|Reviewing progress: Karen Moore, front, and Julie Stockburger check Top Box scores posted in PVH's Women's Care Unit.
|Inpatient satisfaction scores at PVH and MCR have collectively hovered near the 82 percent mark for the last three years. The 2011 goal was 80 percent.
Medical Center of the Rockies and Poudre Valley Hospital received the good news earlier this month that each was recognized nationally for exceeding patient expectations.
In particular, MCR was named overall best performer for the fifth year in a row by Avatar International. The achievement signifies that the hospital is in the top 5 percent of patient satisfaction for U.S. hospitals.
MCR and PVH rely on the independent Avatar to provide evidence-based measurements of patient satisfaction. Avatar is the nation's top surveyor of patient satisfaction, providing services to 500 hospitals and health systems.
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Survey scores from Hospital Consumer Assessment of Healthcare Providers and Systems, commonly referred to as HCAHPS, are also used. HCAHPS relies on a standardized publicly reported survey of patients' perspectives of care in specific hospitals, including PVH and MCR. Survey results cover broader rather than the more specific patient satisfaction issues tracked by Avatar.
Avatar mails surveys to almost every former patient. Patient feedback on the surveys provides a scientifically valid look at the success of 95 MCR and PVH departments and work units. This covers the wide spectrum of patient interaction with clinical caregivers and such ancillary services as housekeeping, parking and billing. Survey results are shared on VIC with all employees and with Colorado Health Medical Group, formerly Poudre Valley Medical Group.
The road to excellence in patient satisfaction has been a long one full of initiatives, campaigns, trial efforts, successes, and passion, always passion for patient satisfaction.
But, regardless of the awards, the journey is not over. In fact, no end is in sight. This is one of those inexorable journeys that will never cease -- it will only continue to become more refined and more scientifically based.
In the latest iteration, hospital departments will have unique benchmarks, a departure from the former method that set a single benchmark for all facilities.
"This is more robust," said Ric Detlefsen, Quality Resources director. "It puts the onus on individual departments and work units to know what their goals are and develop and carry out action plans that will take them forward to the next color."
‘A clearer vision of what patients want'
Twenty years ago the level of patient satisfaction was often determined by personal anecdotes and occasional focus groups, as well as by what clinicians believed patients considered to be excellence in patient care. At best, the process of delineating excellent patient satisfaction from bad boiled down educated guesses.
Then came stiffer competition in the northern Colorado region and with it the need to track patient satisfaction more closely and use the information to develop plans that actively make improvements.
Now, in this era of national health-care reform, patient satisfaction hugely impacts finances through hospital visits and reimbursement legislation. In the future, reimbursement will be based in part on a hospital's HCAHPS scores.
Donna Poduska, PVH's chief nursing officer, was among the decision-makers who directed the hospital into Avatar's arms in the late 1990s. MCR followed suit after opening in 2007.
"Prior to Avatar, we often assumed we knew what patients believed was patient care excellence," Poduska said. "But, in fact, sometimes what we believed didn't line up at all with what patients expected. Now we have a clearer vision of what patients want."
Barb Ochsner, clinical director of MCR's Resource Services, said survey results can sharply slice through complex issues to the good and the bad.
"One thing I like is that survey results can validate the success of improvements that we made," she said. "At the same time we can also target specific areas that need improvements. That helps drive what we do."
About five years ago the organization gave a name-Top Box-to its initiative to improve patient satisfaction scores. Employees in departments and work units that lead the way in Top Box scores have the self-satisfaction of knowing they are among the best, but they also have the honor of temporarily displaying the program's mascot: a statue of three penguins.
Why penguins? The birds have the reputation for working together to make life better for all, a brand of team spirit appropriate for health care workers, too.
Top Box designation for a department or work unit is determined by the percentage of survey questions answered with "strongly agree," the top selection, or top box, out of five possible answers.
In the early days of surveying patients, scores wallowed in the 40-percent realm. But each year, as one initiative after another was put in place to enhance patient satisfaction, the organization upped the system-wide goal. The 2011 goal was 80 percent, which was achieved.
Moving the bar
About two years ago organizations across the country began honing the way they monitor and act upon survey scores. The new thrust made more sense by bringing everything to the level of individual departments and work units, where the closest contact is made with patients.
MCR and PVH recently moved in that direction, too. A month ago the Top Box reporting format was revised from presenting solely numbers-percentages that reflect patient satisfaction-to a new method that includes, among other changes, color coding.
Until the new method was launched, the goal was for the entire organization to achieve at least 80 percent patient satisfaction on the "strongly agree" answer. Now, each department and every work unit related to patient care have a Top Box benchmark specifically for their own areas.
Since each area now has a more focused benchmark, the new goal is for departments and work units to advance from one color to the next-that is, from red to yellow, yellow to green, then to blue, where the goal is to sustain patient satisfaction so scores remain in the blue.
Karen Moore, clinical nurse specialist in PVH's Women and Family Care Department, said the new method refocused the spotlight.
"It used to be that we'd gather in Donna's (Poduska) office and sit around a table and look at the improvement matrix of Top Box numbers for the individual hospital nursing department and health system, and decide what to do to get the best bang for our dollar. We would identify a patient question where results needed to be improved, and that's what the whole staff worked on. Now our efforts are closer to the bed side. That's a good thing."
The techniques for deploying Top Box information remain the same.
Each month results are posted on VIC's news page (look for the twirling penguins in the left column). Because of the time needed to gather patient feedback, survey results typically lag behind three to four months from when a patient was treated. Currently, VIC shows results from inpatients and outpatients treated in March.
Most departments discuss survey results during staff meetings and post scores on bulletin boards in staff lounges. In PVH's Women's Care Unit, for instance, the unit's quality indicators are kept on a board so staff members can see as a reminder where the unit stands on patient satisfaction.
Julie Stockburger, PVH Women's Care Unit's patient care coordinator who updates the board, said employees develop action plans to address areas where the most improvements are needed.
One recent opportunity, she said, involved improving the responsiveness to answering patient calls and requests.
The action plan called for more staff interaction with patients. Unit assistants and housekeepers began restocking supplies and performing other duties more often in the patient's room to offer more human contact. The unit's call system was enhanced so patient requests are answered sooner. Nurses have increased their contacts with patients while unit and department leaders round more to visit patients.
The unit's Top Box score jumped to 82.4 percent, putting it into the blue, the color considered the best on the new Top Box scoring method.
"We have taken ownership of patient satisfaction by doing what we can do to be more proactive," Stockburger said. "This has helped us take care of a patient's needs often before the patient can even verbalize the need."
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