Solutions Starter Emergency Department

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Emergency DepartmentSolutions Starter

This Solutions Starter provides best practices, research, and tools to help you improve the

delivery of health care. These solutions are linked to standard survey sections and questions,

making it easy to find the information you need. Many of these solutions also can be used

to help you improve performance on your custom, or nonstandard, questions.

Press Ganey is committed to providing resources that enable you to continuously improve

your performance and deliver high quality health care.

For assistance, please contact your Press Ganey Consultant.


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Emergency Department

Solutions Starter

Table of Contents

Introduction ................................................................................................................... 1

Additional Resources ................................................................................................... 1

Arrival1. Waiting time before staff noticed your arrival .................................................................................. 4

2. Helpfulness of the person who first asked you about your condition ............................................... 7

3. Comfort of the waiting area ............................................................................................................ 9

4. Waiting time before you were brought to the treatment area ......................................................... 12

5. Waiting time in the treatment area, before you were seen by a doctor .......................................... 16

Nurses1. Courtesy of the nurses ................................................................................................................. 21

2. Degree to which the nurses took the time to l isten to you ............................................................. 24

3. Nurses attention to your needs ................................................................................................... 27

4. Nurses concern to keep you informed about your treatment ........................................................ 30

5. Nurses concern for your privacy .................................................................................................. 33

Doctors1. Courtesy of the doctor ................................................................................................................. 37

2. Degree to which the doctor took the time to listen to you .............................................................. 40

3. Doctors concern to keep you informed about your treatment ....................................................... 424. Doctors concern for your comfort while treating you .................................................................... 45

Lab Tests1. Courtesy of the person who took your blood ................................................................................ 50

2. Concern shown for your comfort when your blood was drawn ...................................................... 53

Radiology Tests1. Waiting time for radiology test ...................................................................................................... 57

2. Courtesy of the radiology staff ..................................................................................................... 60

3. Concern shown for your comfort during your test ......................................................................... 62

Family or Friends1. Courtesy with which family or friends were treated ....................................................................... 67

2. Staff concern to keep family or friends informed about your status during your courseof treatment ................................................................................................................................. 71

3. Staff concern to let a family member or friend be with you while you were being treated ............... 74
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Personal/Insurance Information

1. Courtesy of the person who took your personal/insurance information ......................................... 782. Privacy you felt when asked about your personal/insurance information ....................................... 81

3. Ease of giving your personal/insurance information...................................................................... 83

Personal Issues1. How well you were kept informed about delays ............................................................................ 87

2. Degree to which staff cared about you as a person ...................................................................... 90

3. How well your pain was controlled ............................................................................................... 93

4. Information you were given about caring for yourself at home (e.g., taking medications,getting follow-up medical care) .................................................................................................... 96

Overall Assessment1. Overall rating of care received during your visit .......................................................................... 100

2. Likelihood of your recommending our Emergency Department to others .................................... 103
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IntroductionPress Ganey researchers thoroughly review best practices for each Solutions Starter.We evaluate studies based on their findings and level of evidence. Solutions Startersare effective because of this systematic evidence-based approach.

Use this Solutions Starter as a component of your improvement process. It isintended to supplement, not replace, your partnership with your Press GaneyConsultant.

With your Consultant, clearly define your priorities using Press Ganey reports. Distributethis guide or key sections to staff to stimulate discussion on improvements that wouldwork within your organization. The more involved your front-line team is, the more likely

you will see sustainable change.

Additional ResourcesFor more than 20 years, Press Ganey has been committed to providing insight thatallows health care organizations to improve the quality of care they provide whileimproving their bottom-line results.

Hands-On ConsultingPress Ganeys outstanding consulting service includes more than 100 consultants readyto help. Your Press Ganey Consultant will partner with you to identify priorities, develop

solutions, and take action.

Online ForumPress Ganeys Online Forum is the nations largest online community dedicated toperformance improvement and networking. Connect with over 17,500 Press Ganeyclient members to share knowledge and resources, explore best practices, and discoversolutions to the challenges you face every day. Go topressganey.comand selectForum Login to register.

Press Ganey PartnersPress Ganey's bimonthly magazine features best practices on achieving patient,

physician, and employee satisfaction as well as building a culture of safety andemployee engagement. You also will find compelling first-person success stories andinformative white papers from Press Ganey researchers. Go topressganey.comandselect News & Notes.
http://pressganey.com/cs/our_services/consultationhttp://pressganey.com/cs/our_services/consultationhttps://www.pressganey.com/forumhttps://www.pressganey.com/forumhttp://pressganey.com/http://pressganey.com/http://pressganey.com/http://pressganey.com/cs/news_and_notes/pg_partnershttp://pressganey.com/cs/news_and_notes/pg_partnershttp://pressganey.com/http://pressganey.com/http://pressganey.com/http://pressganey.com/http://pressganey.com/cs/news_and_notes/pg_partnershttp://pressganey.com/https://www.pressganey.com/forumhttp://pressganey.com/cs/our_services/consultation


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Briefings

Receive Press Ganeys Briefingsemailed biweekly to your inbox. This quick readoffers subscribers:

The latest national health care news Best practices in improving safety, the quality of patient care, and satisfaction Resources for creating safe, engaging working environments for physicians and

employees Announcements about upcoming Press Ganey workshops and events

Contact your Press Ganey Consultant to be added to the Briefingsmailing list, or gotopressganey.comand select News & Notes.

Research and Analysis LibraryPress Ganey's Research and Analysis Library gives you easy access to the latestinformation and trends, drawn from more than 7,000 clients and the perspectivesof millions of survey respondents:

Pulse Reportsand Checkup Reportsprovide annual accounts of health care qualityin America as seen through the eyes of patients, employees, and physicians.

Insightful case studies and white papers from Press Ganey researchers offer robustdata and analysis from our database and supporting success stories from clients.

Go topressganey.comand select Research & Analysis.
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Arrival

Section


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Waiting time before staff noticed your arrival

Arrival

QUESTION DEFINITIONThis question measures the patient's perception of the length of time that passed beforeED personnel noticed the patient's arrival. Patients coming to an ED undoubtedly feel asense of urgency about their situation. Having staff available to respond to the patient'sarrival in a timely fashion sends the message that associates understand the patient'ssense of urgency and are ready to help.

PATIENT PERSPECTIVES

"I realize I wasn't the sickest person in the ED that night, but I was really scaredabout the whole situation, and nobody even noticed me!"

"I walked through what looked like the front door with my child who was scared andhurting. We couldn't figure out where to go and there wasn't anyone around to tellus."

IMPROVEMENT SOLUTIONS

Offer the same service and welcoming spirit that patients receive when checking intoa hotel. Valet parking, concierge, escort, professional and courteous staff whoattends to patients' needs.

Does the person inquiring about the patient's condition do so in an empathetic way?

Staff need to get the facts, but patients need to feel that the facts are received bysomeone who cares. For example: "I'm sorry you are hurting so much right now.We're going to help you."

Does the person offer any sense of what will be done for the patient? What can thepatient expect to happen next? "I'm going to take down some information about yoursymptoms and medical history that the doctor will need. Then we will take you backto an exam room as soon as one is available."

Is there someone in the ED that appears to be monitoring the waiting area for newarrivals? Patients walking through the door will likely be scanning the reception areafor the proper person with whom to speak.

Station volunteers or customer service representatives at the entrance of the ED to

serve as greeters and guide customers (patients, family, friends, visitors, etc.) totheir destination.

Does the person monitoring the waiting area make eye contact promptly andverbally greet incoming patients/families? Train staff to engage in these behaviorsand include these expectations in staff evaluations.

Proper signage can be an important aid in situations where the staff is unavoidablyprevented from greeting incoming arrivals promptly. Signs at least confirm for the


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patient where they should go to initiate contact with staff. Signs are no replacement,

however, for a caring greeting expressed promptly by a staff member. As with any time patients/families experience a delay, offer a sincere apology in

instances when staff duties may have prevented them from noticing a new arrivalpromptly.

Remember, patients arriving at the ED are likely to be experiencing a significantamount of fear and anxiety with the situation. Having staff immediately respond totheir presence (even if only to reassure the patient that they have come to the rightplace and you will take good care of him/her) can alleviate much of this stress.

Implement a Physician Assistant (PA) Program. Have several PAs and a set ofnurses handle patients who present less-serious symptoms in the ER. This helpsdecrease door-to-doctor wait times and overall patient length-of-stay, and prevents

patients from leaving without being seen. Have an ER Patient/Family Liaison assist patients and their families with comfort

measures, keep patients informed and answer their questions or respond to theirconcerns. Have the liaison available to assist the nursing staff with transportation ofpatients, and to ensure the ER waiting and treatment rooms are presentable andstocked with supplies.

Provide frequent updates and manage patient expectations: Revisit the patient atleast once every 30 minutes to acknowledge that he/she is still waiting, show thepatient he/she is not being forgotten, explain the continuing delay, and give anestimate of how long the wait will continue.

Acknowledge and apologize: Make sure all staff are aware that the patient has been

kept waiting and apologize even if it is not your fault. (e.g., I realize you've beenwaiting more than (time) minutes/hours and I'm really sorry about that."

RESOURCES1. Arkansas Methodist Medical Center (Paragould, AR). Compass Award Winner,

2007. Available from:http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards

_details_page?contentId=2302. Espinosa JA, Kosnik LK. Towards a Bold Love for ED Systems: 25 Practical

Strategies to Improve Emergency Department Patient Satisfaction. SatisfactionMonitor. Jul/Aug 2000. Available from:

http://www.pressganey.com/galleries/satisfaction-monitor-issues/julaug00.pdf 3. Hackensack University Medical Center (Hackensack, NJ). Success Story Winner,

2007. Available from:http://www.pressganey.com/cs/archives/success_story_archives_details_page?contentId=155
http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=230http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=230http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=230http://www.pressganey.com/galleries/satisfaction-monitor-issues/julaug00.pdfhttp://www.pressganey.com/galleries/satisfaction-monitor-issues/julaug00.pdfhttp://www.pressganey.com/cs/archives/success_story_archives_details_page?contentId=155http://www.pressganey.com/cs/archives/success_story_archives_details_page?contentId=155http://www.pressganey.com/cs/archives/success_story_archives_details_page?contentId=155http://www.pressganey.com/cs/archives/success_story_archives_details_page?contentId=155http://www.pressganey.com/cs/archives/success_story_archives_details_page?contentId=155http://www.pressganey.com/galleries/satisfaction-monitor-issues/julaug00.pdfhttp://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=230http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=230


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4. Highland Community Hospital (Picayune, MS). Compass Award Winner, 2008.

Available from:http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards

_details_page?contentId=2745. Irvington General Hospital (Irvington, NJ). Compass Award Winner, 2002. Available

from:http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards

_details_page?contentId=1806. St. John Macomb Hospital (Warren, MI). Compass Award Winner, 2006. Available


_details_page?contentId=8

7. San Jacinto Methodist Hospital (Houston, TX). Compass Award Winner, 2006.Available from:http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards

_details_page?contentId=78. Tuomey Healthcare System (Sumter, SC). Compass Award Winner, 2006. Available


http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=274http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=274http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=274http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=180http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=180http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=180http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=8http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=8http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=8http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=7http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=7http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=7http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=9http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=9http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=9http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=9http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=9http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=7http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=7http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=8http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=8http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=180http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=180http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=274http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=274


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Helpfulness of the person who first asked you about your condition

Arrival

QUESTION DEFINITIONThis question measures the patient's perception of the helpfulness of the person towhom they first told their story. An important aspect of being helpful is the sharing ofinformation. The patient explains his or her situation, concerns and needs followed bythe staff communicating what is going to happen from this point forward to help resolvethe situation, assuage concerns and meet the patients' needs. This initial person willexplain exactly what is going to happen, who will do it and when it will occur. The patientwill evaluate the helpfulness of this person based upon whether these things happen as

promised (e.g. truthfulness), whether the patient felt s/he was listened to andunderstood, and whether the patient feels treated fairly.


"I felt abandoned. I told the person at the desk my situation, and they treated me likea number and just moved on to the next person."


Does the person ask if the patient has any questions or concerns prior to leaving himor her? Does the person ask if there is anything the patient needs right now in orderto be more comfortable while they wait? Provide the staff with scripts to encourage

them to consistently convey this message. Does the person remain available while the patient waits for the next step to occur?

"I'm going to have you wait right over there until we have an exam room ready. But ifyou have any questions or concerns while you are waiting, I will be right over here.Just ask me, my name is Mary."

Be aware of facial expressions and nonverbal language.

Use every possible mode of communication to inform the patient and family abouthow the Emergency Department functions, what they can expect and what are theresources available to them. Use brochures, booklets, posters, information videos,and trained volunteers with a scripted description.

Offer the patient a blanket, pillow or some other comfort-maker. If medically

appropriate, offer a refreshment, water and/or snack. Volunteers specifically trained in customer service can round on patients in the

waiting room and serve as "patient liaisons"--running small errands, meeting comfortneeds, explaining emergency department routines (e.g., why delays, why patientswho came in later may be seen first, etc.). Some EDs have made these the functionof full-time positions.


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Employ a clear process and timeframe for communicating with patients and families

about delays. Require that anyone working at the registration desk communicatewith family or friends who have been waiting more than fifteen minutes.

Implement something along the lines of "Receptionist Day Out" to show appreciationfor the frontline staff. If possible, have it include training on presenting yourself in aprofessional way or how to deal with difficult with patients.

Have language-appropriate educational materials (such as Spanish) available forservices that are most commonly used.

Have registration employees perform quick rounds in the waiting area to make sureall patients have been registered.

Establish a process of giving patients pagers (similar to those available inrestaurants.) This makes it easy for patients to visit other areas of the hospital to

grab a cup of coffee or make a phone call, and reduces the likelihood of patientsmissing their name being called.

Implement "Mystery Shoppers" to evaluate the care and service patients receivefrom the registration desk. These people are typically selected by using past/presentpatients or staff members.




2. Stavins CL. Developing Employee Participation in the Patient-Satisfaction Process.American College of Healthcare Executives, Fellowship Case Reports. 2002.Available from:http://www.ache.org/mbership/AdvtoFellow/CASERPTS/stavins02.cfm

3. Taylor C, Benger JR. Patient Satisfaction in Emergency Medicine. Journal ofEmergency Medicine. Sep 2004; 21(5):528-532. Available from:http://emj.bmjjournals.com/cgi/content/full/21/5/528

4. Vercler L, Clark PA. Hearing All Patients Voices: Reaching Out to Limited EnglishProficiency (LEP) Patients. Satisfaction Monitor. Jan/Feb 2006. Available from:http://www.pressganey.com/galleries/satisfaction-monitor-issues/janfeb06.pdf

5. WellStar Douglas Hospital (Douglasville, GA). Compass Award Winner, 2007.


http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=230http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=230http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=230http://www.ache.org/mbership/AdvtoFellow/CASERPTS/stavins02.cfmhttp://www.ache.org/mbership/AdvtoFellow/CASERPTS/stavins02.cfmhttp://emj.bmjjournals.com/cgi/content/full/21/5/528http://emj.bmjjournals.com/cgi/content/full/21/5/528http://www.pressganey.com/galleries/satisfaction-monitor-issues/janfeb06.pdfhttp://www.pressganey.com/galleries/satisfaction-monitor-issues/janfeb06.pdfhttp://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=228http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=228http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=228http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=228http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=228http://www.pressganey.com/galleries/satisfaction-monitor-issues/janfeb06.pdfhttp://emj.bmjjournals.com/cgi/content/full/21/5/528http://www.ache.org/mbership/AdvtoFellow/CASERPTS/stavins02.cfmhttp://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=230http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=230


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Comfort of the waiting area

Arrival

QUESTION DEFINITIONThis question measures the patients perception of the comfort provided by the EDwaiting area. Because waiting is such an important issue for hospital EDs, make certainthat the wait is as comfortable as possible for patients and family members.


"We were really under a lot of stress that night. The lousy conditions in the waitingroom did nothing to help alleviate that stress. In fact, it made it worse."


Consult with your facilitys in-house experts (staff and patients) to determine what isneeded to achieve success. If scores went up for the department, talk to themanager and find out what has been happening. Share your findings across theentire organization.

Use natural light, soothing colors, artwork with positive summer/spring naturescenes, healthy flowers, calm landscapes, and depictions with positive socialconnotations (e.g., farms, barns, family, positive facial expressions,multigenerational and multicultural persons, and people in caring relationships).

Network with local artists, shops, museums and vendors to obtain artwork on loan or

by donation. Is there comfortable seating available (and enough of it)? Evaluate your facility's

current seating availability and arrangement. Make sure to conduct evaluationsduring peak times.

Is there something to occupy the patient/familys time while waiting? Is there a TV?Is it in a convenient location? Does it disturb those who want to sit and talk or read?Are there books, magazines or newspapers for people to read? Are they recent? Arethere windows so that visitors can look outside? Are there toys for children to playwith; a childrens movie/video area? Progressive pediatrics emergency departmentsoffer complimentary toys, puzzles and games to occupy childrens time, wall-mounted video games, movies or favorite childrens shows.

Is the area freshly painted? Do the colors coordinate? Compare your colors, visualsand design to the research findings in healing environments (e.g., avoid certaincolors, abstract art, large faces, scenery, etc. which patients tend to find disturbing).Is the temperature in the room comfortable? Does the air circulate, or is it stuffy?Conduct temperature audits regularly.

Is the room clean? Are the carpets and furniture soiled or stained? Does everyoneclean the waiting area, clean their own area and pick up litter or are trash andmesses left for housekeeping?


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Do visitors feel like they are sitting on top of each other? Consider the issues of

personal space in light of the discomforts of illness (e.g., coughing, sneezing, etc.).Is there enough room for people to have an empty chair between themselves andthe people next to them?

Is there a place where visitors can get meals or snacks? More and more are makingamenities available such as refreshment carts with coffee, tea, bagels, muffins, etc.Offer tokens for nearby food or beverage vending machines and/or coupons fornearby restaurants/vendors.

The use of pagers in the ED has risen. Families appreciate the freedom pagersallow; the ability to relax, move about the campus and be in the immediate vicinitywithout being tied to the immediate waiting area.

If planning to redesign or construct the ED facilities, involve everyone: physicians,

nurses, front-line staff, former patients and community members. Diverseperspectives will result in a more patient-centered and constituent-friendly result.Patient comments and satisfaction data can inform these decisions.

Arrange chairs in small groups versus long lines. Many ED patients come withfriends and family members. Most patients prefer to have some privacy whilewaiting.

Keep the waiting area staffed with a patient advocate. The advocate can monitorwait times and help attend to any patient needs.

Conduct your own internal mystery shopping. Have a staff member evaluate thecomfort of the waiting room by sitting the same length of time most patients wait.Something that is comfortable for five minutes may not be comfortable for two hours.

Make sure the waiting area has adequate lighting and/or windows. It is veryuncomfortable to wait in dark crowded spaces.

Ask staff members to bring in previous issues of magazines from their homes tostock the waiting room. Make sure all personal information is blocked out on eachmagazine before placing it in the waiting area.




2. Covenant Healthcare (Saginaw, MI) Success Story Finalist, 2003. Available from:http://www.pressganey.com/cs/archives/success_story_archives_details_page?contentId=68


http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=230http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=230http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=230http://www.pressganey.com/cs/archives/success_story_archives_details_page?contentId=68http://www.pressganey.com/cs/archives/success_story_archives_details_page?contentId=68http://www.pressganey.com/cs/archives/success_story_archives_details_page?contentId=68http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=7http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=7http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=7http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=7http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=7http://www.pressganey.com/cs/archives/success_story_archives_details_page?contentId=68http://www.pressganey.com/cs/archives/success_story_archives_details_page?contentId=68http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=230http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=230


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4. Tuomey Healthcare System (Sumter, SC). Compass Award Winner, 2006. Available


http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=9http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=9http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=9http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=9http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=9


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Waiting time before you were brought to the treatment area

Arrival

QUESTION DEFINITIONPatients who come to the emergency department understandably feel a sense ofurgency about their condition. To patients, lengthy waiting times seem incompatible withthis sense of urgency. When staff members understand this from the patientsperspective, their interactions with the patient/family members will likely make themmore patient-centered.

Producing a satisfying experience for the patient with regards to wait time involves two

components: reducing the actual amount of time patients wait and managing patientexpectations about wait time. It is important to streamline processes to prevent lengthydelays and improve patient flow. Managingpatient expectations can provide anappropriate context from which patients judge the appropriateness of their wait.

This question measures the patients perception of the length of time that elapsedbetween their arrival in the waiting area and being taken to a treatment area.Remember, this question is not asking the patient to estimate the length of time spent inthe waiting area. Rather, it is a subjective rating which will be influenced by the patientsexpectations and beliefs about what an appropriate wait time would be given theparticulars of the circumstances.


"We were scared and panicking, but the staff sure did not seem to share our senseof urgency about the situation!"


Bedside Registration. As soon as the patient arrives, ask minimal information (e.g.,name, birth date, social security number) and get the patient immediately to abed/triage area. Triage the patient first then obtain the requisite registrationinformation at the bedside. This improves flow by eliminating a step in the processand demonstrates to the patient that you care about their welfare, first and foremost.

Fast Track Treatment Area. The least acute patients tend to have the longest waits.Fast track uses mid-level care providers to rapidly care for the less-critical patients(e.g., nurse practitioners can provide most of the care while a physician assigned tothe fast-track "closes").

Pediatric Treatment Area. This can provide comfort items unique to pediatricspatients and families while reducing delays for customers (parents) who tend to bemost insistent (but, perhaps, less acute). Crib, supplies, carts, murals, fish tanks,comfortable floor and furniture, etc.


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Studies have shown that crowded waiting rooms do not affect patient satisfaction

nearly as much as whether or not the patient believes he/she was told an expectedwait time. This means managing patients expectations for wait time, repeatedly, toensure recall.

Develop standard procedures for regularly communicating to patients, keeping themwell-informed of their status, any delays, the reason for delays, anything you can doto make the wait more comfortable, etc.

Implement a Physician Assistant (PA) Program. Have several PAs and a set ofnurses handle patients who present less serious symptoms in the ED. This helpsdecrease door-to-doctor wait times and overall patient length-of-stay, and preventspatients from leaving without being seen.

Relocate a physician and a mid-level provider to the triage area so patients can be

evaluated by a physician immediately upon arrival and while still in triage. You canthen take the urgent patients directly to a bed. Patients who are non-urgent andrequire rapid and/or focused medical treatment (but not necessarily a bed) can besent to a larger waiting area under the supervision of two nurses.

At every stage of the process, "stamp" patients in a time clock so that the team cantrack patients from the time they walk in until a physician discharges them.

Study patient flow by the hour to look for any bottlenecks in the process.

Give a brochure to all patients upon check-in, to educate them on the flow in the ED,expected wait times, etc.

Provide pagers to non-emergency patients to allow them to visit the gift shop, snackshop, or wait in the main lobby of the hospital.

Create a designated ED customer service line as a way for patients and theirfamilies to report real-time compliments or concerns to staff.

RESOURCES1. Baylor Medical Center at Grapevine (Grapevine, TX). Compass Award Winner,


_details_page?contentId=2722. Espinosa JA, Kosnik LK. Towards a Bold Love for ED Systems: 25 Practical

Strategies to Improve Emergency Department Patient Satisfaction. SatisfactionMonitor. Jul/Aug 2000. Available from:

http://www.pressganey.com/galleries/satisfaction-monitor-issues/julaug00.pdf 3. Frick Hospital (Mt. Pleasant, PA). Success Story Winner, 2006. Available from:

http://www.pressganey.com/cs/archives/success_story_archives_details_page?contentId=11

4. Hackensack University Medical Center (Hackensack, NJ). Success Story Winner,2007. Available from:http://www.pressganey.com/cs/archives/success_story_archives_details_page?contentId=155
http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=272http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=272http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=272http://www.pressganey.com/galleries/satisfaction-monitor-issues/julaug00.pdfhttp://www.pressganey.com/galleries/satisfaction-monitor-issues/julaug00.pdfhttp://www.pressganey.com/cs/archives/success_story_archives_details_page?contentId=11http://www.pressganey.com/cs/archives/success_story_archives_details_page?contentId=11http://www.pressganey.com/cs/archives/success_story_archives_details_page?contentId=11http://www.pressganey.com/cs/archives/success_story_archives_details_page?contentId=155http://www.pressganey.com/cs/archives/success_story_archives_details_page?contentId=155http://www.pressganey.com/cs/archives/success_story_archives_details_page?contentId=155http://www.pressganey.com/cs/archives/success_story_archives_details_page?contentId=155http://www.pressganey.com/cs/archives/success_story_archives_details_page?contentId=155http://www.pressganey.com/cs/archives/success_story_archives_details_page?contentId=11http://www.pressganey.com/cs/archives/success_story_archives_details_page?contentId=11http://www.pressganey.com/galleries/satisfaction-monitor-issues/julaug00.pdfhttp://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=272http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=272


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5. Highland Community Hospital (Picayune, MS). Compass Award Winner, 2008.


_details_page?contentId=2746. Irvington General Hospital (Irvington, NJ). Compass Award Winner, 2002. Available


_details_page?contentId=1807. Keenan AM, Melnick G. Robert Wood Johnson University Hospital: The 15/30

Guarantee. Satisfaction Monitor. Jul/Aug 2000. Available from:http://www.pressganey.com/galleries/satisfaction-monitor-issues/julaug00.pdf

8. Miller F, Lindgren L, Farris D. Patient-Centered Emergency Care: Avera McKennan

Takes a Lean approach. Satisfaction Monitor. May/Jun 2008. Available from:http://www.pressganey.com/galleries/satisfaction-monitor-issues/SatMon%20MayJune08.pdf

9. OBrien G. Malcolm Baldrige Award Win Tied to ER Changes. Satisfaction Monitor.May/Jun 2007. Available from:http://www.pressganey.com/galleries/satisfaction-monitor-issues/mayjun07.pdf

10. Ochsner Medical Center - Kenner (Kenner, LA). Compass Award Winner, 2008.Available from:http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards

_details_page?contentId=27611. Ochsner Medical Center - West Bank (Gretna, LA). Compass Award Winner, 2008.

Available from:http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=271

12. Pinnacle Health System (Harrisburg, PA). Success Story Winner, 2005. Availablefrom:http://www.pressganey.com/cs/archives/success_story_archives_details_page?contentId=37

13. St. John Macomb Hospital (Warren, MI). Compass Award Winner, 2006. Availablefrom:http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards



_details_page?contentId=715. Sutter Solano Medical Center (Vallejo, CA). Compass Award Winner, 2007.


http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=274http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=274http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=274http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=180http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=180http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=180http://www.pressganey.com/galleries/satisfaction-monitor-issues/julaug00.pdfhttp://www.pressganey.com/galleries/satisfaction-monitor-issues/julaug00.pdfhttp://www.pressganey.com/galleries/satisfaction-monitor-issues/SatMon%20MayJune08.pdfhttp://www.pressganey.com/galleries/satisfaction-monitor-issues/SatMon%20MayJune08.pdfhttp://www.pressganey.com/galleries/satisfaction-monitor-issues/SatMon%20MayJune08.pdfhttp://www.pressganey.com/galleries/satisfaction-monitor-issues/mayjun07.pdfhttp://www.pressganey.com/galleries/satisfaction-monitor-issues/mayjun07.pdfhttp://www.pressganey.com/galleries/satisfaction-monitor-issues/mayjun07.pdfhttp://www.pressganey.com/galleries/satisfaction-monitor-issues/mayjun07.pdfhttp://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=276http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=276http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=276http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=271http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=271http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=271http://www.pressganey.com/cs/archives/success_story_archives_details_page?contentId=37http://www.pressganey.com/cs/archives/success_story_archives_details_page?contentId=37http://www.pressganey.com/cs/archives/success_story_archives_details_page?contentId=37http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=8http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=8http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=8http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=7http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=7http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=7http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=233http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=233http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=233http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=233http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=233http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=7http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=7http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=8http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=8http://www.pressganey.com/cs/archives/success_story_archives_details_page?contentId=37http://www.pressganey.com/cs/archives/success_story_archives_details_page?contentId=37http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=271http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=271http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=276http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=276http://www.pressganey.com/galleries/satisfaction-monitor-issues/mayjun07.pdfhttp://www.pressganey.com/galleries/satisfaction-monitor-issues/mayjun07.pdfhttp://www.pressganey.com/galleries/satisfaction-monitor-issues/SatMon%20MayJune08.pdfhttp://www.pressganey.com/galleries/satisfaction-monitor-issues/SatMon%20MayJune08.pdfhttp://www.pressganey.com/galleries/satisfaction-monitor-issues/julaug00.pdfhttp://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=180http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=180http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=274http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=274


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16. Tuomey Healthcare System (Sumter, SC). Compass Award Winner, 2006. Available


http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=9http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=9http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=9http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=9http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=9


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Waiting time in the treatment area,

before you were seen by a doctor

Arrival

QUESTION DEFINITIONThis question measures the patients perception of the appropriateness of the amount oftime spent waiting for the doctor to arrive once they left the waiting area and moved tothe treatment area. The issues are similar to those present regarding wait time prior tobeing moved to the treatment area. However, it is important to recognize that to apatient who has just spent time in the waiting area, a move to the treatment areasignifies progress-their treatment is now imminent.

As with the previous question, it is important to remember that this question is notasking the patient to objectively report on the length of time spent in the treatment roomprior to the doctors arrival. Rather, it is a subjective rating, which will be influenced bythe patients expectations and beliefs about what an appropriate wait time would begiven the particulars of the circumstances.

Producing a satisfying experience for the patient with regards to wait time in thetreatment area involves not only reducing the actual objective amount of time patientsmust wait for the care provider to enter, but also, managing patient expectations aboutthat wait time. Streamlining processes to prevent lengthy delays and improve patient

flow and managing patient expectations can provide an appropriate context from whichpatients judge the appropriateness of their wait.


"I just dont understand what could possibly have been taking the doctor so long."


Fast Track Treatment Area. The least acute patients tend to have the longest waits.Fast track uses mid-level care providers to rapidly care for the less-critical patients(e.g., nurse practitioners can provide most of the care while a physician assigned tothe fast-track "closes").

Study your staffing patterns against peak times for high patient volumes. You mayneed to schedule more physician hours or nurse hours for peak times.

Patients may make unfavorable wait time comparisons in seeing the ED physicianvs. seeing their primary care physician. Patients may even expect to be seen quickerin the ED because its an emergency to them. Staff will have to manageexpectations through frequent communication beginning when the patient walksthrough the door throughout the entire visit.


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Communicating with patients regarding when to expect the doctor to arrive given the

current situation in the ED can help bring the patients expectations into closeralignment with those of the staff. That is not to say that patient expectations willcome into complete alignment with those of the ED staff (e.g., patients who thoughttheir move into the treatment area signaled that their treatment was imminent mightbelieve you have forgotten about them or did a poor job scheduling staff if the doctordoes not arrive quickly). Nevertheless, communication skills and well-designedprotocols can overcome such barriers to understanding.

View the wait time issues as a whole system. Evaluate door-to-doctor time andpatient flow throughout the hospital.

The physician may be waiting on results from the lab. Study and reduce radiologycycle time.

Some EDs have experienced success in offering service guarantees. After makingthe requisite quality improvements, some have publicly offered a 15/30 guarantee.See a nurse in 15 minutes and a doctor in 30 minutes--or the visit is free. Not onlydoes this explicitly manage patients expectations, but it also translates into acompetitive advantage in the marketplace.

Make certain all physicians are aware of their scores. Reward, recognize and holdindividual physicians accountable. A single ED physician with very poor scores candrag down the entire ED.

Implement a Physician Assistant (PA) Program. Have several PAs and a set ofnurses handle patients who present less serious symptoms in the ED. This helpsdecrease door-to-doctor wait times and overall patient length-of-stay, and prevents

patients from leaving without being seen. Relocate the physician and mid-level provider to the triage area so that patients can

be evaluated by a physician immediately upon arrival and while still in triage. Youcan then take the urgent patients directly to a bed. Patients who are non-urgent andrequire rapid and/or focused medical treatment (but not necessarily a bed) can besent to a larger waiting area under the supervision of two nurses.

Display two clocks over each door in the ED: one showing time the patient went intothe room, and the other to display how long it has been since a hospital teammember visited the waiting patient.

Display posters reinforcing the fact that patients are not in a typical doctors office,focusing on trauma prevention, and make sure the urgent nature of injuries stated on

the posters. Provide frequent updates and manage expectations. Revisit the patient at least once

every 30 minutes to acknowledge that he/she is still waiting, show the patient he/sheis not being forgotten, explain the continuing delay, and give an estimate of how longthe wait will continue.

At every stage of the process, "stamp" patients in a time clock so that the team cantrack patients from the time they walk in until a physician discharges them.


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12. San Jacinto Methodist Hospital (Houston, TX). Compass Award Winner, 2006.


_details_page?contentId=713. Sutter Solano Medical Center (Vallejo, CA). Compass Award Winner, 2007.


_details_page?contentId=23314. Tuomey Healthcare System (Sumter, SC). Compass Award Winner, 2006. Available


http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=7http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=7http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=7http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=233http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=233http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=233http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=9http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=9http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=9http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=9http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=9http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=233http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=233http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=7http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=7


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Nurses

Section


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Courtesy of the nurses

Nurses

QUESTION DEFINITIONThis question measures a dimension of communication. It is not so much a matter ofwhat is said or done, but how it is said or done. Courtesy is one of the most basicelements of human communication. The degree to which a nurses interaction with apatient is courteous indicates respect toward the patient. In an ED setting, the urgencyof the situation may affect the priority staff assigns to being courteous. Attending tourgent medical needs expeditiously may be of primary importance at any particularmoment. However, courtesy should not be overlooked entirely (nor should rudeness be

shown or tolerated) because it sends an important message regarding respect to thepatient and family.


"I really didnt feel comfortable with that nurse caring for me. Its hard to believesomebody who is supposed to have my best interests at heart could be so rude."


Be positive. Never speak negatively about the patient, other staff, physicians or theinstitution. Provide staff with team building exercises to help improve relationships.

Dont talk about negative aspects of your personal life. Only under rare, exceptional

circumstances is it appropriate to share details of your surgeries, your childbirth,your love life, your religion, etc. To be safe, error on the side of caution by keepingthese personal details to yourself.

Always use "please" when making requests and respond with "thank you" whenconcluded.

Introduce yourself to the patient. Employ a hand shake or gentle touch.

Use ID badges that present the nurses name and distinguish them from otherpersonnel.

When ready to leave the room, ask "Is there anything else I can do for you?" Be aware that nurses appearance (e.g., disheveled vs. well-kept), behaviors (e.g.,

tone of voice), and even smells (e.g., too much perfume, smoke, etc.) can influence

patients perceptions. What is your vacancy rate? What is your turnover? If suffering from a high vacancy

and/or turnover, your organization and management may not be creating a satisfyingan attractive work environment.

Offer customer service, communication, sensitivity and/or empathy training. Helpnurses become aware of how they communicate with patients through their wordsand actions.


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Develop scripts or suggested phrases to help standardize responses to requests.

Take patients requests and expressions of concern seriously. Evaluate your hiring practices. Are you hiring just anyone? Hire nurses with a

propensity for customer service. Gauge customer service skill in the interview. Use apeer-interview process.

Professional and social prejudices can be founts of rudeness; such attitudes need toremain hidden from patients. Sexually active teens, overly worried parents, ordemanding Medicaid patients have not come to the ED to be morally corrected orpunished.

Develop a script for introducing yourself to the patient and family. Give nursesbusiness cards to provide to patients and family as part of the standard introduction.

Understand and respect patients preferences and cultural backgrounds.

Courtesy and respect can be communicated via body language as well. Aninappropriately hurried manner (or standoffish posture) may signify disrespect and alack of courtesy toward the patient.

Courtesy extends beyond the patient and includes the treatment of friends andrelatives escorting the patient

Employee satisfaction and patient satisfaction go hand in hand. If management doesnot meet the needs of the nursing staff, it may be more difficult for staff to meet andexceed the needs of patients.

Ask patients: "What ONE thing can we do to better serve you next time?" Write theanswers on index cards and post them where your team can see them.

Conduct discharge follow-up calls to patients to inquire about any questions orconcerns regarding treatment given during their stay. Provide patients with a numberthey can call should any issues arise.

Maintain eye contact with the patient while they are talking, and while speaking tothem--do not interrupt.

Thank patients for the opportunity to treat them by sending handwritten thank younotes signed by all caregivers.

RESOURCES1. Baylor Regional Medical Center at Grapevine (Grapevine, TX). Success Story

Winner, 2008. Available from:http://www.pressganey.com/cs/archives/success_story_archives_details_page?contentId=160

2. Brady SL, Wojciechowski SL. Planting the Seed for Change: Developing Home-Grown Customer Service Standards. Satisfaction Monitor. Jul/Aug 2003. Availablefrom:http://www.pressganey.com/galleries/satisfaction-monitor-issues/julaug03.pdf

3. CaJacob N, Christian E, Gebauer L, Leeming S, OConner B, Osborn G, Stanga A.A Students Eye View of Emergency Room Culture. Satisfaction Monitor. Mar/Apr2006. Available from:http://www.pressganey.com/galleries/satisfaction-monitor-issues/marapr06.pdf
http://www.pressganey.com/cs/archives/success_story_archives_details_page?contentId=160http://www.pressganey.com/cs/archives/success_story_archives_details_page?contentId=160http://www.pressganey.com/cs/archives/success_story_archives_details_page?contentId=160http://www.pressganey.com/galleries/satisfaction-monitor-issues/julaug03.pdfhttp://www.pressganey.com/galleries/satisfaction-monitor-issues/julaug03.pdfhttp://www.pressganey.com/galleries/satisfaction-monitor-issues/julaug03.pdfhttp://www.pressganey.com/galleries/satisfaction-monitor-issues/marapr06.pdfhttp://www.pressganey.com/galleries/satisfaction-monitor-issues/marapr06.pdfhttp://www.pressganey.com/galleries/satisfaction-monitor-issues/marapr06.pdfhttp://www.pressganey.com/galleries/satisfaction-monitor-issues/marapr06.pdfhttp://www.pressganey.com/galleries/satisfaction-monitor-issues/marapr06.pdfhttp://www.pressganey.com/galleries/satisfaction-monitor-issues/marapr06.pdfhttp://www.pressganey.com/galleries/satisfaction-monitor-issues/julaug03.pdfhttp://www.pressganey.com/cs/archives/success_story_archives_details_page?contentId=160http://www.pressganey.com/cs/archives/success_story_archives_details_page?contentId=160


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4. The Christ Hospital (Cincinnati, OH). Success Story Finalist, 2005. Available from:

http://www.pressganey.com/cs/archives/success_story_archives_details_page?contentId=40

5. Gutter E, Marinaro M. Words...The Most Powerful Drug. Satisfaction Monitor.Jan/Feb 2002. Available from:http://www.pressganey.com/galleries/satisfaction-monitor-issues/janfeb02.pdf

6. Knox Community Hospital (Mount Vernon, OH). Compass Award Winner, 2008.Available from:http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards

_details_page?contentId=2757. Malone MP. Today Is Not Your Day. Satisfaction Monitor. Jul/Aug 2000. Available

from:http://www.pressganey.com/galleries/satisfaction-monitor-issues/julaug00.pdf

8. O'Connell D, Baker L. Communication Skills for the Health Care Team: Physicians,Medical and Office Staff. Satisfaction Monitor. Mar/Apr 2000. Available from:http://www.pressganey.com/galleries/satisfaction-monitor-issues/marapr00.pdf

9. Ryan J, Wojciechowski S. More Than Words...Rx for Scripting Challenges: BestPractice Techniques. Satisfaction Monitor. Jul/Aug 2003. Available from:http://www.pressganey.com/galleries/satisfaction-monitor-issues/julaug03.pdf

10. Saint Joseph Health Center. Success Story Finalist, 2004. Available from:http://www.pressganey.com/cs/archives/success_story_archives_details_page?contentId=56
http://www.pressganey.com/cs/archives/success_story_archives_details_page?contentId=40http://www.pressganey.com/cs/archives/success_story_archives_details_page?contentId=40http://www.pressganey.com/cs/archives/success_story_archives_details_page?contentId=40http://www.pressganey.com/galleries/satisfaction-monitor-issues/janfeb02.pdfhttp://www.pressganey.com/galleries/satisfaction-monitor-issues/janfeb02.pdfhttp://www.pressganey.com/galleries/satisfaction-monitor-issues/janfeb02.pdfhttp://www.pressganey.com/galleries/satisfaction-monitor-issues/janfeb02.pdfhttp://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=275http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=275http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=275http://www.pressganey.com/galleries/satisfaction-monitor-issues/julaug00.pdfhttp://www.pressganey.com/galleries/satisfaction-monitor-issues/julaug00.pdfhttp://www.pressganey.com/galleries/satisfaction-monitor-issues/julaug00.pdfhttp://www.pressganey.com/galleries/satisfaction-monitor-issues/marapr00.pdfhttp://www.pressganey.com/galleries/satisfaction-monitor-issues/marapr00.pdfhttp://www.pressganey.com/galleries/satisfaction-monitor-issues/julaug03.pdfhttp://www.pressganey.com/galleries/satisfaction-monitor-issues/julaug03.pdfhttp://www.pressganey.com/cs/archives/success_story_archives_details_page?contentId=56http://www.pressganey.com/cs/archives/success_story_archives_details_page?contentId=56http://www.pressganey.com/cs/archives/success_story_archives_details_page?contentId=56http://www.pressganey.com/cs/archives/success_story_archives_details_page?contentId=56http://www.pressganey.com/cs/archives/success_story_archives_details_page?contentId=56http://www.pressganey.com/galleries/satisfaction-monitor-issues/julaug03.pdfhttp://www.pressganey.com/galleries/satisfaction-monitor-issues/marapr00.pdfhttp://www.pressganey.com/galleries/satisfaction-monitor-issues/julaug00.pdfhttp://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=275http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=275http://www.pressganey.com/galleries/satisfaction-monitor-issues/janfeb02.pdfhttp://www.pressganey.com/galleries/satisfaction-monitor-issues/janfeb02.pdfhttp://www.pressganey.com/cs/archives/success_story_archives_details_page?contentId=40http://www.pressganey.com/cs/archives/success_story_archives_details_page?contentId=40


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Degree to which the nurses took the time to listen to you

Nurses

QUESTION DEFINITIONThis question measures the patients perception of one aspect of communication withthe nurses. Communication is an exchange between patient and care provider. Patientswill likely express dissatisfaction with nurses who do not allow the patient to be anactive participant in the exchange. Additionally, if care is to be delivered in a patient-centered fashion, then the patient must be given a voice and an active role. Patients arelikely to feel their role has been diminished if the nurses hurry through interactions anddo not make time to listen to what they might have to say.


"I realize they are the medical experts, but I am the one that is affected by all this.Why wont anyone listen to me?"


Train all front-line staff in service recovery, communication skills and emotionsmanagement.

Learn and practice service recovery steps such as: Acknowledge, Apologize, andAct to Amend.

Dont talk about negative aspects of your personal life. Only under rare, exceptional

circumstances is it appropriate to share details of your surgeries, your childbirth,your love life, your religion, etc. To be safe, error on the side of caution by keepingthese personal details to yourself.

When ready to leave the room, ask "Is there anything else I can do for you?" Cultivate a culture that prioritizes and values all patients whether a "good" patient or

a "pesky" patient. This can be accomplished through personal and team exercise.Managers should discourage staff from placing labels on patients.

Acknowledge patient expressions of distress over some aspect of the procedure.

Professional and social prejudices can be founts of rudeness; such attitudes need toremain hidden from patients. Sexually active teens, overly worried parents, ordemanding Medicaid patients have not come to the ED to be morally corrected or

punished. Remind staff it is their responsibility to care for the patient and to keeptheir personal views private.



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Ideally, the admitting person--the first person the patient talks to about his/her

problem--is a nurse, not a clerk. Many people are uncomfortable describing personalhealth problems to non-clinicians, especially if the person looks relatively young.

Examine various types of ED visits from the perspective of the patient andstreamline wherever possible. Are there points where you require the patient torepeat his/her explanation for the condition multiple times (e.g. once to the triagenurse and then again to the ED nurse prior to seeing the physician)? Repeating thesame information to multiple nurses gives the impression that no one is reallylistening.

Do staff utilize proven techniques of active listening? Maintaining eye contact, notinterrupting, nodding, using open-ended questions and reflective responses, etc.--these are all methods to visibly acknowledge your participation and awareness of

what the patient is saying. Provide training to help staff improve this skill. Performing clinical duties while communicating with the patient is acceptable but

significantly increases the need for the acknowledgements of understanding. On theother hand, stopping whatever one is doing to completely focus on the patient sendsa powerful message of respect and concern.

Organize group discussions led by a facilitator that is skillful at helping staff confrontany underlying feelings about who is or is not a "legitimate" emergency patient.There is a tendency to morally evaluate patients when making a medical evaluation.Negative predispositions about which patients are "deserving" can come across ininteraction with and management of patients. These issues may include elements ofracism or socioeconomic prejudices.

Use in-person professional translators whenever possible. Multiple part-timeprofessional translators are a cost-effective option.

Insensitivity to patients, family and friends may be rooted in your nurses jobsatisfaction. How they are being treated will affect how they treat patients. Tap intotheir perspective and do whatever possible to support them.

When a patient is first admitted, spend a moment talking to them about any specialneeds they may have.

When talking with patient, put down your chart or clipboard and make eye contact.This lets the patient know you are really listening.

When a patient seems eager to discuss elements of their life and situation, eventhough you may be pressed to make your rounds, take a moment to listen and

discuss. Let the patient know that while you would prefer to take more time to talk tohim/her, you need to finish some work and if possible will return later to talk further.Never disengage by simply walking away, or by interrupting the patient and cuttinghim/her off. By taking a moment to listen and letting the patient know why you cantstay the patient will not feel cut short.

Acknowledge the patients life outside the ED. Do not forget that patients have otherthings going on in their lives. Let them know that they can use their cell phones ifthey need to arrange things at home or work, empathizing with how inconvenient it is


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for them to spend the morning/afternoon/evening etc, in the ED. If they do not have

a cell phone, offer to get a portable phone for them. Sometimes simply repeating back to the patient what they just told you is enough to

show the patient that you were listening and care enough to make sure its correct.

RESOURCES1. Baylor Regional Medical Center at Grapevine (Grapevine, TX). Success Story

Winner, 2008. Available from:http://www.pressganey.com/cs/archives/success_story_archives_details_page?contentId=160

2. CaJacob N, Christian E, Gebauer L, Leeming S, OConner B, Osborn G, Stanga A.A Students Eye View of Emergency Room Culture. Satisfaction Monitor. Mar/Apr

2006. Available from:http://www.pressganey.com/galleries/satisfaction-monitor-issues/marapr06.pdf

3. Tomlinson JC, Fisher K, Jones E. Transforming the Culture in the EmergencyDepartment: "PR in the ER". Satisfaction Monitor. Nov/Dec, 2002. Available from:http://www.pressganey.com/galleries/satisfaction-monitor-issues/novdec02.pdf

4. Van Wert County Hospital (Van Wert, OH). Success Story Finalist, 2001. Availablefrom:http://www.pressganey.com/cs/archives/success_story_archives_details_page?contentId=130
http://www.pressganey.com/cs/archives/success_story_archives_details_page?contentId=160http://www.pressganey.com/cs/archives/success_story_archives_details_page?contentId=160http://www.pressganey.com/cs/archives/success_story_archives_details_page?contentId=160http://www.pressganey.com/galleries/satisfaction-monitor-issues/marapr06.pdfhttp://www.pressganey.com/galleries/satisfaction-monitor-issues/marapr06.pdfhttp://www.pressganey.com/galleries/satisfaction-monitor-issues/marapr06.pdfhttp://www.pressganey.com/galleries/satisfaction-monitor-issues/marapr06.pdfhttp://www.pressganey.com/galleries/satisfaction-monitor-issues/novdec02.pdfhttp://www.pressganey.com/galleries/satisfaction-monitor-issues/novdec02.pdfhttp://www.pressganey.com/cs/archives/success_story_archives_details_page?contentId=130http://www.pressganey.com/cs/archives/success_story_archives_details_page?contentId=130http://www.pressganey.com/cs/archives/success_story_archives_details_page?contentId=130http://www.pressganey.com/cs/archives/success_story_archives_details_page?contentId=130http://www.pressganey.com/cs/archives/success_story_archives_details_page?contentId=130http://www.pressganey.com/galleries/satisfaction-monitor-issues/novdec02.pdfhttp://www.pressganey.com/galleries/satisfaction-monitor-issues/marapr06.pdfhttp://www.pressganey.com/galleries/satisfaction-monitor-issues/marapr06.pdfhttp://www.pressganey.com/cs/archives/success_story_archives_details_page?contentId=160http://www.pressganey.com/cs/archives/success_story_archives_details_page?contentId=160


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Nurses attention to your needs

Nurses

QUESTION DEFINITIONED patients present particular challenges. How well nurses listen to patients and learntheir unique needs will influence patients' perceptions of nurses' attentiveness.


"The nurse was rude and wouldn't listen to me."


Develop cultural competence among staff. Help them learn to recognize, respectand work with patients different cultures, values, beliefs, practices and rituals.

Anticipate and address common concerns without the patient having to raise themexplicitly.


Ensure staff utilizes proven techniques of active listening. Maintaining eye contact,not interrupting, nodding, using open-ended questions and reflective responses,etc.--these are all methods to visibly acknowledge your participation and awarenessof what the patient is saying. Provide training to help staff improve this skill.

Nurses may be used to dismissing the concerns of certain patients. Organize groupdiscussions led by a facilitator skillful at helping staff confront any underlying feelingsabout who is or is not a "legitimate" emergency patient. There is a tendency tomorally evaluate patients when making a medical evaluation. Negativepredispositions about which patients are "deserving" can come across in interactionwith and management of patients. These issues may include elements of racism orsocioeconomic prejudices.

Insensitivity to patients, family and friends may be rooted in your nurses jobsatisfaction. How they are being treated will affect how they treat patients. Tap intotheir perspective and do whatever possible to support them.

Patients will vary in their tolerance of pain and their willingness to be helped by staff.

While standardized protocols are appropriate in clinical treatment, they may fall shortin personal treatment. Scripting for patient interaction may handle the commonissues, but unique issues will require special solutions.

Publicly recognize and reward those who go above and beyond in service topatients.

Positively reinforce your behavioral standards as systematically and consistently aspossible. For example, nurse managers or the ED director could send hand-written


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notes or cards to associates who were named positively in patients comments,

thanking them for their outstanding work. Do you consistently and memorably reward and recognize nurses who go above and

beyond to provide outstanding service to patients or families? Are nurses empowered with the tools, skills and authority to make judgment calls in

service delivery (such as service recovery) without having to ask permission orpetition multiple channels?

Is your ED too large and cumbersome organizationally to effectively detect and reactto each patients unique service scenario? Consider reorganizing into smaller teamsor a micro-systems approach.

Assess your EDs organizational learning needs. Are there any key servicecompetencies that your staff could benefit from developing (e.g., cultural

competence, teamwork, Myers-Briggs, etc.)? How patient-centered is your staff? Are they even concerned about patient

satisfaction? Do they receive regular (at least bi-weekly) feedback on patientsatisfaction scores, patients comments (compliments and complaints), etc.? Yourinternal communication with and expectations for staff regarding patient satisfactionwill partially determine your outcomes.

Tell the patient what you can do for him/her rather than what you cannot do.

By definition, this question measures the "attention" or action taken when needs ofthe patient are presented. This means either doing what they ask be done, referringit to someone who can, or explaining why it cannot be done. In all cases, you mustcommunicate often with the patient about the status of the request or need. In some

cases, this may be an emotional or spiritual need, which can be tended to simply bychecking in periodically to see how he/she is doing and whether there is anything oranyone that can help resolve their need. This will give the patient a sense that theirspecific needs are being tended to.

Have a "needs log" book or system in place in order to track which patients haveexpressed needs. This will also track who first acknowledged the need, whether itwas taken care of, and the date/time it was taken care of. This will give staffownership of patients needs and ensure that nothing is overlooked. Notify thepatient that this process is in place to ensure they have their needs met oracknowledged in a timely manner.

RESOURCES1. CaJacob N, Christian E, Gebauer L, Leeming S, OConner B, Osborn G, Stanga A.

A Students Eye View of Emergency Room Culture. Satisfaction Monitor. Mar/Apr2006. Available from:http://www.pressganey.com/galleries/satisfaction-monitor-issues/marapr06.pdf

2. Malone MP, Ryan J, Wojciechowski SL. The Cultural Components of a PatientCentered Organization. Part I. Satisfaction Monitor. Mar/Apr 2003. Available from:http://www.pressganey.com/galleries/satisfaction-monitor-issues/marapr03.pdf
http://www.pressganey.com/galleries/satisfaction-monitor-issues/marapr06.pdfhttp://www.pressganey.com/galleries/satisfaction-monitor-issues/marapr06.pdfhttp://www.pressganey.com/galleries/satisfaction-monitor-issues/marapr06.pdfhttp://www.pressganey.com/galleries/satisfaction-monitor-issues/marapr06.pdfhttp://www.pressganey.com/galleries/satisfaction-monitor-issues/marapr03.pdfhttp://www.pressganey.com/galleries/satisfaction-monitor-issues/marapr03.pdfhttp://www.pressganey.com/galleries/satisfaction-monitor-issues/marapr03.pdfhttp://www.pressganey.com/galleries/satisfaction-monitor-issues/marapr06.pdfhttp://www.pressganey.com/galleries/satisfaction-monitor-issues/marapr06.pdf


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3. Malone MP, Ryan J, Wojciechowski SL. The Cultural Components of a Patient

Centered Organization. Part II. Satisfaction Monitor. May/Jun 2003. Available from:http://www.pressganey.com/galleries/satisfaction-monitor-issues/mayjun03.pdf

4. Tomlinson JC, Fisher K, Jones E. Transforming the Culture in the EmergencyDepartment: "PR in the ER". Satisfaction Monitor. Nov/Dec, 2002. Available from:http://www.pressganey.com/galleries/satisfaction-monitor-issues/novdec02.pdf

5. West Georgia Health System (LaGrange, GA). Compass Award Winner, 2007.Available from:http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards

http://www.pressganey.com/galleries/satisfaction-monitor-issues/mayjun03.pdfhttp://www.pressganey.com/galleries/satisfaction-monitor-issues/mayjun03.pdfhttp://www.pressganey.com/galleries/satisfaction-monitor-issues/novdec02.pdfhttp://www.pressganey.com/galleries/satisfaction-monitor-issues/novdec02.pdfhttp://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=229http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=229http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=229http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=229http://www.pressganey.com/cs/industry_awards/compass_awards/compass_awards_details_page?contentId=229http://www.pressganey.com/galleries/satisfaction-monitor-issues/novdec02.pdfhttp://www.pressganey.com/galleries/satisfaction-monitor-issues/mayjun03.pdf


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Nurses concern to keep you informed about your treatment

Nurses

QUESTION DEFINITIONThis question measures the patients perception about the nurses communicationregarding the treatment process. A variety of things happen to the patient in the hospitalED, and the communication of these things often falls on the shoulders of the nurse.The patients rating results not only from what was communicated but also what wasnot. Unanswered questions, surprises, confusion and/or a lack of understanding abouthow something or process works all speak to a lack of information from the patientsperspective.

The patient expects to understand:

What will happen

When it will happen Why it will happen

Who will make it happen

Where it will happen

How it will happen

The result of it happening


"Ive never been to the emergency room before. I really had no clue what was goingon."

"Nobody told me that I might have to spend the night in observation. I was totallyunprepared."


Compose and have "scripts" or phrases designed to communicate to the patient in acomforting manner (e.g., How to say in a nice way what Medicare will or will notcover; How this procedure will feel; How we will care for them, etc.).

Publicly reward and recognize nurses who go above and beyond to meet patientsneeds.

If information cannot be obtained or provided, explain why and apologize. Consider your patients language needs--offer information sheets in different

languages, multilingual nurses and/or translation services. Inform patients of theseservices.

Make certain all literature and educational materials are readable by patients with alow-literacy level.


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Make certain that patients receive the volume of information they desire. Some

patients may desire no information or suffer from information overload. Others maynot be able to get enough. If you have to choose without patient input, err on theside of offering information.

How patient-centered is your staff? Are they even concerned about patientsatisfaction? Do they receive regular (at least bi-weekly) feedback on patientsatisfaction scores, patients comments (compliments and complaints), etc.? Yourinternal communication with and expectations for staff regarding patient satisfactionwill partially determine your outcomes.

Develop communication protocols that hardwire certain standard phrases to specificencounters which frequently occur during an ED visit. These are typicallyexplanations and information about what is happening that patients need and desire

but staff frequently overlook because the activities are so familiar. For example,concise explanations about blood draws, IV sticks, pain control, etc.

Have patient education materials or written documents/brochures on commonconditions and treatments that can supplement the verbal explanations of the nursesand physicians.

Conduct workshops and brief-learning sessions (being aw

Documents

Solutions Starter Emergency Department