Running head: CARING HOSPITAL PATIENT SATISFACTION

Caring Hospital Patient Satisfaction Learning Team RES/320

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Caring Hospital Patient Satisfaction Executive Summary Caring General Hospital (CGH) is committed to understanding patient needs and is making every effort to ensure patient satisfaction. Asking questions, listening to the responses, and improving day-to-day operations are primary goals for CGH. By providing a survey, CGH received valuable feedback from those whose opinion matters most, the patients. These surveys were distributed to patients who had been treated at CGH. Additionally, CGH asked 144 subjects to participate in a phone interview. Our target audience included 700 men and women, ages 18 to 60.More than 50% of the subjects asked to participate in the survey responded to the questionnaire and only 40% of the subjects asked to phone interview participated. The subjects were asked to rank his or her satisfaction in several categories during his or her stay at CGH. The primary goal was to gather information on how CGH ranked from the moment the patients stepped into the facility to the time of discharge. To get a complete understanding of the strengths and weaknesses at CGH, the subjects were asked the following questions and the percentage of satisfied or dissatisfied is noted: How would you rate the receptionist/administration? 65% satisfied. How would you rate the cleanliness of the hospital? 67% dissatisfied. (Needs improvement) How would you rate the food? 60% dissatisfied. (Needs improvement) How would you rate the care you received from the nurses? 55% satisfied. Were the nurses respectful? 87% satisfied. Were you satisfied with the way the nurses answered your questions? 91% satisfied.

CARING HOSPITAL PATIENT SATISFACTION How would you rate the care you received from the doctors? 53% satisfied, 40% somewhat satisfied. How would you rate the way the doctors answered your questions? 51% satisfied, 42% somewhat satisfied. Were the doctors respectful? 93% satisfied How would you rate the care you received from the specialized care professional(s) (example: lab tech who drew your blood, x-ray)? 34% satisfied. (Needs improvement) Was your treatment/procedure clearly explained to you? 88% satisfied Were you involved in the decision affecting your care? 87% were involved. Were you kept informed about the care planned for you? 91% were informed. Was your religious and spiritual preferences addressed by the hospital staff to your satisfaction? 90% dissatisfied (Needs further research) The areas that need immediate improvement or further study are cleanliness, food, and address patients religious or spiritual preferences. Where CGH fell critically short was in satisfying patients religious or spiritual needs. In this area, CGH will need to conduct further research. Introduction Caring General Hospital (CGH) was ranked as the nations top medical care provider in 2011.CGH provides service to every variety of patients, from newborns to senior citizens. The goal is to ensure that everyone that walks into the CGH facility has the best experience regardless of his or her circumstance. To understand CGH strengths and weaknesses a panel of researchers developed a short

survey to administer to patients, past and present. The patients were asked to rank how he or she

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was treated in every department visited at CGH. The board of directors at CGH voted to develop a survey that would be administered to 700 past and present patients. Five hundred subjects were selected to participate in a survey questionnaire and the remaining subjects would be asked to participate in a short phone interview. Patient satisfaction varies, depending on the department, so CGH board decided that it was important to understand what patients think about the facility and staff from admission to discharge. Patient satisfaction is CGH number one goal. Caring General Hospital will continue to strive to satisfy patients needs regardless of their age, gender, race, income, or religious beliefs. Caring General Hospital is honored to have been chosen as the nations #1 healthcare facility but recognizes the need make improvements in this rapidly advancing society. At Caring General Hospital, patients come first and his or her opinion will always matter. The Problem Customer satisfaction is essential to business survival. Customer satisfaction means customer loyalty and loyalty is a key factor in fiscal success. Hospitals who meet the needs of patients encourage continued patronage of hospital services that increases volume of business and profit. Satisfied patients return to the same hospital for future medical care, and help generate more business by recommending the hospital to friends, family, and acquaintances. Hospitals that recognize the value of customer satisfaction and loyalty continuously measure satisfaction. Despite the high cost of health care, customer satisfaction within the sector is virtually steady at 78.5 (negligible +0.1%) score that exceeds the national average for sectors and industries (75.8 as of the fourth quarter of 2011) (Piasecki, 2012). One concern for hospitals is competition from private medical practitioners. The American Customer Satisfaction Index (2012) reported the following:

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Patients show a preference for ambulatory care (such as Office visits to doctors, dentists, and optometrists) over the hospital care (inpatient, outpatient, and emergency room services). For 2012, Ambulatory care earns an ACSI score of 81 (+1.3%), a level of patient satisfaction that has been nearly steady over time. Hospitals move in the opposing direction, dropping 1.3% to 76. For hospitals, emergency room care puts downward pressure on patient satisfaction averaging a low 66 (down from 72 in 2011). Doctors and nurses are at the forefront of hospital care and their services weigh heavy on customer satisfaction and loyalty. The quality of service provided by administrative staff, food service, and cleanliness of the hospital contribute immensely to patient hospital satisfaction. A hospital that earns patient loyalty by satisfying his or her needs increases its revenue and stays in business. Caring General Hospital is the nations best hospital in 2011. In an effort to continue to provide the best service and increase preference for hospital care, it is conducting a survey that focuses on patient satisfaction with medical practitioners, administrative staff, food quality, and cleanliness of the hospital facility. Literature Review Health care providers agree that focusing on patient satisfaction is the right thing to do. The truth about patient satisfaction is that they can help you identify ways of improving your practice (White, 1999). Health care is a competitive market and hospitals with marginal scores in patient satisfaction surveys may face financial hardships. The Hospital Consumer Assessment of Health Plans Survey (HCAHPS) article published in the HCAHPS website suggest rating care and patient items like care provided by doctors,

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nurses, hospital staff, and cleanliness of the hospital environment should be included in a patient satisfaction survey. HCAHPS survey items complement data hospitals currently collect to support improvements in internal customer services and quality related activities (Center for Medicare & Medical Services, MD, n.d). The Journal of Internal Medicine reports that patients care experience and satisfaction increase when hospitals address patients religious and spiritual concerns. A survey conducted by the University of Chicago on January 2006 and June 2009 showed that about 20% of patients report that religious desires were not addressed during hospital visits. The team found that just over 40% of patients wanted to discuss religious or spiritual concerns while in the hospital, but in only half the cases did a conversation take place (Reynolds, 2011). Food service at hospitals is an area that provides the highest opportunity for improvement. Food service falls way below patient satisfaction (Blizzard, 2002). Hospitals need to improve the food quality, appearance, and delivery methods to raise food service satisfaction scores. Nurses care is a key factor in patient satisfaction. Patients spend more time with nurses than with doctors. Nurses must be capable of genuinely caring for patients, not just taking care of them. The plan to tie Medicare reimbursement to patient satisfaction has management paying attention to patient satisfaction feedback. Senior leadership is paying more attention than ever before and will turn to the nursing department to ask, What are we doing about patient satisfaction? (Hendren, 2004, p. 1). Starting October 2012, Medicare will base part of hospital reimbursements on patient satisfaction scores. Patient advocates believe tying care to reimbursements will improve patient care. Under the Center for Medical and Medicaids value-based purchasing proposal,

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Medicare will begin withholding one percent of its payments to hospitals starting in October 2012. That money--$850 million in the first year--will go into a pool to be distributed as bonuses to hospitals that score above average on several measures (Rau, 2011). Caring General Hospital has been diligent with its effort to maintain a high level of patient satisfaction and prides itself as the nations top health care provider in 2011. To live up to its commitment of providing the best care and the happiest patients, the management of CGH asked patients Are you satisfied with the services we are providing? During the months of February and March 2012, CGH tasked a working group to conduct a survey to measure patient satisfaction with doctors, nurses, administration, staff, food, and cleanliness of the facility. The survey questions were based on the patient satisfaction articles this paper reviewed. The methodology was influenced by the discussions on Hospital Consumer Assessment of Health Plans Survey (CAHPS) as posted on the CAHPS website. Research Design The research techniques used to conduct the survey for CGH were targeted questions that specifically addressed patients satisfaction with doctors, nurses, administration, food, and the facility. The board of directors decided on a targeted survey, as they believed that this type of survey met the requirements typically set forth by this type of research. The board elected to keep the number of surveys down to a manageable level of 700 surveys and was to be administered by administrative staff. According to All out Marketing (2011), a targeted survey typically will be yes or no answers. The board requested questions be direct and short. The board voted on two types of surveys with the same questions, but that would be delivered by two different methods. The sample group for self-administered questionnaire would be patients who stayed at CGH for more than a day. The consensus for this decision was that

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these patients would have positive and negative areas fresh in their mind and the board wanted to ensure that data received would be accurate and prompt. The second type of survey to be developed was a phone survey, using a sampling of patients of CGH that stayed no longer than a 24-hour period. The board determined that this type of survey was sufficient as long as it was conducted within 72 hours of patient discharge to receive honest and accurate feedback. Methodology Caring General Hospital Survey, a respected leader in health care, is committed to providing the best service to its patients. A hospital satisfaction group was commissioned to develop and conduct the survey that will measure patient satisfaction with doctors, nurses, administration staff, food, and cleanliness of the hospital facility. The working group is led by the human resources department head with representative members from each department subject to the survey. The working group decided that the best way to answer the hospital managements concern about patient satisfaction is to use measurement questions. Cooper and Schindler (2011) state that measurement questions are questions participants must answer if the researcher is to gather the needed information and resolve management question. The hospitals budget and workforce constraints limit the survey methodology to a selfadministered questionnaire and telephone survey. Compared to in-person interviews by trained interviewers, self-administered questionnaires and telephone surveys have lower response rates. To maximize patient participation, the working group solicits the cooperation of front-line hospital staff in administering the survey. The front-line staff distributes and encourages patients to complete the questionnaire.

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The survey will be administered on a volunteer basis to a target group. The working group understands that the data from the survey will gather valuable information that will satisfy hospital administrations questions about the level of patient satisfaction with hospital services, but the data will not provide information usable for analysis of target or representative sample. After careful deliberation, the working group decided that the best way to reflect the survey participants degree of attitudinal favorableness toward the object or subject of interest is to use the Likert summated rating scale. Likerts rating scale can be summed to measure the participants attitude. During the preliminary analysis plan, the group develops a dummy table to test how well the questionnaire measures the level of patient satisfaction with hospital services. The dummy table shown in Exhibit 1 would match the patient level of satisfaction with hospital food. The working group decided that Likert Scale effectively measures patient satisfaction. Exhibit 1. Dummy Table for Level of Satisfaction with Hospital Food Very Satisfied 4 Somewhat Satisfied 3 Neither Satisfied nor Dissatisfied 2 Somewhat Dissatisfied 1

The working group developed a complete list of investigative questions pertaining to patient satisfaction with hospital services. From the compilation of investigative questions, the group formulated target questions to address patient satisfaction with doctors, nurses, administrative staff, food, and cleanliness of the facility. The group used the instrument design guideline from the Cooper and Schindlers Business Research Methods, 11th Edition to develop and test the question content. According to Cooper and Schindler (2011), Four questions, covering numerous issues, guide the instrument designer in selecting appropriate question

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collection: Should this question be asked (does it match the objective)? Is the question of proper scope and coverage? Can the participant adequately answer this question as asked? Will the participant willingly answer this question as asked? The questionnaire was finalized using Likert summated scale to measure the patients responses. The Caring General Hospital patient satisfaction questionnaire was distributed to 500 patients by front-line staff during the months of February and March 2012. Additionally, staff made calls to 200 discharged patients. Completed surveys were collected and submitted to the human resources department for data entry and analysis. Results and Analysis General Questions

How would you rate the receptionist/administration?

100 90 80 70 60 50 40 30 20 10 0 65

15

13

7 Somewhat Dissatisfied (1)

Very Satisfied (4)

Somewhat Satisfied Neither Satisfied nor (3) Dissatisfied (2)

Patient satisfaction with the hospital administrative staff was at 65% very satisfied, 15% somewhat satisfied, 13% neither satisfied nor dissatisfied, and 7 percent somewhat dissatisfied.

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How would you rate the cleanliness of the hospital?

100 90 80 70 60 50 40 30 20 10 0 67

13

12

Very Satisfied (4)

Somewhat Satisfied Neither Satisfied nor (3) Dissatisfied (2)

Somewhat Dissatisfied (1)

65% of the participants were dissatisfied with the hospital cleanliness. Major area of concern for management.

How would you rate the hospital food?

100 90 80 70 60 50 40 30 20 10 0

60

12

16

12

Very Satisfied (4)

Somewhat Satisfied Neither Satisfied nor (3) Dissatisfied (2)

Somewhat Dissatisfied (1)

60% customer dissatisfaction with hospital food is a major concern. The quality, quantity, and preparation of food has to improve.

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Health Care Providers - Nurse

How would you rate the care you received from the nurses?
100 90 80 70 60 50 40 30 20 10 0

53 45

1 Very Satisfied (4) Somewhat Satisfied Neither Satisfied nor (3) Dissatisfied (2)

1 Somewhat Dissatisfied (1)

Nurses have a very rating of 55% very satisfied and 43% somewhat satisfied.

Were the nurses respectful?

100 90 80 70 60 50 40 30 20 10 0 Yes No 13 87

87% of the respondents are of the opinion that the nurses are respectful.

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Were you satisfied with the way the nurses answered your question?
100 90 80 70 60 50 40 30 20 10 0 91

Yes

No

Very high mark of 91% very satisfied with the way nurses answered the patients questions. Health Care Providers Doctors

How would you rate the care you received from the doctors?
100 90 80 70 60 50 40 30 20 10 0

53 40

4 Very Satisfied (4) Somewhat Satisfied (3)

Neither Satisfied nor Somewhat Dissatisfied Dissatisfied (2) (1)

The doctors receive high marks of 53% very satisfied and 40% somewhat satisfied on quality of care received by the patients.

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How would you rate the doctors answered your questions?

100 90 80 70 60 50 40 30 20 10 0

51 42

5 Very Satisfied (4) Somewhat Satisfied Neither Satisfied nor (3) Dissatisfied (2)

2 Somewhat Dissatisfied (1)

The patients gave the doctors high marks on how their questions were answered. 51% of the respondents were very satisfied and 42 were somewhat satisfied. 4% were neither satisfied and 3 were somewhat dissatisfied.

Were the doctors respectful?

100 90 80 70 60 50 40 30 20 10 0 Yes No 3 97

Patients rated the doctors at a very high mark of 97%.

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Specialized Care

How would you rate the care you received from specialized professionals (lab tech who drew your blood, x-ray, etc...)
100 90 80 70 60 50 40 30 20 10 0

34 21 10

35

Very Satisfied (4)

Somewhat Satisfied Neither Satisfied nor (3) Dissatisfied (2)

Somewhat Dissatisfied (1)

35% somewhat dissatisfied is a concern Review of the processes and procedures will be conducted Treatment/Procedure

Was your treatment /procedure clearly explained to you?

100 90 80 70 60 50 40 30 20 10 0 88

12

Yes

No

A very high mark but there is room for improvement.

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Were you informed of the care planned for you?

100 90 80 70 60 50 40 30 20 10 0 91

Yes

No

A very high mark but there is room for improvement. Other concerns

Was your religious and spiritual needs addressed by the doctor and /or hospital staff to your satisfaction?
100 90 80 70 60 50 40 30 20 10 0 90

10 Yes No

Serious concern for the hospital Procedures for satisfying spiritual and religious needs of the patients will be implemented

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Tell us about the areas in which we could improve: Food does not taste good. Why is breakfast serve at almost 10 a.m.? Toilet in the reception area is dirty I am a Muslim. How come there is no Imam at the hospital? It hurts when you take my blood. The result of the patient satisfaction survey provides both comfort and cause for concern. The doctors and nurses enjoy high level of satisfaction and confidence from the patients. The administrative staff has a high satisfaction rating of 65% and a low of 7% but there is room for improvement. The specialized care (laboratory technician, x-ray technician, etc...) has a marginal rating. The specialized care processes and procedures will be reviewed. Treatment has an average rating of 87% satisfied. A major concern is the 90% response from the survey participants that their religious and spiritual concerns are not addressed by the hospital. The hospital administration is seriously studying this concern. Procedures for responding to the spiritual and religious needs of the patients will be implemented as soon as the plan of action is finalized. Conclusions and Recommendations Based on the compilation of the survey results areas that need to have more focus and solutions would be the quality of the hospital food, cleanliness of the hospital, and the addressing of spiritual or religious beliefs. Because these three areas received below par grades, the board has developed a few initiatives to work on turning these results around. In reference to hospital cleanliness, the recommendation will be to evaluate the cleaning crews, process, and frequency of rotations. The patient rooms should be thoroughly cleaned,

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including moving of furniture after each patient is discharged. The waiting rooms should be cleaned every four to six hours to ensure that they are in top shape for patients friends and family during his or her visit. Another area of concern is poor food quality. One recommendation is that the cafeterias incorporate daily specials of a healthy variety. In addition, fresh foods instead of frozen meals will improve customer satisfaction. Using fresh local products for hospital meals would make meals more enjoyable (Eat Where Your Food Lives, 2012). The last area the board has made a recommendation has to do with religion and patients spiritual belief. The survey has shown low score of satisfaction in this area. Each patient as part of his or her checking in process should be advised concerning the religious areas of the hospital available to him or her. If no areas exist, it is suggested that CGH determine an adequate and appropriate area for a religious or spiritual gathering. Additionally, it would be advised to contact several clergies of various faiths to ascertain if he or she would be available to provide guidance and assistance to patients who request them. It is not recommended to ask the patients what religion they practice, but just to advise them of services available should he or she request them. In conclusion, the survey and interview highlighted several areas of improvement for CGH. The board of directors will continue to strive for 100% customer service satisfaction and improve those areas that need it. Hospital stays are stressful and can be very traumatic for patients and families. Caring General Hospital strives to let every patient know We see YOU!

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Reference All Out Marketing. (2011). Retrieved from http://www.alloutsuccess.com/marketingminute/176/quick-and-easy-tips-for-a-targetedsurvey Blizzard, R. (2002, November 19). Hospital Food: Ingredient in Patient Satisfaction? Retrieved from http://.gallup/com/7249/hospital-food-ingredient-patient-satisfaction.aspx Center for Medicare & Medical Services, MD.(n.d). HCAHPS. Retrieved from http://www.hacppsonline.org Cooper, D. R., & Schindler, P. S. (2011). Business Research Methods, Eleventh Edition. Retrieved from http://ecampus.phoenix.edu/content/eBookLibrary2/content/eReader.aspx Eat where you food lives. (2012). Retrieved from http://chefmonicapope.keepercollection.com/content/display/page/about-us Hendren, R. (2004, January 4). To Boost Patient Satisfaction Scores, Engage Nurses. Retrieved from http://www.healthleadersmedia.com/content/NRS-260917/To-Boost-PatientSatisfaction-Scores-Engage-Nurses.html## Piasecki, A. (2012). The American Customer Satisfaction Index - Press Release April 2012. Retrieved from http://www.theacsi.org/index.php?option=com content&view=article&id=277%itemid=353 Rau, J. (2011, April 28). Medicare to Begin Basing Hospital Payments On Patient Satisfaction. Retrieved from http://www.kaiserhealthnews.org/stories/2011/Apr/2008/MedicareHospital-Patient-Satisfaction

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Reynolds, D. (2011, August 10). Conversations About Spiritual Concerns Help IMporve Patient Satisfaction. Retrieved from http://www.emaxhealth.com/1506/conversations-aboutconcerns-help-improve-hospital-patient-satisfactions White, B. (1999). Measuring Patient Satisfaction: How to Do It and Why to Bother. Retrieved July 20, 2012 from http://www.aafp.org/fpm/1999/0100/p40.html