Improving Patient Satisfaction: A Medical Student Focused Performance Improvement Project

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Debra Patterson
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1 Improving Patient Satisfaction: A Medical Student Focused Performance Improvement Project Shauna Roberts, M.D., Gerald Early, M.D., M.A., Jill Moormeier, M.D., Ashley Bauer, Neha Sharma, Nikoo Cheraghi, Aaron Bonham, M.S., Louise Arnold, Ph.D. University of Missouri-Kansas City Truman Medical Center Key Contact gerald.early@tmcmed.org Background Medical students are important providers, particularly in safety net health care. They spend more time with patients than either resident or faculty physicians, have an opportunity for relationship building with patients, can discover dissatisfiers and potentially can improve inpatient satisfaction scores. Their time and impact on patient care might be made more productive and satisfying by structuring additional elements of active roles in team care. Teaching institutions frequently have lower patient satisfaction 1 and we were unable to find studies of medical student s direct impact on inpatient satisfaction scores. Purpose of the Study To determine whether medical students provided with data feedback about their team s performance and information about successful methods of improving patient satisfaction, can improve hospital inpatient patient satisfaction scores. All of our patients interact with medical students. Methods This study was limited to medical student docent teams at Truman Medical Center Hospital Hill (TMC) which is an urban, core safety net hospital as well as a primary teaching hospital. The study lasted from July 2008 to July As part of TMC s strategic goal of quality outcomes, patient satisfaction is measured with Press Ganey data. Press Ganey is the largest hospital patient satisfaction survey group, working with more than 1000 hospitals; TMC began participating in early After patient discharge from inpatient status the patient s contact information is forwarded to Press Ganey through a secure portal. Press Ganey sends surveys to a sampling of patients (in English and Spanish) and 13.85% of surveys were returned. The responses are de-identified and analyzed before being made accessible to TMC. Fifteen medical student teams consisting of 8-10 students on their annual two month Internal Medicine docent service rotation constituted the intervention group. They received information about how to improve patient satisfaction (Appendix), their team s historic patient satisfaction data and new patient satisfaction survey data that was updated

2 every two weeks. These medical student teams were monitored for change, comparing the baseline and post intervention survey results. Results During the time of the intervention there was a statistically significant improvement in the Overall Satisfaction performance for the intervention teams (p=0.039). Although small favorable incremental changes were seen initially in the other measures (see survey questions, Appendix A.2) they were not significant, and deterioration occurred during hospital wide focus on discharge medication reconciliation (along with a decrease in patient satisfaction scores associated with the discharge process). Many patients wrote appreciative notes regarding medical students and this phenomenon had not previously been observed. Conclusions and Implications 1. Medical student based intervention can impact Overall patient satisfaction. 2. This method, at least as applied, was not successful in improving patient satisfaction scores relating to Satisfaction with the Physician. 3. We postulate that patients did not perceive the medical students as physicians nor as survey measurable members of the healthcare team. Resource 1. Clare PA, Drain M, Leddy KM, Wolsin RJ. Patient Satisfaction in Academic Medical Centers. Annals of Behavioral Science and Med Educ. 2005; 11:

3 Appendix A.1 Angry Patients Reasoning with an enraged person is not possible o Only objective is to reduce level of arousal so discussion becomes possible Techniques: Respect personal space Be aware of resources people, space, objects Behave with dignity and respect toward the other person Give choices if possible Empathize with feelings, not behavior Give consequences of inappropriate behavior without threat or anger Explain limits and rules in firm but calm and respectful manner Do NOT: Ask questions about how they are feeling Interpret feelings Say, I know how you feel. Argue or convince Say Calm down. Belittle or minimize the problem Argue, blame, give orders Lecture Take insults personally or try to defend the insult Cross arms Shrug shoulders Point finger Touch Turn your back Be at a lower eye level Guidelines: Pay attention when patients become anxious and try to help Listen to their concerns, allow their full list Remain calm but firm Watch your body language-do not be dismissive but be engaged Meet what they need to the best of your ability Allow them to retain dignity, while avoiding injury Pay attention to your instinct and call for help if needed

4 Appendix A.2 SERVICE RECOVERY Service recovery is a tool to recognize, prevent, and correct unmet expectations. It is an immediate acknowledgement to a patient s concern or complaint that is handled with respect, sensitivity, and professionalism. When conducting service recovery, use the HEAT model: Hear them out Empathize Apologize Take responsibility Hear: The patient most likely feels like no one is listening to their concern or complaint. Show him/her you are by being still, making eye contact, and paraphrasing the complaint back to the patient when they have finished to let them know you have heard and understood. Be careful to ensure your body language and tone of voice show concern. Can you describe what your concerns are? So what you re telling me is Empathize: Let the patient know that you hear and understand their concern. Put yourself in their place and try to understand how they might be feeling. I can understand how this could be difficult for you. I can see how this must be frustrating. Apologize: Saying you re sorry is not the same as admitting fault. You are simply letting the patient know you are sorry this was his/her experience. We re sorry you were inconvenienced. Thank you for being patient. Sorry for the delay. Take Responsibility: If you receive the complaint, you own the complaint! Provide solutions and make sure the patient knows that you will be taking care of his/her problem and let them know what you plan to do. Be sure to update the patient on progress and outcomes. Mr. Smith, here s what we can do Mr. Smith, I ve spoken with the charge nurse and Key Words at Key Times Service Recovery I m sorry What can I do to make this better for you? Here s what I d like to do Would it be okay if Thank you for taking the time to share this concern with me. Thank you for giving us the opportunity to improve our service. We want to ensure you receive very good care. Thank you for understanding.

5 Table 1a- Press Ganey Data for One Clinical Rotation (Part 1) Clinic Example of Patient Satisfaction How well your pain was controlled Skill of physician Friendliness/courtesy of physician Physician kept you informed Physician concern questions/worries Time physician spent with you Physician Satisfaction Overall Satisfaction Baseline Data 1st Update 2nd Update 3rd Update 3 rd Update, n =21 Target benchmark is 90th percentile; 3 rd Update scores for Physician Overall are at the 1 st percentile in NAPH and 1 st percentile in the Large Press Ganey Database Table 1b Specific Questions for Residents and Medical Students from Press Ganey Resident/Med Student Specific Questions - 3rd Update Confidence in care from residents* Courtesy/profess interns/residents* Hse staff identified themself/roles*

6 Press Ganey Survey Questions: TMC HH data is based on the following survey questions: Time physician spent with you Physician concern questions/worries Physician kept you informed Friendliness/courtesy of physician Skill of physician How well your pain was controlled Overall satisfaction with physicians Overall hospital satisfaction

MEDICAL ASSISTANT : COMMUNICATION WITH PATIENTS.

MEDICAL ASSISTANT : COMMUNICATION WITH PATIENTS. The most important abilities of a CMA are: the ability to Communicate effectively, with professionalism and diplomacy to all types of patients. Recognize