What's on patients' minds? Forums, surveys, help staff improve the patient experience

Laurel Hibbard, RN, Adult ED, talks with patient Patricia Rowland. ED staff are communicating more frequently with patients about their status, which, along with reducing length of stay, has helped improve the ED's patient satisfaction scores.
Laurel Hibbard, RN, Adult ED, talks with patient Patricia Rowland. ED staff are communicating more frequently with patients about their status, which, along with reducing length of stay, has helped improve the ED's patient satisfaction scores.

To improve our patients' experience, it's important to see things from their perspective.

But that's not always easy for busy employees who are on the providing end of the care.

That's where Patient Experience Forums come in. Every two weeks, leaders and frontline staff from each Yale-New Haven Hospital service line meet through Patient Experience Forums to review patient comments and patient experience scores to identify trends. Patient and family advisors are members of each forum, providing the patient perspective from personal experience. In addition, patient survey scores and comments are shared with all unit/department staff.

"It's critical that all staff members are knowledgeable about what patients are thinking so they can contribute their ideas and be prepared to help in improving the patient experience," said Cynthia Sparer, senior vice president, YNHH and executive director, Yale-New Haven Children's Hospital. "They are the face of the organization to our patients."

But knowing how patients feel about their care isn't enough, so members of each Patient Experience Forum also use scores and comments to identify items requiring action and create work plans to address them. Every month, leaders from Patient Experience Forums present their work plans, next steps and progress reports to a hospital-wide Patient Experience Steering Committee.

Creating a quiet, healing environment is one issue the Patient Experience Forums and hospital as a whole have been working on that comes up repeatedly in survey scores and comments. Sparer recalled rounding on a patient care unit recently when the assistant patient service manager excused herself to talk to a group of new residents. The APSM returned and explained that she was reminding the residents to use library voices.

"Instead of being punitive, she made it part of their learning experience," Sparer said. "We have a lot of work to do on quiet, but that's how it starts. We're seeking to build a culture where quiet and all of the other patient experience behaviors we talk about take root."

Quiet is crucial, but it's just one element of creating a healing environment, Sparer said.

Clinical staff are also discussing how they can change the way they deliver care to ensure patients get the rest they need. In some cases, staff might be able to wait until later in the morning to draw blood or perform other procedures to avoid waking patients, or perform several procedures at once to avoid disturbing patients' rest multiple times. Clinical staff are not the only employees who play a role in the patient experience, which begins with the patient's arrival and includes employees across the hospital.

"A positive patient experience is not about one interaction," Sparer said. "Everybody plays a role."

As a result of patient feedback and the work of its Patient Experience Forum, PFAS staff with Women's Services at the York Street Campus now escort patients in labor to their destinations rather than just giving them directions.

Patient feedback has also helped guide changes in the Adult Emergency Department at the YSC that have helped dramatically improve satisfaction scores. One major change is better and more frequent communication from staff. Every ED staff member who enters a patient room introduces him- or herself, and throughout a patient's stay, frequently updates patients about what's going on, said Mark Sevilla, RN, MSN, director, Emergency Services.

"When I round on patients, I find they know who their caregivers are — or they can point to the white board in the room that lists their caregivers' names — and they know what tests or procedures they're waiting for," he said. "We've also seen a change in patient survey comments. Before, a lot of people said they were left alone and no one told them what was going on. Those comments are very infrequent now."

The other major contributor to higher satisfaction scores is reduced length of stay for patients who are treated in and discharged from the ED. To tackle this issue, department leaders reviewed data and sought ways to reduce waiting, treatment and discharge times. One improvement they instituted is a "pull to full" system, in which patients are brought to empty beds as soon as beds are available.

"When you're in a treatment room, the perception is that you've begun treatment, vs. sitting in the waiting room," Sevilla said.

Better communication and reduced length of stay have helped increase overall Press Ganey satisfaction scores at the York Street Campus Adult ED from the 9th percentile two years ago to the 43rd percentile for the third quarter of this fiscal year, when the overall satisfaction score reached 85 percent. ED staff aren't stopping there, Sevilla said.

"Successfully addressing these two major issues — which are key to a positive experience for ED patients — opens the door for us to implement other changes that will further improve patient satisfaction," he said.