Patient Power Pays Off: What World-Class Hospitals Are Doing To Make You A Satisfied Customer

Gulf Breeze, FL - The consumer revolution has led to changes in virtually every industry. We increasingly expect to have things "our way"-from burgers to cell phone plans to bank accounts to mortgage loans-and companies comply. So it's no big surprise that the country's best hospitals are adopting patient-centered health care models. What is surprising is the depth of the strides that have already been made. According to renowned health care consulting firm Studer Group, patient-driven hospitals are becoming the rule rather than the exception.

"There has definitely been a paradigm shift," says Quint Studer, the firm's founder and CEO and author of Hardwiring Excellence: Purpose, Worthwhile Work, Making a Difference (Fire Starter Publishing, April 2004, ISBN: 0-9749986-0-5, $28.00). "Hospital administrators and management teams are well aware that empowered consumers are shaping the goods and services they buy across every spectrum of business. And they are acting on this knowledge with heartening speed. The most successful hospitals are those that listen to what customers want and give it to them. It's that simple."

Studer Group recently hosted a conference titled What's Right in Health Care. More than 900 executives from some of America's top hospitals got together to share stories about what they're doing to improve their health care environments. They found that once they adopt new patient-centered policies, everything else-from patient satisfaction to employee retention to financial stability-falls into place.

Here, Studer Group identifies the characteristics of top-performing hospitals across the country:

• They strive to create a caring, friendly environment. Employees at successful hospitals understand that patients might feel vulnerable or uncomfortable in what seems like an alien environment. They don't know what to expect or how to behave. In short, they don't know how to "be in the hospital." However, patients do know what feels right. So great hospitals work to create an environment of warmth, courtesy, compassion, and promptness. They want patients to have a positive experience and to feel comfortable asking questions and making requests. Creating the right environment is Job One for top-performing hospitals, and their policies reflect that fact.

• They employ "Key Words at Key Times." Patients typically feel "in the dark" about what's happening to them at various times during their stay. Great hospitals take steps to keep patients enlightened about every aspect of their care, even those that may seem insignificant. One small but powerful way to achieve this is by implementing what Studer Group calls "Key Words at Key Times." If a hospital has curtains between beds and a nurse walks into a room and pulls the curtains closed without saying anything, the patient might think that something terrible is about to happen. If the nurse simply says, "Mrs. Medley, we want to make sure you have privacy here at our hospital. Let me close those curtains for you," it puts the patient at ease.

• They regularly communicate credentials. In health care, experience is everything. But too often, a highly experienced doctor wrongly assumes that patients know his or her background. Referrals are so common that many patients really have no idea how experienced a physician might be. That's why great hospitals coach care providers to volunteer their credentials: "I'm Dr. Livingston. I've performed over 8,000 of these procedures during the past 10 years." It's amazing how a sentence like that can calm a patient's anxiety.

• They communicate the plan for patient care. Health care professionals tend to be naturals at clinical procedure but may not be as good at keeping patients informed. Often, they may wrongly assume patients already know what's going on. Great hospitals insist that employees keep patients "in the loop" during each and every interaction. In fact, Studer teaches his clients a system for focusing on interaction with the patient at every service point. The model includes Acknowledgment, Introduction, Duration, Explanation, and Thank You. For instance, a phlebotomist getting ready to perform a blood draw on a patient would use the model in this way:

  Acknowledgment: The phlebotomist makes eye contact and smiles as he enters the room. He says, "Hello, Mrs. Smith, I apologize for waking you, but I want to be sure Dr. Livingston has the results of your blood test when he comes to see you today. We want to make sure you get very good care here."
  Introduction: "I'm Eric, a phlebotomist here at Caring Heart General. I want you to know I'm very experienced at this procedure. I've been specially trained by Caring Heart in this procedure and I've done 50 of these blood draws daily for more than 10 years now."
  Duration: "This should take less than five minutes and then I will turn the lights off so you can go back to sleep. I'll draw some blood from your arm, take it to the lab and have it tested, and the results will be on the chart for your doctor in about 30 minutes."
  Explanation: "First I'm going to check the ID band on your arm for your safety. Then I'll put this tourniquet on your arm while I draw the blood. You're going to feel a poke that will be a little uncomfortable, but it should take just a few moments and I'll tell you when I'm done. Do you have any questions?"
  Thank You: "Thank you for being so cooperative. I'll make sure this gets down to the lab right now so Dr. Livingston can schedule your surgery. Is there anything else I can do for you?"

• They communicate well with family members. Great hospitals make sure that doctors are focused on the needs of the patient as much as possible. They look for ways to maximize their communication with family members. One recommendation that Studer Group offers its clients is that doctors ask families to organize a "communication chain." Every time a physician provides a medical update, the family member he or she speaks with takes responsibility for passing that information along to everyone else. That way, the physician doesn't have to repeat the same information over and over to multiple family members. An efficient system means that the doctor can spend more time treating the patient.

• They make visiting hours as accommodating as possible. One of the worst things about being in the hospital-especially when your stay is a longer one-is the feeling of isolation. Knowing that people heal better when they can spend time with their loved ones, some great hospitals are expanding their visiting hours. Studer shares an e-mail he received from an ICU manager: "Open visitation can easily work in an ICU," she wrote. "After all, every room is a private room so there are no roommate issues to deal with. Quint, you're right: Who are we to tell a family that they can't be with their loved one in some of the worst moments of their lives? We often forget that we are merely guests in our patients' lives . . . we shouldn't control the amount of time and support they give each other."

• They create a visitor-friendly experience. Hospitals can be intimidating and confusing for everyone, even visitors. Small things can make a world of difference. "Great hospitals have a 'no pointing' rule," explains Studer. "If an employee sees a visitor who looks lost or perplexed, he doesn't wait for her to ask for help. Instead, he goes up to her-whether he's the janitor or the CEO-and asks, 'Can I help you get to where you need to go?' Then, he doesn't just point her in the right direction. He physically walks with her to her destination. It's all about perception. The result is the same-the visitor ends up where she needs to be-but the process of getting there is a much more positive one."

• They don't make patients wait. Patients hate waiting, particularly in emergency departments. Not only can it cause prolonged pain-and prolonged anxiety about their injury or illness-it can make them feel that they don't matter to the hospital. But if for some reason they have to wait longer, a periodic "update" from a staff member can go a long way. "At a great hospital, a patient won't have to wait any longer than half an hour to see a medical care professional," says Studer. "Great hospitals invest in their staff so there is no epidemic of delay; they make sure to have enough personnel available at all times. However, there will be occasions in which a longer wait is unavoidable. When that happens, great hospitals make an effort to check on the patient and keep him 'in the loop.' It's a small courtesy that makes a world of difference."

• They never make patients feel rushed. No one likes to feel like just another component on a medical assembly line. Everyone knows that doctors are very busy and under pressure to maximize time spent with patients, but an "I'm here to serve you" attitude goes a long way. Great doctors physically sit down when they talk to a patient. Believe it or not, when a doctor sits down with a patient, the patient perceives him or her as having been there twice as long. And a friendly, "Is there anything else you'd like to talk to me about?" underscores the point.

• They follow up after discharge. Often, patients are confused about what to do after they get home from a hospital stay. But even if this isn't the case, they appreciate a follow-up phone call. And the best hospitals make these calls a matter of policy, insisting that physicians call a certain number of patients per day. "A woman told me a story about boarding her dogs with a veterinarian when she went on vacation," explains Studer. "While she was on vacation she got a call. It was the veterinarian saying, 'I just want to let you know your dogs are doing great. So you don't need to worry about them. Just have a good time.' Why shouldn't patients get calls like this from doctors? If veterinarians can do it, why can't we? And follow-up calls are not just a 'feel good' practice. I read about a study on congestive heart failure that showed that when hospitals kept in contact with these patients, the number of re-admissions decreased significantly."

• They make certain doctors and nurses communicate about patient care. Patients find a lot of comfort and confidence in the fact that the right hand (nurses) knows exactly what the left hand (doctors and/or the next shift of nurses) is doing so their care is well-coordinated. That's why the best hospitals are vigilant about clear, concise, and visible communication between staff members. Patients feel much more at ease when their care is well-documented by nurses who have their chart ready for the physician.

• They insist that staff members show confidence in each other. Health care is a team effort. Patients know this, and want to see that the "players" like and trust one another. They want to hear lots of positive comments. Great hospitals make it a priority to ensure good working relationships between doctors and nurses. And, according to Studer Group, they encourage care providers to practice verbal affirmation/confirmation. For instance, a nurse may be coached to make statements like, "Dr. Johnson is a great doctor! Did he answer all your questions?" Such interaction is reassuring to patients.

• They diligently manage patient pain. "Treating pain is both an art and a science," says Studer. "Great hospitals operate with the understanding that patients watch the second hand, not the minute hand, in regard to pain medication. So they schedule the medication so that patients don't have to wait too long or ask for it. Let's face it; if you spend much of your hospital stay suffering, you're probably not going to be a very satisfied patient when you leave."

• They ACT to alleviate patient disappointment. Obviously, despite all efforts to create a patient-centered experience, mistakes do happen. It's how hospitals handle complaints that makes all the difference. When they acknowledge that they made a mistake, they set the stage for recovery and also validate the patient's experience. Studer Group says that top-performing hospitals follow the acronym ACT: They Apologize, Correct the service, and Take actions/make amends. "I know one hospital that gives out stuffed bears and gift certificates when service doesn't meet patient expectations," reveals Studer. "They empathize. They recognize that a complaint is a gift. It draws attention to a weak spot and allows the hospital to correct it. Viewing complaints as opportunities enables employees to display a good attitude, and that makes all the difference."

• They use feedback to create a positive culture. While there are benefits to letting employees know when things go wrong, the converse is also true. Great hospitals make it a point to let employees know when things go right. They pass along compliments whenever possible. A culture in which positive comments are maximized helps attract and keep the best doctors and nurses, which in turn creates the best environment in which to receive care. "Patients actually play a big role in keeping care providers happy," points out Studer. "Tell a nurse who was most helpful during your stay-or write it on a patient satisfaction survey-and it will probably get back to that person and make his or her day. And that will keep the good employee happy, which in turn will keep him or her at that hospital."

• They make bills clear and understandable. No one enjoys receiving a hospital bill, especially with health care costs spiraling to ever-increasing heights. But worse than the bottom line is the confusing bill. And worse even than that is unresponsive "service" from the billing department. "Great hospitals recognize that, from the patient's point of view, the bill is the final dimension of care," says Studer. "They make sure the bill is patient-friendly, with understandable language and accurate itemizations. And they provide easy access to information and are friendly and helpful when patients call with questions."

• They invest in great leadership. Of course, all of the "great" practices listed above don't occur in a vacuum. Doctors, nurses, and other staff members must be taught to do them. And that means hospital administrators must make quarterly leadership training a priority. "I had a hospital CEO point out to me that Starbucks spends 40 hours per year on training each employee how to make coffee," says Studer. "So why would any hospital spend less than that on leadership training? Certainly, the patient experience is at least as important as the quality of a cup of decaf!"

• They know that when employees are well cared for, patients will be well cared for. It sounds pretty "common sense," but sometimes hospitals fail to make the connection that happy employees are the key to happy patients. High-performing hospitals go to great lengths to keep their employees happy and create a culture that fosters employee satisfaction. They create an organizational culture in which high achievers can flourish-a place where great doctors and nurses want to be. When you attract and retain the best and the brightest employees and empower them to achieve in a very high-performing atmosphere, you have an absolutely unbeatable combination-particularly in regard to creating patient satisfaction.

This last point touches on an important question: What can you, the patient, do to help make hospitals better places to stay? First, says Studer Group, educate yourself. Knowing what to expect-i.e., the above characteristics of patient-driven hospitals-will empower you to speak up when you're not satisfied. Then, well . . . just speak up.

"Patients are generally not 'regulars' so it's understandable that they don't know what to expect from a hospital," says Studer. "But when they identify the issues ahead of time-and when they feel empowered to ask questions-it raises the expectation level. And higher expectations lead to policy changes, which lead to higher standards of care. Often hospitals do things a certain way just because they've always been done that way. As the paying customer, you really do have the power to change things. Use it. Future patients may thank you for it."

About the Author:
Quint Studer, a former hospital president and 20-year health care veteran, is founder and CEO of Studer Group, headquartered in Gulf Breeze, FL. An executive coaching firm and national learning lab, Studer Group is devoted to teaching tools and processes that organizations use to achieve sustained focus on service and operational excellence. Partner organizations see clear results in the arenas of higher employee retention, greater customer satisfaction, healthy financials and growing market share, and improvements in various other quality indicators.

A nationally recognized health care management thought leader, Studer was named one of the "Top 100 Most Powerful People" by Modern Healthcare. Studer has devoted his professional career to helping health care organizations become world-class leaders in service and operational excellence. He has contributed to features in USA Today and Inc. magazine, and has authored in-depth feature articles on consumerism, service excellence, organizational alignment, and communicating quality to major health care trade journals.

Studer's 20-year career in health care management includes positions as COO of Holy Cross Hospital in Chicago and president of the Baptist Hospital, Inc. in Pensacola, FL. As a result of Studer's leadership, Baptist Hospital was awarded the prestigious Quality Cup by USA Today and the Rochester Institute of Technology. Studer led both hospitals to the top 99 percentile in employee and patient satisfaction as compared to hospitals nationwide in an independent health care survey.

Studer received B.A. and M.A. degrees in education from the University of Wisconsin, Whitewater. He has the honor of serving on the Board of Directors of the 32,000-member Healthcare Financial Management Association, a national professional organization of CFOs and finance executives in health care.

About the Book:
Hardwiring Excellence: Purpose, Worthwhile Work, Making a Difference (Fire Starter Publishing, April 2004, ISBN: 0-9749986-0-5, $28.00) is available at bookstores nationwide, major online booksellers, or directly from the publisher by calling (866) 354-3473. Copies also can be purchased online through the Studer Group website at www.studergroup.com.