5 straightforward ways to improve patient satisfaction in hospitals

Patient satisfaction and improving the hospital experience is being discussed in hospital boardrooms across the country. Now that financial reimbursements are directly tied to HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey scores, there is a significant incentive to do so. A multitude of ideas are being put forward into how this can be achieved, and hospitals are investing heavily to get tangible results. Many involve complicated and expensive methods that unfortunately border on being a bit gimmicky. Examples include reorganization of medical floors and staff, computer-based solutions, pamphlets,  and other free “treats.”

However, what is often overlooked is simply listening and acting on patients’ most basic complaints. Here are 5 of them; straightforward ways to give patients a better hospital experience:

1. Time with doctors and nurses. This is nearly always top of patients’ healthcare wish list. Patients simply want more time with their doctors (and so do the doctors). Time to sit down, talk through everything that’s wrong and what treatment options exist. One of the biggest barriers allowing this to happen is the sheer scale of documentation tasks that are required of doctors and nurses. This has reached epidemic proportions. Slow and cumbersome information technology plays a large part, with some studies suggesting that doctors now spend close to only 10 percent of their day in direct patient care. There is something very wrong when doctors and nurses spend 4 or 5 times more of their day in front of a screen than with their patients. We need to swing the pendulum back to direct patient care.

2. A good night’s sleep. Usually the first complaint I hear when I walk into a patient’s room first thing in the morning. Whether it’s a noisy neighbor, noisy staff or repeatedly having their vital signs taken during the night—there’s plenty to wake patients up in a hospital. How can anyone get better if they can’t rest? Sleep is, after all, when our bodies replenish and heal. Let’s tackle this head-on by making hospital floors quieter and more soothing places to be, rather than so “rough and tumble.”

3. Better hospital food. So common a gripe for hospitalized patients that it’s become a bit of an endearing joke. Whenever I hear this from a patient, I usually try to answer in jest: “Well, we can’t make hospital food too good otherwise people will not want to get better!” But all joking aside, it would be good to see hospitals serving up some delicious (and healthy) nutritious options. This doesn’t need to be gourmet upscale restaurant food, but can definitely improve with a little more thought.

4. Be clear about wait times. When hospitalized patients are waiting for tests, be it a CT scan or a cardiac stress, the times of tests are often very uncertain. This can be very frustrating for patients who often cannot eat before certain procedures. Giving a more accurate time, plus or minus say an hour, will greatly help patients and their families in knowing what to expect (it doesn’t have to be to the nearest minute). Better co-ordination, feedback to the patient’s nurse, and direct communication with the patient should be standard protocol.

5. Multidisciplinary rounding. Instead of the patient seeing their doctor at a completely random time during the day, hospital bedside rounding should be conducted at defined times with the full care team. This should include the doctor and floor nurse at the very minimum. The attending physician should lead the rounds, with the aim of having a complete and clear plan for the day in place as early as possible. This care plan and anticipated day of discharge should be fully discussed with the patient (and their family).

These five solutions are much less complicated than many of the ideas that are being bandied around by hospitals — and don’t involve multi-million dollar investments. The answers are much closer to home than we may think. To use a cliché — it’s not rocket science: We should get back to basics, start listening to what patients tell us about how they experience their hospital stay, and start to act. Solving these 5 problems alone has the potential to transform patients’ hospital experience.

Suneel Dhand is an internal medicine physician and author of Thomas Jefferson: Lessons from a Secret Buddha and High Percentage Wellness Steps: Natural, Proven, Everyday Steps to Improve Your Health & Well-being.  He blogs at his self-titled site, Suneel Dhand.

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  • southerndoc1

    “Time with doctors and nurses . . . it’s not rocket science”

    I guess I’m not that smart. I don’t see any possible way in today’s system for doctors and nurses to spend more time at the bedside. Please enlighten me.

    • hawkeyemd1

      lol… Honestly, I try my best… And many times, I have to leave the bedside precisely to go to a meeting on quality, or budget, or utilization, or EMR training, or some other meeting… I’m open to anything that improves patient care, but much of this is counterproductive… My two cents, but understand the thought… I’m with SD1 on this, though.

    • guest

      Healthcare systems need to allocate less money to pay administrators to supervise, audit, nag and monitor doctors and nurses. The savings should be used to improve staffing levels in hospitals.

  • Lisa

    I think it is as simple as time with doctors and nurses.

    I live in California. There number of nurses to patients is a matter of law. However, there are no laws regarding the number of ancillary staff. When I had my second hip replaced two years ago, there was one NA on a surgical wing with over 50 patients. As a direct result, the care I received was bad.

    Some of the bad care was just an annoyance, such as never getting water so I could wash and brush my teeth. Other aspects were more problematic – not getting ice for pain control, despite multiple request via the intercom system, delays in getting the urinary catheter removed (in over 48 hours) because I was not supposed to get out of bed without supervision and there was no one to assist me if needed to pee. I was supposed to be wearing TEDs post surgery. They were not put on post surgery for some reason. I pointed this out to the nursing staff when I got to my room, yet it took 24 hours (and the involvement of my surgeon) before they appeared. My leg, by this time was quite swollen. I can go on and on.

    My satisfaction level was quite low.

    • southerndoc1

      What you experienced two years ago was paradise compared to what you get now.

    • Deceased MD

      I am sorry for your experience. But If you don’t mind saying what hospital was this? I think the California health system is pretty abominable and it really depends what part of the country you live in–although as SD1 says it’s getting bad everywhere.

      • Lisa

        The hospital is owned by Dignity Health. The hospital was much better before it was bought by Dignity Health.

        • John C. Key MD

          Wow, the only “Dignity” I know is a chain of funeral homes.

          • Lisa

            Dignity Health is a non-profit organization that owns a large number of (formerly) Catholic hospitals.

          • Deceased MD

            I had a pt who went to one speech therapy visit at a ‘Dignity” hospital. had to pay out of pocket: the bill” $400. No doctor just a 45 min eval with a speech therapist. They overcharge like crazy.

          • querywoman

            The “Dignity” chain of funeral homes cost big time money!

        • Deceased MD

          haha. Yes I am familiar with them. It is a wonderful name. i have seen it as a commercial on the side of a bus. The fact that they name themselves the very OPPOSITE of who they are speaks volumes. Sort of like the energy lobbyists websites having websites like cleanair.org or something. Dignity is the complete opposite of what you got. Anyway I completely empathize with you. You deserve better! For that matter we all do!

          • Lisa

            Yeah, I’ve seen their name on the side of a bus too. Along with all these fancy magazines delivered to my house. Ugh,,,

  • FriendlyJD

    Sleep. I am never more exhausted and cranky than when I leave the hospital, having failed to get more than 2 hours of consecutive sleep in 3 or 4 days.

    Every night it’s the same: 11pm vital check, 12am IV beeping bc a bag is low, 2am blood draw, 3am nurse wants urine sample so docs can have the results before rounds; 3:30am IV alarm (again); 4am meds; 5am doctor wanders into wrong room; 6am vitals; 6:30 another doctor into wrong room, ect.

    • Lisa

      Our local hospital does not have solid walls between rooms, just folding walls. Therefore, there is no sound privacy. You can hear everything that is being said in the room next door. ugh.

  • DoubtfulGuest

    Very well said, thank you. I also respectfully suggest that doctors will get a much better sense of each patient’s character (honesty, responsibility, maturity), when we’re given the information we need to function well in the system.

  • Lisa

    Seven minutes is totally inadequate when you are hospitalized for something serious. And presumably you wouldn’t be in the hospital if something wasn’t seriously wrong. Suggesting that patients speak really fast or not speak at all is demeaning. I really hope you are being sarcastic.

    Seriously, I have been hosptialized four times in the last six years – three surgeries and once for cellulitis. The amount of time my doctors spent at my bedside was minimal, but that was not an issue. My major issues were with the nursing care and staffing levels.

    Perhaps hospitals need to be forced into accepting lower profit margins. Large salaries for CEOs do nothing to improve patient satisfaction.

  • PCPMD

    Doctors sepnding more time with patients sounds wonderful in theory, but doesn’t really work out too well in practice. Some back of the envelope math:
    The typical hospitalist (the main doctor that takes care of you when you’re hospitalized) has 15-20 patients on their census daily. Whlie their shift is often 12 hours for better continuity, to get anything done, all 15-20 patients must be rounded on, individually assessed, and a treatment plan put into place by 12-2pm. The afternoon is then spent reassessing patients and reviewing test results that came through.

    Assuming the average work day begins at 8 a.m., that gives the doctor ~ 24 minutes between one patient and the next (that’s assuming a low census, and having until 2pm to see all of the patients). in 24 minutes, you must review the entire patient chart, any/all tests from the previous day and that morning, overnight events, examine the patient, write your note to document and organize your thoughts, and come up with a game-plan for the day.

    This is assuming you don’t receive a single page or call form the nurse, or from patients who want to be seen first, or from specialists, or from patient families wanting to be updated. This is also assuming you do no admissions during the day, have no clinic responsibilities and do absolutely nothing else besides round on patients, and take no lunch (or only eat late in the afternoon each day). This also assumes you’re funtioning 100% efficiently, and are not post-call, ill, or otherwise compromised.

    In summary, spending more time talking to patients = less time caring for them. More time explaining test results = less time thinking about them and analyzing them.
    The solution, one would think, would be to cut the census in half. But that would require doubling to trippling the entire nation’s hospitalist workforce. Not only would this be financially untennable, but it would require a large pool of highly trained doctors who love inpatient work, but abhore specializing, and are currently idle and out of work. Alternatively, you would need to cannibalize from your already shrinking pool of primary care doctors (since most doctors who work as hospitalists either come from primary care, or chose hospitalist work in leu of primary care) to better staff the hospital.
    Absent these two contingencies, spending more time at the bedside only gives the appearnce of better care, while actually compromising or dealying it.

    • John C. Key MD

      It isn’t your fault–you are caught in the tentacles of the current sick system and those nematocysts are hitting you all the time.

      It isn’t your fault…but it is your choice.

  • John C. Key MD

    I think you could have stopped with #1 and called it communication. I can’t pretend to tell you how everyone an find the time that is needed, but my experience as a patient, a physician, a spouse, and a family member is that I think I can forgive anything but being left in the dark, or similarly, made a victim of miscommunication by others.

    And if your care is coming from a “team”, well, you are already on the losing team. Better demand to see the Captain of the Ship.

  • wahyman

    It would be nice if quality of care could make the list.

    • Lisa

      Quality of nursing care should be highlighted, in my opinion.

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