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"[Fewer] problems with care make a hospital a more favorable place to work."

Measure for measure

Nationally, several health care consulting groups rate hospitals on patient satisfaction measures and other quality of care issues, including patient safety and clinical outcomes. Many hospitals hire the consulting firms to do a private survey to see how they match up against certain benchmarks as well as other facilities.

For example, Stanford Hospital and Clinics in Palo Alto, Calif., recently adopted the patient satisfaction tools of Lincoln, Neb.-based NRC/Picker in an effort to use patient feedback to improve operations and service.

Stanford Hospital has been conducting patient satisfaction surveys for years-but the NRC/Picker approach is a better, more scientific way to obtain that information, said Nick Gaich, vice president of material management and customer service.

"Our old survey was basically a rating tool-it told you if you were bad or good, but it didn't tell you why," Gaich said. "Now, we're asking our patients about specific activities and behaviors we can measure and act on."

Instead of asking patients to rate the hospital's service as "excellent," "good," "fair" or "poor," the Picker survey asks about specific behaviors, such as "How many minutes did you usually wait before your call button was answered?" "Did a doctor or nurse tell you accurately how you would feel after the surgery?" or "Did staff talk in front of you as if you weren't there?"

One section of the survey focuses on physicians, with questions such as "Did you have confidence in the doctors treating you?" and "When you had important questions to ask a doctor, did you get answers you could understand?"

Strength in numbers

At Huntington Hospital in Southern California, Press Ganey Associates of South Bend, Ind., provides the "report card" on patient satisfaction.

Press Ganey also did a survey of 906,902 patients in 34 states that showed the nursing shortage has an effect on patient satisfaction. The study, released in May, said the higher the ratio between working registered nurses and residents in any given state, the higher the rate of patient satisfaction with the quality of nursing care.

Bonny Ciribassi, RN, said Huntington Hospital has used the Press Ganey surveys to focus on specific issues revolving around patient satisfaction. The hospital took part in the 2003 PEP-C survey as a means of comparing results and earned the highest mark of three stars.

"PEP-C was really a validation tool and told us pretty much the same thing as the Press Ganey surveys," said Ciribassi, vice president of patient care services at Huntington. "It validated what we already know about patient care and was a good validation for the staff as well."

One problem the Press Ganey surveys revealed was solved by a task force that included nurses and involved improving patient flow in the emergency department. Waiting times were shortened and procedures were revised to get blood tests back more quickly to patients. Also, better communication with patients on how long they might have to wait for an X-ray or other tests was established.

"We did a lot of customer service training, including role playing for certain situations. It really brought up our scores dramatically in the patient satisfaction surveys," Ciribassi said. "Nursing satisfaction also went up when we did the redesign around patient flow because we concentrated on many of the things nurses found frustrating. We've since improved patient flow throughout the hospital."

Hospitals now taking part in patient satisfaction surveys will be better prepared to meet a standardized approach to obtaining data for a national survey being launched by the federal government in 2004. The results will be publicly reported by the federal Centers for Medicare & Medicaid Services, which decided Nov. 4 to make the survey voluntary rather than mandatory. Still, about 3,000 hospitals say they'll participate in the ratings, and indications show that hospitals' Medicare funding may be linked to these performance measures.

Michael Hays, president and CEO of NRC/Picker, said the issue isn't whether the government survey is mandatory or voluntary. "The important thing is the percentage of hospitals that step up to the plate and get involved in public reporting," Hays said.

Patient satisfaction scores, Hays said, don't necessarily correlate to hospitals that achieve Magnet status or are put on the Top 100 lists because a lot of those ratings are based on clinical outcome measures. Consumers need the information that patients provide on their hospital experiences.