Find your facility’s fit

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Patient care

Find your facility’s fit

Piece together an effective patient satisfaction program

After reading this article, you will be able to:

  • Identify strategies to boost patient satisfaction

Achieving complete patient satisfaction is every facility’s goal when implementing a patient satisfaction program. But it takes innovative nurse leaders to find the right pieces for the program and an engaged staff to make them fit.

This was the situation at Norton Suburban Hospital, located in Louisville, KY, whose postoperative unit’s collaborative program pushed its overall Press Ganey patient satisfaction score from the 1st percentile in 2006 to the 97th percentile in 2007. Two years later, the score lingers in the 92nd percentile.

“We tried a lot of different approaches during the [previous two years] and nothing was successful,” says Shelia Goold, RN, CBN, nurse manager of the unit. “We had to make some major changes.”

Identifying weak spots

Goold and Carol Goss, MSN, RN-BC, medical-surgical clinical educator at the facility, set out to make changes by first reviewing nursing literature and other facilities’ best practices. They sought to pinpoint areas in which their unit could improve and developed the following measures:

  • Customer satisfaction team. Goold, frontline staff members, and a representative from the facility’s service excellence department formed a unit team to garner staff feedback about patient satisfaction practices that were ineffective and how they could be improved. The team also met with patients to ask what was most important to them.
  • Patient satisfaction surveys. The unit monitored Press Ganey surveys to compare its results to those of other hospitals across the country.

Goold and Goss then built initiatives around four questions on the survey in which the unit scored poorly. The initiatives focused on how staff members:

  • Controlled patients’ pain
  • Included patients in treatment decisions
  • Paid attention to patients’ personal and special needs
  • Responded to patients’ calls

Hosting a convention

Goss organized a patient satisfaction convention and invited all hospital units to educate everyone about the new patient satisfaction initiatives and ensure that all staff members understood them. The convention included the following discussion and training exercises:

  • Norton Healthcare service basics: Covered the importance of safe work habits, communication, teamwork, and professional behavior
  • Press Ganey 101 session: Explained how to interpret patient satisfaction survey data
  • Torchbearer training: Taught key individuals tactics for creating a customer service team that they later initiated on their units


“We set [the convention] up like a Republican and Democratic convention,” says Goss. “We had a big hall decorated and [formed] delegates from each of the units.”

Further education about patient satisfaction initiatives were provided to staff members via group and one-on-one meetings, role-playing sessions, and postings on the unit.

Improving staff communication and behavior

Goold and Goss realized that a culture change was also needed to enhance patient satisfaction on the unit, so they developed programs to build a harmonious work environment. They held training sessions on improving multigenerational communication, as well as classes defining horizontal violence that gave staff members tools to address inappropriate behavior. They also implemented a zero tolerance policy for the unit and required all staff members to sign a “Commitment to coworkers” form (see p. 8).

Centering on patients’ needs

Goold and Goss knew patient satisfaction scores couldn’t increase without enhancing staff communication with patients.

Thus, they implemented bedside shift reporting so staff members could perform handoffs in patient rooms, instead of at the nursing station. As a result of their involvement in the development of the program, “staff felt like they owned the program, and we felt they would be more likely to use it,” says Goss.

They also focused on other efforts to encourage patient involvement in care and to ensure that staff members honed in on patient needs, including:

Hourly rounding. Nurses and ancillary staff members in the unit began performing hourly rounds, which Goold says decreased call-light use immensely.

Whiteboards. Patient rooms on the unit now feature dry erase boards, which contain information pertinent to each patient’s care. The information is updated as needed. In addition, all interacting staff members must list their names and contact information on the whiteboards.

Goold says nurses focus on four main areas that are important to patients:

  • Pain. This includes the acceptable pain level determined by the patient, as well as pain medication ordered and the last time it was administered.
  • Information. Patients tell nurses who they want to keep informed of their care, such as a spouse or child, and nurses serve as their messenger.
  • Activities of daily living. Nurses identify the level of activity assistance needed.
  • Special needs. Nurses incorporate anything that is important to the patient in their care (e.g., the patient wants dentures in before seeing visitors).

“Keeping pain under control is of utmost importance,” says Goold. “We talk to patients about their appropriate pain threshold, what pain they are currently experiencing, and what is an acceptable pain level—and we work with them to maintain that pain level.”

Elevating patient satisfaction scores

All these initiatives combined to increase patient satisfaction scores. Goss and Goold attribute the unit’s success to ongoing education and engagement that can be achieved by involving staff members in the building of the program from the beginning.

Commitment to coworkers

As your coworker, with a shared goal of making our patients feel like VIPs (very important patients) by providing high-quality care to patients and families, I commit to the following:

1. I will make a great first impression by always following the Golden Rule: Do unto others as you would have others do unto you.

2. I will accept responsibility for establishing and maintaining healthy interpersonal relationships with every member of this staff. I will talk to you promptly if I am having a problem with you. The only time I will discuss it with another person is when I need help in deciding how to communicate with you appropriately, demonstrating courtesy, clarity, and respect.

3. I will establish and maintain a relationship of functional trust with you and every member of this staff. My relationships with each of you will demonstrate teamwork by being equally respectful, regardless of job titles or levels of educational preparation.

4. I will maintain a secure and trusting environment by not complaining about another team member and ask you not to as well. If I hear you doing so, I will ask you to talk to that person.

5. I will do the right thing by not criticizing, infighting, sabotaging, gossiping, nit-picking, intimidating, threatening, excluding, devaluing, scapegoating, bullying, discouraging, ignoring, or belittling. If I hear you doing so, I will ask you not to as well.

6. I will demonstrate compassion by accepting you as you are today, forgiving past problems, and ask you to do the same with me.

7. I will be committed to ensuring a safe environment by finding solutions to problems rather than complaining about them or blaming someone, and ask you to do the same.

8. I will show appreciation by affirming your contribution to quality service when you keep patients and families informed and participate in the unit process improvement.

9. I will acknowledge your worth by looking at you as I walk down the hall and speaking to you within 5 ft., and ask you to do the same.

10. I will demonstrate compassion by remembering that neither of us is perfect, and that human errors are opportunities not for shame or guilt, but for forgiveness and growth.

11. I will demonstrate pride in my unit, my hospital, and my system by holding myself and my coworkers accountable to stopping horizontal violence in the workplace.

I understand that there is a zero tolerance culture related to horizontal violence in my unit.

____________________________________________________ ______________

Signature Date

Source: Norton Suburban Hospital, Louisville, KY. Adapted with permission.