see which of their hospitals EDs wait times are short.  The wait times are updated continuously.

By improving patient throughput, and allowing patients to know up front their waits, ED staff may be less likely targeted for name dropping…and allowed to spend more time taking care of patients.

It is interesting if you think about this as it relates to HCAHPS, because HCAHPS does not measure satisfaction with food.   This thought prompted the following question from an executive at the ACHE Congress in March, “If HCAHPS doesn’t care about food service, why should I be concerned about our food satisfaction scores?  I’d rather put our hospital’s resources into areas that are measured.”

My friend at Press Ganey, Deb Paller, Vice President Physician & Employee Business Unit shared the following analysis of items with the highest correlation with “Likelihood to Recommend.”

Food did not make the list. Deb confided, though, that it appears that at the extremes … very bad food, or excellent food, seems to have an impact.

More clarification was brought by an April/May 2009 article in the Journal of Healthcare Management entitled Patient Satisfaction: Focus on The Excellent (note ACHE password required) by Koichiro Otani, PhD, associate professor, Division of Public and Environmental Affairs, Indiana University–Purdue University, and several executives at BJC Healthcare.

The purpose of this study was to find out what influences adult patients to rate their overall experience as “excellent.” The study used patient satisfaction data collected from one major academic hospital and four community hospitals.

“The increasingly competitive nature of the healthcare market makes it more important than ever for healthcare organizations to focus on “excellent” patient satisfaction ratings,” write the authors.

Furthermore, attribute importance is a relative concept.  Yes, nursing care and staff care were stronger than food and room attributes.  But this does not mean that food and room are not important.  Food and room are very important attributes to improve and were statistically significant components.

“Considering the nature of a hospital stay, it makes sense for patients to put a higher value on staff and nursing care than on room and food,” said the authors.  I agree – people don’t come to hospitals for the food and courtesy.  However, providing for the basic human needs of food and kindness, in a clean environment, in the most stressful of situations if done exceptionally, says much to patients and doing it in a way that earns excellent marks can make a difference.  I talked to Dr. Otani about the study.  He said: “When competing hospitals provide the same level of quality nursing care and staff care, food or room have a strong potential to make a difference in overall satisfaction.”

Which brings me back to the comment that started this thought from Todd Linden.  If satisfaction with your staff and nursing care, food service, and room is Excellent…you’ve got a better shot at being rated Excellent overall … and staying one step ahead of your competition.

So, “does food matter?” I believe that it absolutely does.