Monday, May 14, 2007

Top Ten ways to raise your Emergency Department Satisfaction scores

So you’re a Hospital CEO, Emergency Physician Director, or ED Manager. Your latest patient satisfaction scores are lower than your competitor Hospital across town and your in a panic. The results are in the newspaper. Your job is on the line. Try this Nurse’s tried and true top 10 list of how to raise your scores in a hurry. Get your staff on board, here is how.

10. Prescribe Tylenol and other OTC meds: Patients love it because it will mean that their health coverage might cover the cost (at least publicly funded plans will). What’s a little ink on a prescription pad if it moves you up a notch on the survey.
9. Make the Nurses Apologize: Remember, the customer is always right. No matter how dysfunctional and disruptive their behavior apologize if anything upsets them. Smoking in the bathroom, cussing at the Nurses, no problem. If the Nurses refuse have the supervisor apologize and offer the patient a free drink voucher in the cafateria for not meeting their expectations. You can deal with this obvious case of insubordination later.
8. “MR CEO Take down these walls”: Eliminate secure entrances and relax visiting policies. They are only there because those damm Nurses are control freaks. Let the family in and make ER care a group event. Now isn’t everyone happy. More people to practice your scripts on (see #1). Besides, the odds are in your favor you wont have a security event. At least during your tenure as CEO, Director, or Manager. Here is one facility that was not so lucky.
7. Don’t spend to much energy on those excluded from the survey: Quietly leak out who is excluded from the survey (most institutional and mental health patients, and transfered patients in case you are curious) so staff can direct their energies appropriately. Hey, even a demanding CEO knows that you can only kiss so much butt per shift. The key is kissing the right butts.
6. Valet parking: If cost is an issue, lay off your ER Techs, or if you feel bad about that just change their job description, have them put on a suit and park those cars.
5. Prescribe antibiotics for every cough and ear ache: Again, the customer is always right and we dont treat patients, we treat customers. They didn’t drive all this way to get told a viral illness will not benifit from antibiodics and to take Motrin, drink lots of fluids, avoid second hand smoke, and rest. No, give them an antibiotic. Who cares about the treatment guidelines, this one is not measured. They will get better regardless in a couple of days and no doubt will attribute it to the antibiotic. And give them the good stuff, Cipro, makes them feel special and gives you bonus points come survey time. Also good for many bioterrorism events.
4. Hire Travel Nurses: The best thing about Travel Nurses is there easy to get rid of. Yes they are expensive but so is orientation, training, benefits, continuing education, step raises, and all the other stuff that your staff nurses have come to expect. Travel Nurses are not interested in the politics, problems, and shortcomings of the institution, or patient advocacy. They will come to work and not complain, generally be nice, and do as they are told. If they dont, send them packing.
3. Minimize threatening patient education: Crutch walking, wound care instructions, fever control, all great stuff but don’t let those Nurses get to proactive in educating patients. You can loose survey points if some Nurse talks to much about the dangers of smoking, obesity, shaking your child, or any other threatening subject. If the Nurses don’t comply limit their ability to give instructions by eliminating those handouts or use a electronic record that gives instruction control to the Doctor (like Tsystem). After all, Doctor does know best.
2. Provider is Triage: Replace your Triage Nurse with a Midlevel Provider. Your Midlevel can treat and street in a 1 minute Triage exam most of your common complaints as long as they do not engage in any meaningful conversation and follow items 10, 7, 5, and 3 as above. The Nurse, should you choose to keep one in Triage, can stand behind the Provider and quietly scribe the notes. You can call it "Team Triage" and tell them how importnat they are to the "Team". You’ll need a good generic checklist type H&P intake form (I recommend Tsystem or equivalent). The more complex patients will be assigned to the ER for the MD to see. But guess what, you can reduce your ER’s Door To Provider time to nearly zero on all patients by having your PA scribble down some preliminary orders before handing the patient over. Who cares if they ever get done. This is chart buffing at its finest.
1. Scripting to the Test: Teach your staff to memorize the test questions that patients get on their survey so you can have them script their conversation and prompt the patient to remember specifics when filling out their survey. “I am closing the curtain to protect your privacy Mr Jones” will score high on the question “The Nurse paid attention to my privacy needs? “Thank you for choosing Acme Medical Center for your care provider”. This one will get you a more likely to recommend. Not only does scripting guide the patient in completing their survey, it eliminates unnecessary Nurse conversation.

The sad part of this list is the items cited are becoming common practice at many Healthcare organizations.


ERnursey said...

definitely practiced at my facility. Most non medical people reading this list won't believe it, too bad it is true.

Max E Nurse said...

In general practice in the UK we have QOF (quality and outcomes framework) - Basically financial rewards for meeting set targets... This gets fairly equal abuse. The Government also states the money awarded is to improve pt care further. Good idea, nice car doc!!!


poody said...

oh so true these are some of the many reasons I will never ever work in a hospital again. My last job at the hospital was PACU.I had a patient write a letter to the CEO to complain about the treatment she received in the PACU.She said I tod her I would not give her any ice chips unless she opened her mouth! She also said I stood at the foot of the bed and told another nurse all about her! The nerve. I was actually called into the head nurse's office and repremanded and was instructed to write an apology to the lady. I did as instructed informing the bitch that I did say she would have ot open her mouth to get ice chips in there and the whole telling her business ot another nurse yeh that's called report! The CEO,DON,and the head nurse could not understand my indignation at such a request.

Dabeet said...

You people make me sick. This is what is wrong with healthcare. People that are sick do they not deserve to be treated like you would want to be treated?I know you all hate your jobs don't you?...because you are in the wrong field. Don't become a nurse because it pays is a calling to help people. Please quit today. IF you or a family entered your ED ..would you wait? would you have bed side registration? would people be nice to them? would you expedite there care? OF COURSE YOU WOULD >>>BUT BECAUSE ITS FOR YOU. But not for anyone else? And as for the PACU nurse would you like it if someone treated your love one like that? Calling a sick patient a bitch because you treated them poorly? Please quit tomorrow . You hate your jobs because you picked the wrong field. Customer Service is very simple: Streaming proceses
Accountability of people and compassion.
Cutomer service actually makes your job easier. You people however will never get it ...You are B team members and I am sure your employers and coworkers know it. They don't wan't to work with you as well. The saddest thing is that B team people ...Don't even know they are. Take care and I feel sorry for your patients and your managers. I would stop blogging on healthcare you are embarrassing yourself.

Dabeet said...

Well I will say thank you to ERMurse I never heard of the Studer Preformance Tool, Lets take a look at it shall we. In reading three of your Blogs and spending about 15 minutes or so I see that you are not only a B team member but you are exactly this:

Demonstrates little commitment to the work unit and the organization.

Does not communicate effectively about absences from work areas. Handles personal phone calls in a manner that interferes with work. Breaks last longer than allowed.( I am sure this is the case)

Does not achieve goals
Points out problems in a negative way
Positions leadership poorly
Master of We/They
Passive aggressive
Thinks they will outlast the leader
Says manager is the problem

Low....But I knew that already. Can u fix cars?

Lauren said...

Dabeet you have some anger issues and clearly have no experience working in these fields. You are the one who writes in these ridiculous, irrational, unfounded complaints the PACU nurse refers to.

The truth is patient satisfaction scores are sleezy, money driven, business like demands wrapped in 'what's better for the patient' lies that in many cases delays care, drives up healthcare costs, leads to increased turn over and burn out rates, causes you to endure the nurse Ratchets, leads to over prescribing of antibiotics and so bad little bugs like MRSA (not sure what that means, then maybe you should stop commenting on medical personell sites you ignorant fool) and over prescribing of narcotics contributing to why prescription drug abuse and overdoses has now risen over street drugs.

Thanks for playing but your not adequately equipped for this conversation!

DreamER said...

Great to have a forum to say it like you feel it. Nurses are human too! We say things worse than bitch sometimes. We have our frustrations! I found this blog while searching for information on pt satisfaction in ER. I will be doing research for my capstone project in this area! I am presently in a DNP program and would like to do something to increase quality of care on a genuine level and not for perks. I will receive my reward when I finally graduate with this degree. Your ideas will be greatly appreciated!

DreamER said...

PS.. I think you are quite brilliant Lauren!

Dabeet said...

Lauren, I have accomplished more in EM over 17 years than you ever will. People like you with your uncaring attitudes don't belong in healthcare. Hang another wrong med, yell at another patient, get written up again and find a job in the Fast Food industry where you belong. You and Murse married?

Anonymous said...

Ouch! .... to all the PA's out there! I understand your point and your ramblings... but I hope you don't show this kind of attitude at work!