In many instances, a patient’s first exposure to a hospital is the emergency department. If that experience is positive, the patient and his family also have a favorable impression of the hospital. If not, it can lead to a bevy of negative consequences, including poor patient satisfaction scores, reduced reimbursement, lower staff morale, and increased risk of malpractice suits.
As a provider, you have the opportunity to make an impact on hospital performance and patient satisfaction by not only providing high-quality clinical care but also by focusing on communicating clearly and compassionately.
Quality of Care Essential, But So Is Communication, Compassion
Providers often emphasize the quality of care as the sole metric for patient satisfaction. While several studies have demonstrated a clear relationship between patient satisfaction and the quality of care, that alone is insufficient to ensure patients and their families leave the ED feeling good about the treatment they received.
Effective communication accompanied by compassionate care fosters a healthy provider-patient relationship and engenders trust that can lead to better outcomes, both physiologically and psychologically.
To paraphrase an old adage, “Patients don’t care how much you know until they know how much you care."
Why Patient Satisfaction Is Important
Because CMS links patient satisfaction scores through HCAHPS to reimbursement, a hospital's ability to stay open and provide medical services for the community depends on improving the patient experience.
Despite the possible limitations of current survey methodologies, they are an integral part of the daily practice of emergency medicine, and there is no downside to having good scores or working to improve the ones you have.
That is why you should regard every person who comes to the ED much the same as a restaurant or retail business treats its patrons — as customers, not just patients. Acknowledging the patient-customer paradigm helps ensure we uphold their right to personalized service and, hopefully, meet (or exceed) their expectations.
Contributing Factors to Poor Patient Satisfaction
The ED faces some unique challenges when it comes to improving patient satisfaction:
- Lack of an established provider patient relationship;
- Long wait times due to high volume and ED overcrowding;
- Patient volume increases while resources to manage remain the same;
- Deprioritization of low acuity patients, who make up 25-45 percent of ED visits;
- Communication issues, such as failure to inform patients about wait times, inadequate explanations of diagnoses and test results, when to resume normal activities, and when to return to the ED;
- Provider attitudes that emphasize the quality of care rather than building rapport.
If allowed to persist, these factors can multiply until the community holds a negative opinion of the ED and hospital, leading to loss of market share.
Patient Satisfaction and Malpractice Risk
Studies show that the risk of a malpractice suit is related to patients’ dissatisfaction with their providers’ ability to establish rapport, administer care and treatment consistent with expectations, and communicate effectively. Providers who were frequently sued were most likely to be seen as hurried, uninterested, and unwilling to listen and answer questions.
When malpractice attorneys were asked to give the primary reason the patient pursued litigation, they reported that more than 80 percent were due to communication issues, 35 percent to provider attitudes, and another 35 percent to failure in communication.
Conversely, good customer satisfaction results in fewer lawsuits and reduces other risk management issues. Anger, not injury, triggers most claims; empathy and good interpersonal skills are its antidotes.
Benefits to Improved Patient Satisfaction
Several benefits accompany improved patient satisfaction:
Patient satisfaction leads to staff satisfaction. Good customer satisfaction creates an environment the staff enjoys, resulting in higher morale and less turnover. It is a virtuous cycle: improved staff satisfaction further improves patient satisfaction within the health care system.
Patient satisfaction improves financial growth. Positive customer satisfaction and excellent care have the potential to produce a customer who is likely to remain loyal to that hospital long-term.
Statistical data shows a clear relationship between hospital profitability and customer satisfaction. Press Ganey estimates that improving patient satisfaction scores from fair/good to good/very good equal $2.3 million in annual revenue from repeat customers.
Better patient compliance. Patients are more likely to comply favorably to instructions, which leads to a better response to treatment, improved safety, and lower readmission rates.
How to Improve Patient Satisfaction
Since, as providers, we are limited in the time we have available to spend with individual patients, how do we ensure quality interactions with patients and their families? By following these patient-centered communication techniques during the three phases of treatment:
Phase 1: Initial Evaluation
- Greet patient formally and smile. Apologize for the wait and acknowledge other people in the room.
- Make real eye contact. By doing this, patients perceive you have spent more time with them.
- Wear your name tag. Proper dress communicates professionalism.
- Introduce yourself. Shake hands, sit down, and ask, “What can I help you with today?” Studies show sitting down, even for a brief period, improves patient perception of time spent with them.
- Listen empathetically. Patients need to tell their story so allow them to speak with minimal interruption for one minute. (Studies show the patient usually talks for an average of 18 seconds before the provider interrupts.)
- Appear unrushed, even if you are.
- Try to establish what the patient’s expectations are. Set up realistic expectations for the visit. You will be more likely to have a happy patient if you achieve realistic mutual expectations.
- Tell the patient what is going to happen and how much time it will take. Overestimate time and outline the plan clearly.
- Perform at least one non-medical gesture (e.g., give the patient a pillow or blanket, adjust the bed, etc.).
- Remember that nonverbal cues and tone are about 80 to 85 percent of communication.
Phase 2: Middle of Visit
The team should periodically inform, update, explain, and control pain.
Phase 3: Conclusion of Visit
- Educate the patient regarding your initial impression and treatment plan. Include limitations in the diagnosis to eliminate the patient’s expectation of certainty. Give the patient and family members an opportunity to ask questions.
- Provide appropriate discharge instructions, for the following reasons:
- Failure to provide discharge instructions and appropriate follow-up with a consultant or PCP are common causes of lawsuits;
- Written discharge instructions should be action specific (what, when, where) and time specific (not “see your doctor if not better”). Always tell them to return if their condition worsens or any new symptoms develop;
- Although the task of discussing the discharge instructions may be delegated to nurses, the provider is responsible for providing specific and general instructions to the patient and answering any questions;
- Explain uncertainty in the diagnosis. The patient’s medical condition may get worse or be misdiagnosed. The discharge instructions should act as a safety net to deal with this possibility.
Providing excellent clinical care is the first order of business when patients visit the ED. But don't stop there. To improve patient satisfaction, communicate effectively and act compassionately.
Having a high-quality interaction with ED doctors and staff leaves the patient with a better impression of the ED and hospital, increases survey scores, minimizes malpractice risk, and fosters a relationship of trust that can lead to your hospital becoming the place patients go to for their health care needs for a long time to come.