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Patient Satisfaction Must Start With Nursing Satisfaction

Posted on Wed, Nov 16, 2016
Patient Satisfaction Must Start With Nursing Satisfaction

By Alberto Hazan, MD

Ever since the U.S. government decided to link Medicare reimbursement dollars to patient satisfaction scores, hospital administrators have been obsessed with improving the quality of care for patients visiting their emergency departments. While the motivation may be partly financial, the goal of improving the patient experience during emergency department and hospital visits is an admirable one.

Unfortunately, many of the tactics used by administrators have done little to achieve that goal. Hiring national “experts” on customer service to give lectures to the hospital staff, or introducing catchy mnemonics to guide physicians in conducting more compassionate patient interviews, have been equally ineffective in markedly improving patient satisfaction.

If we aim to better the patient experience in the emergency department (and the rest of the hospital), we need to shift our focus from the patients to the nursing staff. After all, the people who spend the most time with patients are not the physicians but the nurses. If nurses are dissatisfied at work, patients will inevitably be dissatisfied with their experience.

Recent discoveries in the field of positive psychology have demonstrated that being successful in any endeavor (including improving patient satisfaction in emergency departments) requires happiness as a prerequisite. If we truly want to improve the safety, care, and experience of our patients, then we need happier people at work. In his book, The Happiness Advantage: The Seven Principles of Positive Psychology That Fuel Success and Performance at Work, Shawn Achor highlights the link between success and happiness: “Studies show that simply believing we can bring about positive change in our lives increases motivation and job performance; that success, in essence, becomes a self-fulfilling prophecy.”

Ensuring we have happier nurses won’t just improve patient satisfaction; it will, more importantly, improve the safety and well being of anyone being treated in the emergency department. Happier people are more aware of their surroundings, they take more pride in their work, and they’re less likely to make mistakes. In the ER, this is imperative. A happier, more engaged nursing staff will be able to recognize red flags (including physician error), identify septic patients, and stay on top of their workload.

Ultimately, success in the emergency department means many things: taking good care of patients, looking after their best interests, and ensuring they do not have a life- or limb-threatening illness. Being successful isn’t just about improving patient satisfaction scores. It also means taking care of patient anxiety, treating their pain, and making them comfortable. It means that nurses (and physicians) are in a state of flow, can handle stress, and are aware, in the moment, and conscious of what they’re doing. This will help them work better as a team. Being happy at work also provides nurses with self-confidence and self-esteem: “The more you believe in your own ability to succeed, the more likely it is that you will,” says Achor.

If our nursing staff is happy, they are likely to see working in the ER as a calling rather than a job. In other words, “people with a calling view work as an end in itself.” Achor makes a case that happy employees have different priorities beyond just earning a paycheck: “Their work is fulfilling not because of external rewards but because they feel it contributes to the greater good, draws on their personal strengths, and gives them meaning and purpose.”

When nurses view their work as a calling, they can see more clearly the benefits they provide to patients, such as alleviating pain and suffering, quelling anxiety, diagnosing illness, and providing compassionate care.

How to Engage Your Nursing Staff

I recently became the director of the emergency department at Desert Springs Hospital Medical Center in Las Vegas. As soon as I took over the position, my mind reeled with the changes I wanted to make to ensure that patients were adequately taken care of, treated with respect, seen in a timely manner, and that their pain, anxiety, and questions were addressed quickly and effectively. I soon realized the most effective way to bring about such changes is to make sure that the people spending the most time with those patients—the nursing staff—are adequately taken care of.

I’ve started asking nurses about their goals and frustrations. I don’t schedule meetings with a bunch of doctors to figure out how to best improve patient satisfaction, but rather I ask the nurses themselves, individually and in real time:
 

  1. What is your overall satisfaction working at our hospital?
  2. What is the most stressful thing about your workday?
  3. What can we do to improve your workday?
  4. Do you feel rested? Do you have enough breaks?
  5. Do you enjoy working with your colleagues? Is there anyone here who drives you down?

I’m not sure what changes will come out of this. Maybe we will mandate an 8-hour workday, or provide a better schedule. Maybe we will increase our staff, or make sure nurses don’t waste time on non-clinical chores like finding equipment. Maybe we will promote more social events, or have more discussions in real time, especially after traumatic experiences like the death of a pediatric patient or a major resuscitation, to ensure hospital staff deal with the grief inherent in treating dying patients.

Regardless, I’m starting the process where I should: focusing on the people at the heart of patient care.

Dr. Alberto Hazan is an emergency physician and the director of the Desert Springs Hospital Medical Center Emergency Department in Las Vegas. He is the author of the medical thriller Dr. Vigilante and the preteen urban fantasy series The League of Freaks.

This post originally appeared on KevinMD.com.

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Patient Engagement Can Cut Costs, Improve Outcomes

Posted on Sun, Feb 08, 2015
Patient Engagement Can Cut Costs, Improve Outcomes

Initiatives can decrease hospital visits, cut morbidity and mortality, up treatment adherence

MONDAY, Feb. 2, 2015 (HealthDay News) -- Patient engagement initiatives can decrease costs without sacrificing quality care, according to an article published Jan. 22 in Medical Economics.

According to the article, physicians are expected to reduce costs and accomplish more at each patient visit; be responsible for a tremendous medical repertoire; and meet meaningful use objectives, pay-for-performance measures, quality incentive measures, and medical home elements, all in the context of a shortage of primary care physicians.

The article emphasizes the value of patient engagement, similar to customer-empowerment initiatives employed in other industries. Patient self-management represents an important element of the chronic care model, designed to guide higher-quality chronic illness management in primary care. Patient engagement initiatives have led to decreases in hospital visits, reduced morbidity and mortality, and improvements in treatment adherence and quality of life associated with chronic diseases. Scheduling appointments; managing correspondence, refills, and prior authorizations; and facilitating communication with the medical team are areas for patient engagement. Many patients embrace this responsibility and perceive this as better-quality care.

"Although barriers will exist for individual patients to adopt this system and its associated technologies, we must focus on developing an infrastructure that supports and encourages active patient participation in their health care," according to the article.

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