Case Study: Improving Patient Satisfaction through Collaboration and Communication

Improving patient satisfaction is key to transforming the overall reputation of a hospital. Bradford Regional Medical Center (BRMC) partnered with The Exigence Group in November 2008 in an effort to increase Emergency Department (ED) volume through improved patient satisfaction in its 109-bed acute care facility. Exigence led Bradford on a path towards success through the development of an active relationship with hospital administration, resulting in an increase in fast track volume, an increase in revenue and a dramatic improvement in patient satisfaction and loyalty.

Bradford Regional Medical Center offers a 24-hour physician-staffed ED nestled in the foothills of the Allegheny National Forest in northwest Pennsylvania. It is less than a two-hour drive from major urban centers like Buffalo, Cleveland and Pittsburgh and operates within the Upper Allegheny Medical System.

Brian Walters, D.O., Chairman of Emergency Medicine and Medical Director of BRMC’s Emergency Department, quickly developed a strong working relationship with the nurse manager to drive ED process changes.

“The key to quality conversions came through the efforts of direct communication,” Dr. Walters said. “It was essential to talk with the nurses and staff to find what could be improved upon and create a plan of action. Exigence empowered the staff through encouraging the discussion of their own ideas and suggestions.”

In order to effectively impact the organization, Exigence and BRMC:

• Developed a close working relationship with administrative team and medical staff
• Implemented bedside triage and immediate bedding
• Improved provider education (increased Core Measures goals, decreased downcodes)
• Implemented “AIDET” scripting program
• Designed and executed call-back programs by both Exigence and the hospital
• Implemented nurse rounding and nurse D/C scripting

The results are dramatic and convincing:

• Overall ED patient satisfaction scores (Press Ganey) now in the 95th percentile, with all physician-specific indicator scores in the 90th percentile or above
• 10% increase in ED volume over previous year
• Length of stay (LOS) decreased by 50% in the first year
• ED chart down-codes decreased from 14% to less than 2%
• Patient grievances declined from an average of 46 per year to only 2 YTD in 2010

Case Study: Patient Satisfaction, Core Measures and the Rise to Number 1

Improved patient satisfaction positively affects patient volume, advances a hospital’s reputation and ultimately enhances a hospital’s bottom line. Mount St. Mary’s Hospital (MSMH) in Lewiston, New York, had average patient satisfaction scores of 3.5/4.0 prior to contracting with Exigence. With Exigence’s leadership and dedication to improving patient satisfaction, the average scores are now 3.9/4.0.

Dr. Lloyd Brown, Medical Director of Mount St. Mary’s ED, led the effort to improve patient satisfaction. Some of the programs he directed include:

• Implementation of point-of-care cardiac testing
• Implementation of a “Door to Doc” policy to reduce the number of patients returned to the waiting room by the triage nurse
• Implementation of “Code 450,” a hospital-wide initiative to accommodate admitted patients
• PACS implementation: Worked with radiologists to streamline a recent installation—experienced a decrease in call-back discrepancies within the first three months
• Creation of a “Fast Track” program to expedite throughput of non-urgent cases
• Implementation of “Bedside Registration” to decrease time to physician evaluation
• Aggressive Core Measures compliance resulting in 95% overall adherence
• Implementation of an Exigence Hospitalist program that has resulted in a very successful collaboration to transition patients from ED to floor and provides solid back-up for on-call PAs overnight

“We know that waiting patients are unhappy patients, said Dr. Brown. “We’ve been able to work with departments and personnel throughout the hospital to reduce length of stay in the ED and improve overall customer service—and the results speak for themselves.”

Core Measures Leader

In addition to significantly improving patient satisfaction scores, Mount St. Mary’s Hospital was ranked number one in the Ascension Health for Core Measures as of July 2008. Ascension Health is the largest Catholic health care system and the largest non-profit delivery system in the United States with 66 acute care hospitals in 20 states and the District of Columbia.

According to Dr. David Pryor, Chief Medical Officer of Ascension Health, key factors influencing success are “clear goals, aligned and supportive management and caregivers, and transparency.” Exigence emergency department and hospitalist physicians, mid-level providers and management team were recognized by the MSMH administration for playing a significant role in achieving this mark of distinction.

Case Study: Patient Satisfaction Rapid Recovery

In every industry, customer satisfaction makes the difference between success and failure. In healthcare, many people consider Press Ganey as the “gold standard” for assessing customer satisfaction—Press Ganey works with more than 7,000 health care organizations to measure and improve their quality of care. Prior to contracting with Exigence, Olean General Hospital (OGH) wasn’t satisfied with its Press Ganey scores for its Emergency Department (ED). Today, the OGH’s ED overall Press Ganey scores have skyrocketed to the 95th percentile. Which begs the question, how does a hospital transform its operation from average to spectacular in less than 24 months?

Olean General Hospital is a 186-bed rural regional referral center located 90 miles south of Buffalo, New York. The hospital serves approximately 100,000 people from the southwestern New York and northwestern Pennsylvania. The hospital emergency department serves 31,000 patients annually.

Prior to Exigence’s arrival, the ED experienced serious personnel issues that resulted in high turnover. Exigence worked with OGH administrators and medical staff to identify and recruit a team of dedicated leaders who worked in concert to set goals, create action plans and deliver true cultural change.

Dr. Henri Lamothe, Medical Director of the OGH Emergency Department since July 2007, believes that a collaborative approach is the key to dramatic improvement. “We bring everyone to the table to ensure that there is buy-in for change. Ultimately, patients are the winners—as evidenced by the impressive improvement in patient satisfaction scores.”

In addition to establishing a dedicated leadership team, Exigence helped to improve processes and programs that directly affect patients. Major programs include:

• A new triage protocol
• A revised throughout process that places greater emphasis on physician leadership
• Professional development program for nurses
• Time goals for patient contact
• Inclusion of ancillary departments in turnaround time analysis and new program development and implementation

In 2007, Olean General contracted with Exigence to design and implement a Hospitalist program that has improved patient flow, quality of care, relations with area primary care physicians and reduced length of stay.

Olean General Hospital and its senior management team were recently named as a Thomson Reuters 100 Top Hospital®: Performance Improvement Leader. The award recognizes hospitals that have made significant progress in improving hospital-wide performance over five consecutive years.