Improving Patient Satisfaction in the Clinic Setting

  We all recognize that patient satisfaction is aimed at identifying ways you can improve your clinical practice. This should translate into better care and happier patients. A patient satisfaction survey also shows your staff and the community that your wound clinic/hospital is interested in quality and looking for ways to improve. Today’s marketplace is demanding data on patient satisfaction to be used to empower consumers.

  There are three primary reasons many healthcare professionals remain skeptical about patient satisfaction surveys; the belief that the data is unreliable, the results do not justify the costs or they just do not believe in surveys. Even though these surveys will demonstrate that a practice is interested in quality and in doing things better. I personally believe that success starts with cultivating an environment that embraces quality improvement. This starts with each and every employee understanding that this is part of your clinic’s vision, values and goals. This concept must be demonstrated from the top down. In other words, lead by example. Also, remember survey results are a snapshot of how your patients view your clinic at that time.

  Let’s take a look at the three primary areas where you need to focus;

  1) Provide quality healthcare.
  2) Make care accessible.
  3) Treat patients with courtesy and respect.

  Ask yourself, is your patient satisfied with his or her healthcare? You can generally detect on your initial assessment and subsequent visits whether a patient is satisfied with the care they have or are receiving. If you suspect there is some dissatisfaction begin to ask questions immediately, do not wait for the problem to escalate. There may be issues that are completely out of your control, so discuss them. Many of these problems become very miniscule with a good listener.

  Secondly, do we make care accessible? I feel pretty certain we would all answer yes to this question. Hence the first things I ask you to do is place yourself in your “patient’s shoes” just for one visit. I am honestly recommending that you make an appointment with your patients and follow through with the process. The insight you gain will be very impactive. The National Committee for Quality Assurance indicates that the primary reason a patient expresses dissatisfaction is “wait time”. I recommend a very careful assessment of patient wait time. Is it your scheduling system; is it the promptness of the healthcare provider’s arrival, or too little space, too many patients? These are all things we may be able to assess, adjust, and improve. If the issue is the patient’s transportation that may be something more difficult to address. I distinctly remember a specific patient who traveled by public handicapped transportation. She lived outside of the city hence her home pick-up time was prior to 10 AM and the pick-up time at the clinic to return home was 2 PM. Her weekly wound clinic appointment times were going to consume nearly an entire day. This took effort on our part to explain the process, encourage her to pack a lunch/snacks, and find a comfortable and reasonable place for her to wait. We went the extra mile to set the expectations up front, before this became a wedge of disappointment that would hinder our success.

  Lastly, are the MD’s and staff caring and compassionate? We certainly believe all of our colleagues are compassionate and caring, but we all can have “off” days. My suggestion is approach this as a team, if one of your team is having an “off” day, step to the plate and offer assistance. If you really have a staff member who is not measuring up to your goals, visions, and values you need to make the difficult discussion and set a plan in motion to rectify the situation.

  The piece of the puzzle that is so very important in this process is patient accountability. Patient non-compliance accounts for 10% of all hospital admissions and costs Medicare an estimated $200 billion per year. The well-known unhealthy behaviors of smoking, poor diet, and lack of exercise are the major contributing factors to diabetes, obesity and, cardiovascular disease. At least one of these diagnoses is seen in nearly every wound clinic patient. As payment shifts from production-based to performance-based there is a clear motivation to providers to make certain patients are complying with the prescribed treatments and participating in their healthcare to improve outcomes.

  Patient, family, and significant other education is clearly a path to patient compliance. It is also very important to have the patient fully understand the prescribed treatments, understand the expectations of the wound clinic staff, understand his/her responsibilities, as well as the consequences of non-compliance. Many times this requires constant encouragement from the wound clinic staff and family. I have also personally found that other patients experiencing similar issues may have the most impact in helping a patient and his or her family work through issues. I recommend using your detective skills and finding the family members that possess the most influence over your patient. This individual(s) can help with modifying unhealthy behavior and supporting compliance. This is all part of the concept of patient engagement:

  1) Self-care: Have the patient do as much quality care for themselves as possible.
  2) Guidelines rule: Help patients ask for the care they need.
  3) Veto rule: Help your patient’s say “no” to care that is not in their best interest.

  Your patient should look forward to his or her visit to the clinic. Is the wound clinic environment you and your staff create a warm, welcoming and enjoyable place to visit? Does your patient feel welcome? Does your patient believe that during his or her visit they are the center of attention? If the answer is no, ask yourself, WHY? Then set out to make adjustments.

  It is also very important to take a more holistic approach to patient care. As a healthcare provider today we should be concerned with modifying unhealthy behaviors. Our population’s fitness is dropping and our waistline is expanding. How many of us recommend a gradual exercise or walking program as part of our prescribed plan of care. If every one of our wound clinic patients would strive for 20 minutes of exercise 3 times per week, we would all see a significant improvement in cardiovascular function and improved circulation. It is very simple behavior modification that has tremendous impact for our wounded population. The patient will very quickly realize you care about their well-being. I attended a seminar this past September that involved a one hour session of patients sharing their experiences in a wound care clinic. Each patient individually spoke about the modifications they made to unhealthy behaviors. The primary focus was diet and exercise. Each and every patient emphasized their improved health, their lifestyle changes, and the debt of gratitude they owe to the wound clinic staff. That is patient loyalty.

  Patient must be encouraged within their own abilities to make better decisions about their health. There are multiple resources that indicate that providing incentives for patients to take better care of themselves can be very effective.

  What we are all aiming to do is improve patient loyalty. It is a patient centered approach to quality management. Remember from the patient’s perspective it is these points that been identified as most important:

  1) Waiting time.
  2) Waiting room and procedure room cleanliness.
  3) Thoroughness of the medical exam.
  4) Patient/Physician communication and interaction.
  5) Staff courtesy and compassion.
  6) Ease of getting an appointment and referrals.
  7) Billing procedures and personnel.
  8) Facility access and parking.

  As I review this list my reaction may be that I can certainly not control all of these factors. I am one small part of this hospital complex. You may be right, but it is all about setting patient’s expectations. If you only remember one tiny tidbit of this article, please let it be this: what is your patient’s perspective of your clinic?

Pamela G. Unger, PT, CWS is VP Medical Affairs and Clinical Education at Celleration, Inc in Eden Priaire, MN. For questions or comments email her at punger@celleration.com.

References

1. SF Jenks, MV Williams, EA Coleman, “Rehospitalizations Among Patients in the Medicare-Fee-for Service Program, NEMJ, April 2, 2009. 360(14): 1418-28.

2. White, Brandi, Measuring Patient Satisfaction: How to do it and Why Bother. Fam Pract Manag. 1999 Jan; 691):40-44.

3. www.ncqa.org

4. www.cms.gov/HospitalQualityINIT

5. Hospital Consumer Association of Healthcare Providers and Systems