How to Improve Patient Satisfaction Scores By Using Data

By guest contributor Dr. James Merlino, chief experience officer and associate chief of staff of the Cleveland Clinic health system

Our journey to improve patient satisfaction began over 10 years ago, when Cleveland Clinic’s CEO Dr. Cosgrove adopted a guiding principle to put patients first.

The reason we started down this path of putting patients first was because we knew our patients had choices for their care. For example, half of our heart patients are from outside of Ohio — they have plenty of other options for their care.

Because we wanted our patients to continue to choose Cleveland Clinic, it was important for us to get service right. I talk about our journey in detail in my book, Service Fanatics. Our goal throughout the process was to ensure we were taking a service-excellence approach. This meant developing a strategy that included ways to improve the patient’s experience of care.

Designing a service-excellence strategy with analytics

First, we had to address our patient satisfaction scores — we weren’t doing so very well with them back in 2009. Our scores had plateaued, and we ranked among the lowest for physician communication with patients. This was in comparison to 15 other top hospitals like Mayo Clinic, The Johns Hopkins Hospital, Massachusetts General Hospital, and the Ronald Reagan UCLA Medical Center. That’s when I came on board and took the job of chief experience officer at Cleveland Clinic.

We wanted to improve these scores, so we hired an outside firm to conduct a robust quantitative and qualitative study to see exactly what patients wanted. That’s when we discovered our patients’ top three concerns: respect, good communication among staff, and happy employees during their stay.

We were surprised by these findings, and I never would have known any of this without digging into the data with hardcore analytics. But through analytics, we gained valuable insights as to how patients really felt. Their top concerns are as follows:

  1. Respect
    Respect is important to patients because they want providers to treat them like individuals and engage with them personally. This goes against everything providers have learned, though, because we’re taught to be objective and unemotional. For patients, however, this personal connection is important because patients tend to feel that when providers connect with them on a personal level, those providers will make fewer mistakes.
  2. Communication between caregivers
    Since patients aren’t medical experts, they use proxy measures like communication between physicians and nurses to assess the type of care they’re getting. Take, for example, the doctor who walks into a patient’s room at 7:00 a.m. to speak with a patient. Then at 9:00 a.m., a nurse comes in, and the patient asks the nurse to repeat what the doctor said, but the nurse doesn’t know. The perceived lack of communication between the doctor and the nurse leads some patients to believe that they are receiving substandard care — because that’s what would happen if the doctors and nurses aren’t even talking to each other.
  3. Happy providers
    Patients want to see happy providers because happy providers are more approachable. Take, for example, the doctor who walks into a patient’s room but appears to be in a hurry. Patients are going to ask fewer questions because they don’t want to contribute to whatever they think the doctor is dealing with. In another example, if a nurse or a doctor walks into the patient’s room and appears to be angry, the patient is often less likely to engage out of concern that he or she will make the provider angrier, or because it’s perceived that the provider is actually angry with or because of the patient.

Using patient comments, anecdotes, and verbatims to drive improvement

We’ve also had great success using patient comments and anecdotes to drive improvement initiatives.

When we had problems in our emergency department (ED), we asked ED leaders what they thought were the major contributors to patient dissatisfaction. They answered, “It’s the wait times.”

Then we drilled down into the data and conducted focus groups. We were surprised to discover that on the scale of what’s most important to patients, wait times were the least important. Displays of concern and caring, however, were most important. The following image highlights our findings.

scale of importance for patient satisfactionDrilling into the data showed us what was most important to patients: displays of concern and caring.

All along, we thought our patient satisfaction scores were low because of terrible wait times, but instead, patients were much more concerned about receiving communication from the hospital workers and being treated with respect.

As result of our discoveries, we piloted an initiative where everybody in the emergency department was taught to communicate with each patient during their wait. For example, the janitor sweeping the hallway near the patient might say, “I know you’ve probably been here a long time. Is there anything I can get you?” Patient experience scores suddenly went up.

While Cleveland Clinic still isn’t where we need to be — we’re at the 67thpercentile for all hospitals that report their doctor communication scores — we’ve made amazing progress with our overall patient satisfaction scores. I’m extremely proud of our accomplishments. But we wouldn’t have made these improvements without data to show us the problem.

Putting patients first to improve patient satisfaction

If health systems want to improve the patient experience, they need to put the patients first and at the center of everything they do. The “soft stuff” counts to patients, and patients will continue to gauge their quality of care on their own proxy measures (like being treated respectfully) because that’s what they understand. Hospital leaders may believe that patients are more concerned about issues like long wait times, but the data shows otherwise.

To really become transformational and succeed in the value-based care environment, hospitals need to understand their patients’ needs. And even though we can’t fix every little problem, we can zero in on the things that matter. And the only way to know how to zero in what matters is by looking at the data.

Interested in learning more about how to build a superior patient experience?

service fanaticsChanging a health system’s culture to become patient-centric is tough. But the transformation is vital, especially for an industry that touches people at their most vulnerable times in life. As someone who watched their father die in the hospital — and go through a patient experience that was less than ideal — I am passionate about improving the experience for all patients. That’s why I’ve written a book about this subject and invite you read it also. Learn more about Service Fanatics: How to Build Superior Patient Experience the Cleveland Clinic Way.

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