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Get a high five for your patient care


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Patient satisfaction scores fell to 33% at CHRISTUS Hospital-St. Mary in Port Arthur, TX, in 2005. It was a number that didn't sit well with the organization's nursing directors and managers.

"We immediately formed a patient satisfaction team to determine what lengths we were going to go in order to make our patients happy," says Jane Rawls, RN, MEd, the CNO at CHRISTUS, a 661-bed hospital. "We were on a limited budget and knew we could do this cost-effectively by changing mind-sets, attitudes, and overall culture."

The patient satisfaction team comprised Rawls, nursing directors, unit managers, and Tami Vanderheiden, RN, guest relations manager. The group met daily to review issues on patient units and implement initiatives to address patient needs. Several changes, including giving managers and directors ownership of their units, satisfaction ratings, emerged from the meetings.

In just one year, these changes boosted patient satisfaction scores above the 90th percentile at St. Mary's.

Round to hear needs

The team began its journey toward improving patient satisfaction scores by having unit managers conduct daily patient rounds. Rounding enabled staff members to hear firsthand what patients wanted in terms of care, as well as patients' perception of the care they were receiving. When managers entered a patient's room, they would identify themselves as the manager of the unit and state their name, how long they'd been at CHRISTUS, and their clinical experience. Then they would hand the patient their business card and say, "If you need anything, please contact me."

"It truly is about empowering the patient, giving them the person to talk directly to in order to make their problems go away," says Rawls. "And staff nurses were excited that managers were rounding on patients every day. The fear for the staff was that they were going to be held solely responsible for increasing patient satisfaction scores and management wouldn't have any accountability piece to it."

Rate quality of care

During the rounding, the managers wanted to gauge the level of patient satisfaction. Thus, they created a scoring system called 5-on-the-Board.

To use the system, a manager would ask a patient to rate his or her care on a scale of 1–5 (with 5 being "very good"). The manager would write the patient's response on a dry erase board located in the room. He or she would then explain that the board is where the patient's care was rated and note that the number may be adjusted if service issues occurred.

If the patient gave a score lower than 5, the manager would ask, "What can I do to improve?" and he or she, along with staff nurses, would take action. For example, if a patient gave a score of 4 because he or she disliked peas and had been given peas for the past three days, the manager would immediately call the director of food service from the patient's room to resolve the problem.

"Making the phone call from the patient's room had a huge impact because they knew they were being cared for and we were immediately resolving their concerns," says Vanderheiden.

Shop mystery style

Even though the hospital's patient satisfaction scores were rising, "I've learned that after 12 months, things start to drop off, and you don't make rounds as you should," says Rawls. Therefore, a mystery shopper team was formed.

The mystery shopper team had a representative from every department in the hospital (e.g., HR, business services, and nursing). Before the mystery shoppers made patient rounds, Rawls and Vanderheiden would review patient surveys to drill down on problem areas. For example, if a patient complained of being served cold food, the mystery shopper would go to the particular unit identified and observe how quickly the food trays were being delivered to the floor and to the patient and where the trays were set up in the patient's room. After the food was delivered, the mystery shoppers would go into the patient's room and ask the following four questions:

1. I see you have a 5 on the board. Who did that?

2. Have you met your manager today?

3. Has your manager made rounds every day?

4. Do you know what that 5 on the dry erase board means?

Rawls would receive private feedback from the mystery shoppers on what they observed and heard from the patient. Units whose staff members were successful with their scores and communicated well with patients received small rewards.

Reap the results

The time quickly came when managers and staff nurses did not receive anything below a score of 5. The high ratings led to patient satisfaction scores consistently above 90% starting in 2006 at CHRISTUS Hospital-St. Mary. Along with happier patients, the rating brought other benefits to the organization.

CHRISTUS Health System includes more than 40 facilities, and St. Mary's has achieved the highest patient satisfaction ratings for the past two years thanks to its initiatives. Management shared its program with its sister hospitals and submitted an abstract for the system's Touchstone award—an award signifying that CHRISTUS facilities strive for excellence.

All CHRISTUS facilities are eligible to submit best practices, which are evaluated on clinical quality, service quality, business literacy, value to the community, and spirit exchange.

"We were up against some heavy competition—it's like [a] Grammy or Oscar Award," says Rawls.

But their hard work on raising patient satisfaction scores paid off. CHRISTUS Hospital-St. Mary received a Touchstone award for its 5-on-the-Board program.

Don't stop

Although the hospital is at the top of the charts for patient satisfaction, its staff members are not stopping the enthusiasm and support. To keep patient satisfaction initiatives at the forefront, an interdisciplinary satisfaction team was created that involves directors from every department within the organization. The team meets weekly to assess patient needs and quality care.

"This brought teamwork to the entire management team because you don't have nursing working with just nursing—everyone is working together and identifying ways to improve care," says Rawls.