About three years ago, our hospital was abuzz about patient satisfaction. Our HCAHPS scores were lower than expected, and there was a push by the administration to improve them. As a hospitalist, I wondered to myself, what could I possibly do to improve them? I already believed I was doing a very good job communicating effectively with patients.
Many years ago, I developed the habit at the end of each encounter of always asking patients, “What questions do you have for me?” Their responses were rarely focused on their health or why they were in the hospital. Instead, they frequently seemed to revolve around things such as an upcoming imaging or blood test, their first meal, and the most often, when could they finally go home.
That got me thinking. If these are the questions and issues patients really care about, why not anticipate these questions and issues by initiating that conversation with patients before they bring it up with the doctor? I did just that. As a result, I developed my own three-part tool that I would use to conclude each patient encounter. The entire process would take only about 60 seconds, and if one of the steps didn’t apply to the patient, I would simply skip it and proceed to the next step. Here is my three-part tool:
1. When can I eat?If the patient was not on a full diet, I would tell the patient why they were not being allowed to eat and then tell them when they could expect to return to a regular diet. Often, it was because the patient was NPO in anticipation of an upcoming test like an endoscopy or cardiac catheterization, which made a nice segue into my next question.
2. When is my test? If the patient was waiting for an important test for which the result could alter their hospital stay or treatment plan, such as an MRI or blood culture, I would tell them when the test was tentatively scheduled and approximately how long it would take to get the results. I would then tell them what the likely decision would be based on the potential results. Finally, I would mention that it is entirely possible that a test could be postponed because of another patient’s emergency need for the same test, but that every effort was being made to get the test done on schedule.
3. When can I go home? Based on the patient’s admitting diagnosis, I would provide the best-updated estimate of their hospital length-of-stay, typically a range such as two-to-three days or at least one more day. I would also mention why it would take that long as well as the fact that this was an estimate and it could change based on the patient’s condition or availability of resources.
After addressing these three questions, I would end by asking my usual question, “What questions do you have?” After doing this three-step process numerous times over many months, I noticed something surprising. Many patients would respond to my usual ending question “nothing doctor, you’ve answered all of my questions.”
At that point, I realized I was onto something. By addressing some of the most common concerns of patients without having to be prompted, I was demonstrating to them that I might be understanding their most important and immediate concerns. Moreover, I noticed the tone of these patients who felt I addressed their concerns as relatively pleasant and calm, which made my job easier. A few months later, when I received my next patient satisfaction scorecard from the hospital, I was in the top 25 percent of my practice group, up from my previous report. My partners noticed my score, and I shared with them what I was doing. After initiating my process, their anecdotes revealed much of the same results that I had discovered.
If you are looking for a way to improve your patient satisfaction scores in the hospital, especially something that is short and simple to implement, don’t feel like you need to reinvent the wheel. I would simply recommend pre-empting patient questions and concerns by addressing these three common patient issues when staying in the hospital. Who knows, you might be surprised by how many patients say to you in a positive way, “Nothing doctor, you’ve answered all of my questions.”
Rajil M. Karnani is a hospitalist.
Image credit: Shutterstock.com
