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What’s the single easiest, fastest and most powerful way to ramp up your patient satisfaction scores by 30 percentile ranking points?

100% Patient Call – Backs.

Here is an example of what we are talking about from an Emergency Department we worked in not so long ago….

This was the result of a combination of changes. They started at 35 percentile ranking on Press-Ganey for the prior year. The target was 75 Percentile Ranking. As you can see here, within a matter of a month their scores shot up to the 98^th percentile ranking. Most consultants would pack up and plead victory at that point.

But as you can see, human behavior is not a linear process. And to sustain that behavior requires a host of additional changes and new behaviors: a transformed culture. It was after about seven months that we knew the client was going to sustain at least top quartile performance, at least 75^th percentile ranking. And with normal variation, they have held on average around the 79^th percentile ranking for the two years since the project.

Many changes were involved, including a house-wide throughput initiative which cut Length of Stay in the Emergency Department in half and got inpatients discharged from the nursing units by noon..

But today we’re going to talk about the one single most important initiative that made the biggest impact and that is 100% Patient Call Backs. We see time and again this is one very effective strategy, which can dispel hopelessness in the staff quickly and replace it with enthusiasm. Just don’t let it become complacency, because to sustain and further change, more needs to be done. But this is the best jump-start.

It may seem strange that something which has nothing to do with the patient’s experience during their visit to the Hospital could change satisfaction scores so completely.

WHY DOES THIS WORK???

There are several reasons.

I will present them in three basic comments; in the order of personal value, but not necessarily the order of actual statistical impact on scores:

1. A call-back to confirm treatment effectiveness and patient well-being is really the appropriate completion of care in the minds of patients.

In an excellent operation, whether it is in healthcare or any other business or service, the satisfaction of the client is confirmed live, person-to-person by a representative of the organization at the close of and again somewhat after the process is completed. It confirms that the client has received the entire service, and that the end point of that service is set by the client, not the provider. It is giving back the authority and control that every customer expects and is entitled to. They cannot enjoy what they have experienced if it is entirely not their choice. And in Emergency Care the options for treatment are largely out of the patient’s hands.

The Call Back is a way to restore that sense of control, that the on-going care of the patient is a partnership. It isn’t a matter of the patient being simply a mass of biochemical parts under the management of the MD when they are in the hospital, and then like a product off an assembly line, they are shipped out on their own without any further support.

In the Number One Hospital the whole person is involved all the way through, and especially after their visit. It is far more than another opportunity for service recovery and prevention of readmissions. It is the clinical opportunity to re-direct care and prevent problems from happening early when some part of the treatment needs to change.

Most ED visits, and hospital stays, end with some healing still to take place. The treatment actually is complete when the patient is healed, and that isn’t in the hospital. So following up until that happens continues that partnership, continues to give patients control over the problem, the trauma to which they were a victim, but now they are the one managing that issue, facilitating their healing and restoration in partnership with the Doctor, God and their family.

And their health crisis is an experience which can bring all a little closer together.  The Number One Hospital is very willing to share that experience, to participate in their appropriate role in that relationship since this is an important chapter, and can be a turning point for the better,  in the lives of their patients.

For this reason the follow up call should ideally be made by a clinician particularly versed in providing phone support and customer satisfaction. If that person can be the clinician who treated the patient, all the better. But if the patient’s caregiver is not particularly strong in managing the comfort and understanding of their patients, then it is best to utilize the help of an RN who does have great interpersonal strengths: listening and teaching skills. That is most important and impactful.

2. When patients leave, their experience is judged in retrospect, and that is a different conclusion than their experience while at the hospital. The two assessments are related, but they are by no means the same. How readily the patient heals, and how completely they heal influences their judgment about the Hospital. You can have very little influence on that at the time when they have not yet healed. It is after their healing is established that the Hospital can help the patient make a realistic assessment of that level of healing.

The call – back is a means of helping put that second opinion into a better perspective by offering to listen, to reflect, and to provide assistance to the patient once they are in that time period where they are making that retrospective evaluation.

3. Statistical Sampling. By encouraging all patients to complete the Satisfaction Survey during the after-care call-back, those patients who have made a generally good evaluation will be more motivated to reciprocate their thanks by making more effort to participate in the survey. Patients select whether to participate, and so the ones with significant dynamic tension, unresolved issues or complaints, will most certainly seek the ear of the survey. To balance the scales it is important to let all patients know that this survey is quite significant to the Hospital and it is something the patient can do to encourage the Hospital to keep up the good work.

When more patients who had a good experience participate in the survey, the over-all scores leap up.