25 January 2016

HCAHPS: Challenges of Increasing Patient Satisfaction in the ED

As healthcare reimbursement continues to shift to a value-based scale, patient satisfaction scores are playing a larger role and are receiving more attention from hospital executives.

According to a recent article in HealthLeaders, 1.5% of all Medicare payments in 2015 are based on a hospital’s Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) score. This will increase to 2% by 2017. While elements of patient satisfaction and quality scores have always been a priority for healthcare providers, the increasing monetary value that is tied to these metrics elevates those issues even more. The following graph, which was included in the HealthLeaders article, illustrates this shift in priorities.

As the graph illustrates, there is a tremendous focus on patient satisfaction – which can be a difficult metric to achieve in the emergency department. Sheridan’s own Dr. Catherine Polera spoke with FierceHealthcare’s Ilene MacDonald about this issue and how to achieve patient satisfaction in the ED. As chief medical officer for Sheridan’s emergency medicine division, Dr. Polera knows how important patient satisfaction is in the ED, and the barriers to achieving it.

The first challenge is evident: the emergency department is a place where doctors are short on time and can be dealing with critical situations — conditions that make it difficult to exceed patients’ expectations for the timeliness of their care and the attention they receive. As Dr. Polera points out, all patients in the ED want to be seen immediately, but doctors and nurses often need to triage in order of acuity. Many patients are not aware of the intake processes, so the key is matching perception to reality. Communication is key here, and triaging must be explained so as to match patient expectations with reality. If patients do not expect that they will be seen immediately, they are more likely to be understanding of a reasonable wait. Be real; if there is a wait, apologize. Try to connect with the patient. Assure them that you acknowledge their complaint is legitimate.

The other challenge is one that plagues doctors in all departments: lack of customer service training. Dr. Polera rightly makes the point that many hospitals expect doctors to take it upon themselves to improve the patient experience though they have never been trained on how to do so. This is an aspect of training that can easily be incorporated into ED orientation and continuing education programs.

Dr. Polera can speak about these difficulties from her own personal experience. She struggled with patient satisfaction scores fresh out of residency. She often used complicated medical jargon when explaining diagnoses to patients; but over time, learned to treat patients as she would her friends or family members. “It’s not enough to know the medicine,” says Dr. Polera. “You have to be a well-rounded provider. The expectation is that we do more than get [diagnosis and treatment] right. We are doing it in a timely manner and with a smile on our face.”