In Search of Satisfaction

Healthwire
May/June 2012
Feature Story

Unions and hospitals should work together to improve patients' experiences

WHEN IT COMES TO healthcare in the United States, Americans typically pay for quantity, not quality. Our healthcare system is a fee-for-service payment model that creates incentives for lots of tests and procedures that don’t always result in the best care. This focus on volume rather than on wellness serves only to increase the cost of care, which is why the United States has the most expensive health system in the world. Controlling the cost of healthcare was a top priority in crafting the Affordable Care Act.

The health reform law includes provisions that encourage cost shifting by giving incentives to providers for their quality of care. Hospitals will be scored on their ability to follow appropriate processes, to produce certain outcomes and to achieve a certain level of patient satisfaction. High scores will bring rewards and low scores, penalties.

Patient satisfaction is of particular concern for hospitals because starting in October, Medicare will withhold 1 percent of each hospital’s payment for goods and services, but the hospitals will have a chance to “earn that money back” based on their overall quality score; patient satisfaction will constitute 30 percent of the overall score.Hospitals fought to get the weight of the score reduced to 20 percent but were unsuccessful.

Medicare will use the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey (see page 5) to measure patients’ perceptions of their hospital experience. The surveys are key to Medicare’s plan to reward hospitals for the quality of care they provide. The random sample survey asks patients questions about their recent hospital stays, covering areas such as communication with nurses and doctors, responsiveness of staff, the cleanliness and quietness of the hospital environment, pain management, discharge information, the overall rating of the hospital and whether the patient would recommend the hospital.

Hospitals are offering nurses training on how be more customer-friendly in hopes of boosting these scores.

No script needed

The concern, say AFT members, is that many providers are responding to this new emphasis on patient satisfaction by hiring consultants. It’s money, many say, that would be better spent on hiring more staff.

“You don’t need to train people in communicating if you have enough staff,” explains AFT Healthcare director Mary MacDonald. “Everything that hospitals want to achieve with patient satisfaction will require proper staffing.”

At Jersey Shore University Medical Center in Neptune, N.J., workers received training on how to improve patient satisfaction from the Disney Institute (the professional development and experiential training arm of the Walt Disney Co.). The meetings and presentations were designed to teach the workers customer-service skills. The training asked hospital staff to look at patients as guests; this was an idea that Pam Reinhardt, a neonatal intensive care unit nurse at the hospital, struggled with. Reinhardt also found it unnecessary to be coached on how to talk with patients.

“Nurses are pretty compliant. It’s in our nature to put the patient first,” she says. “You don’t need a script to say ‘Good morning’ or to ask ‘How are you feeling?’”
Having consultants from Disney come into the hospital has changed the atmosphere, says Reinhardt, a member of Health Professionals and Allied Employees (HPAE) Local 5058. The consultants also emphasized uniformity in appearance, so now all workers—from nurses and housekeepers to doctors and dietary staffers—must cover any tattoos and piercings.

Terry Myers, a labor and delivery nurse at Armstrong County Memorial Hospital in Kittanning, Pa., believes the focus on customer service by hospitals misses the mark.

Myers’ hospital also has held training sessions for its nurses on customer service. “There are times when I feel like a waitress as I step into a patient’s room and announce: ‘Hi. I’m Terry, and I’ll be your nurse today.’ Patients are being turned into clients. It’s become a whole different ball game.”

Healthcare is a business, but the nature of the business is serious, she says. “It’s not all smiles. Sometimes what needs to be done [to a patient] is painful. ‘Yes, it hurts, but you will get better.’ There are certain things in this work that aren’t pleasant, and there are certain expectations that can’t be met. How long it takes to answer a call bell is rather subjective when you’re in pain.”

Myers, who is president of the Armstrong Nurses Association/Healthcare PSEA at the hospital, would like to see a more realistic snapshot of the patient experience. “It’s likely that people who had a good experience will not fill out the surveys, but the ones who had a perceived problem will.”

But Myers has no problem with being held accountable for the things that nurses actually can improve; however, “sometimes with these surveys you get negative feedback on things you have no control over, like the rooms are too small.”

Before the hospital started using the HCAHPS survey, the hospital used its own survey for patients. “We have talked about going back to those surveys to give us a better idea of where we’re going and what needs to be fixed,” says Myers.

The way she sees it, now is a good time for unions and hospitals to partner to find the best way to improve a patient’s experience.

“Having our own surveys will allow a comparison and allow a true focus on caring for patients, which will result in improving satisfaction scores.”

One satisfying idea: Hire more staff

Most nurses and health professionals are wondering if linking satisfaction scores to reimbursement will eventually get hospitals to adjust their staffing ratios.

The role of the nurse has always been to provide medical care and support to patients and their families. However, the constant cuts to staff make it difficult for health professionals to do their jobs in a manner they believe is best for the patient.

Research studies have revealed a strong link between staffing and quality of care. Most recently, the March 2012 British Medical Journal published a study which found that deficits in the quality of hospital care were common in all countries, including the United States, and that improving hospital work environments (with adequate staff) might be a relatively low-cost strategy to improve safety and quality of care, as well as increase patient satisfaction.

In most hospitals, patients and families are probably aware that nurses can’t spend a great deal of time at each patient’s bedside. A nurse on a medical/surgical unit is likely to have seven or more patients to care for during an eight- or 12-hour shift. Without proper staffing, it’s a struggle to provide safe patient care.

Natacha William, a per diem nurse in the long-term care division at Bergen Regional Medical Center in Paramus, N.J., hopes the hospitals will use these survey results to take a closer look at what’s really happening.

“Our tasks are overwhelming. There is no time to properly educate patients, and we find patients returning to our care again and again,” says William, a member of HPAE Local 5091 at the hospital.

“A lot of times patients feel like they are a burden to you because they see you in a rush,” says William. “A patient may get the exact care he needs, but the nurse may not have time for extended care or ‘customer service.’”

Not just a labor issue

Community members can be strong allies in our effort to provide safe, quality care, says AFT Healthcare’s MacDonald. “Too often people see this issue as a labor or union issue, but we can engage the community on this as well.”
 
For its part, the union can propose changes to improve quality with input from members on the frontlines as well as the community. Unions also can partner with employers to create a gain-sharing program or effort. To do this, hospital employees can work with their hospital managment to set certain goals to improve patient satisfaction. When those goals are met, workers are compensated.

“The best way for union members to make an impact is to get involved,” says MacDonald. “Frontline workers should make their voices heard on quality improvement.”

—ADRIENNE COLES