"In the world of patient populations, the ED is arguably the most difficult to understand, predict and treat effectively. Most patients who arrive at the ED are in crisis – real or perceived – because of this, the importance and need for ‘customer service’ in the ED can’t be understated.”
- Rick McCraw, Principal and Assessments Lead
This article was published by Becker’s Hospital Review on June 21, 2017. Emergency medicine is a complicated and rewarding specialty filled with unique challenges. Positioned at the “front lines” of care delivery, emergency departments (ED) treat patients in an environment that is by nature stressful and chaotic. From managing capacity, to triaging patients, to navigating life-threatening illnesses and injuries, some EDs experience pandemonium daily. Adding to the tense environment of the ED is the growing regulatory pressure to improve efficiency, reduce costs, and increase throughput – all the while providing the best care experience for patients and staff. As healthcare leadership looks to optimize EDs, beyond considering performance metrics which impact reimbursement and revenue, they also have to develop strategies for delivering a positive and consistent patient experience. This positivity has been shown to improve HCAHPS scores and ensure a stronger hospital market share, while encouraging the high-value and high-quality care that patients and families deserve.1 Here are three key strategies for healthcare leadership to consider as they work to place patient experience at the heart of ED optimization.
Implement Customer Experience in Patient Interactions
Because of this ‘human factor’, the ED experience is not black and white, bringing new importance to the nuances of relationships and communication. Treating ‘customer service’ with similar importance to any other clinical process will help ED professionals reframe their standards and hone their skills. Put another way, if customer service is part of the healthcare job description and a sought after, recognized trait in the workplace, both staff and patient satisfaction will improve. A recognized fact in clinical practice and literature is the powerful, intrinsic link between engaged, satisfied staff and patient satisfaction.2 When staff is engaged and satisfied, patient satisfaction scores increase. This can be attributed to the growing trend of patient-centric care, which places a greater emphasis on the physician-patient relationship and engagement. Today, more than ever, patients want to be a part of the healthcare decision-making process, and those who are engaged as decision-makers tend to be healthier and have better outcomes. Reimbursement is not the only thing changing in healthcare; providers are realizing the importance of delivering a consistent, positive customer experience in the ED and beyond.
In the world of patient populations, the ED is arguably the most difficult to understand, predict and treat effectively. Most patients who arrive at the ED are in crisis – real or perceived – because of this, the importance and need for ‘customer service’ in the ED can’t be understated. Emergency department staff are evaluated by patients at every turn; their actions impact the reputation of the individuals providing care and the overall fiscal viability and success of the health system. Compounding this, patients evaluate their experience in the hospital not only on clinical processes and outcomes, but on how they were treated as a person.
Engage Leadership and Optimize Processes
To overcome the challenges of the ED patient population and implement positive change, staff need the full support of management. Connecting staff to the purpose behind the patient experience is an essential first step towards success. Examples of successful behaviors that support the patient experience include the use of positive language in patient interactions, bed side shift reporting and lobby rounding. In addition, structured leader rounding for staff and patients supports the hardwiring of desired behaviors. Leaders who fail to embody these skills will not be able to evoke them in others. A top-down management commitment, from the hospital C-suite to the ED director, must be in place to hold all accountable and drive an optimized patient experience. Positive validation and recognition will make these initiatives succeed over the long term.
Healthcare providers all over the country are teaming up with strategic partners to better deliver high-quality patient care by developing tactful initiatives and programs to transform hospital EDs – one rural community trauma center, which partnered with Philips restored staff morale and staff involvement, as well as saw a 23% increase in overall ED director score.3 However, tactics based on staff commitment can only go so far, and can even be undermined, without effective management and throughput processes within ED operations. In contrast to an inpatient experience where patients may have a general sense of their condition, wait times, and their expected length of stay at the hospital – the ED does not operate by the same rules of engagement. ED patients need to feel that they are moving through the process – at a certain point, patients become upset from waiting too long for physician intervention, and no amount of status updates or provisional resources can make up for this problem. Process, and more specifically, timing and flow, is critical. For example, if you visit a restaurant you want to be taken care of in a timely fashion – drinks should come before the appetizers, appetizers before the main course and the main course before the dessert. Similarly, patients in the ED want to feel like they are moving through an efficient process – from arrival to discharge. A 408-bed community hospital engaged with Philips to provide an interim ED leader and to help them improve performance. As a result, the hospital was able to increase patient satisfaction by 334% to the 100th percentile, decrease the left without being seen (LWBS) rate by 41% and improve the arrival-to-provider times by 44%.4
Win Hearts and Minds
As with any relationship, a strong foundation of trust is very important for successful patient-physician interactions. Perceived trust is imperative for healthcare provider success in the short and long term. In the Emergency Department setting, the sick are vulnerable – emotionally and physically, but often times, also financially. Adding to that is the sometimes reluctant, discretionary power given to providers on behalf of the patient and system, resulting in a perceived “imbalance of knowledge and power” which can characterize healthcare relationships.5 Trust can counteract this, and it is something that healthcare providers often take for granted. Trust in a healer is sacred, and frequently the prerequisite for seeking care and the reason for returning to a particular provider, hospital, or health system. Healthcare leaders should promote and recognize this in their clinical practice, and remind staff why they chose to pursue a career into healthcare in the first place: to help and make a difference in the lives of others. By creating an environment that empowers employees to make a difference, healthcare leaders can influence trust and positive staff behaviors; ultimately winning the hearts and minds of care providers for long-term, engaged care interactions. In summary, a holistic and integrated approach to optimizing and improving the patient experience in the ED is necessary to see results, as there is no one-size-fits-all solution. If everything in healthcare is connected, the ED is no exception. Healthcare leadership cannot get great patient experience without improved patient throughput. Similarly, hospitals cannot get great patient experience scores without a certain level of staff satisfaction. As healthcare providers begin to tackle this complex challenge of improving the patient experience, focusing on strategies that include structured, purposeful programs will be the key to long lasting, positive impacts in the ED and beyond.
Read the article as published by Becker's Hospital Review at Three strategies to improve the patient experience in the emergency department
About the authors
Rick J. McCraw, MBA, MHA, RN, CEN, FACHE Director, Client Development
Rick has over 30 years of emergency, trauma, and physician practice leadership experience. He led a Level 1 trauma center ED and has reduced door to provider times, the decision-to-admit to inpatient bed times, implemented point-of-care testing in the ED, and streamlined nursing workflow and the ED discharge process. Rick is a certified nurse specializing in emergency nursing.
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Beth Fuller, DNP, RN, CEN, CCRN, CFRN Consulting Principal
Beth has over 35 years of emergency, ICU, and critical care transport leadership experience in academic medical centers and community hospitals. She possesses extensive clinical and leadership knowledge and experience and has led ED change and reduced cost while improving patient satisfaction and employee engagement. Beth has assisted several organizations in redesigning their triage systems based on best practices, resulting in substantial decreased length of stay, decreased left without being seen rates, and improved patient satisfaction. She holds nursing certifications in critical care, emergency nursing, and flight nursing.
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1 Berkowitz, B. (January 31, 2016) "The Patient Experience and Patient Satisfaction: Measurement of a Complex Dynamic" OJIN: The Online Journal of Issues in Nursing Vol. 21, No. 1, Manuscript 1. 2 Patient satisfaction in the Emergency Department: a review of the literature and implications for practice Boudreaux, Edwin D. et al. Journal of Emergency Medicine, Volume 26, Issue 1, 13-26. 3 Philips. Interim healthcare leadership leads to improved employee engagement in the ED. Retrieved from: http://www.usa.philips.com/healthcare/articles/consulting/interim-ee-leadership 4 Philips. Interim healthcare leadership helps to improve patient satisfaction and throughput metrics in the ED. Retrieved from: http://www.usa.philips.com/healthcare/articles/consulting/process-improvement.html 5 Goold, S. D. (2002). Trust, Distrust and Trustworthiness: Lessons from the Field. Journal of General Internal Medicine, 17(1), 79–81. http://doi.org/10.1046/j.1525-1497.2002.11132. [1] Patient satisfaction in the Emergency Department: a review of the literature and implications for practice Boudreaux, Edwin D. et al. Journal of Emergency Medicine, Volume 26, Issue 1, 13-26. [2] Philips. Interim healthcare leadership leads to improved employee engagement in the ED. Retrieved from: http://www.usa.philips.com/healthcare/articles/consulting/interim-ee-leadership [3] Philips. Interim healthcare leadership helps to improve patient satisfaction and throughput metrics in the ED. Retrieved from: http://www.usa.philips.com/healthcare/articles/consulting/process-improvement.html [4] Goold, S. D. (2002). Trust, Distrust and Trustworthiness: Lessons from the Field. Journal of General Internal Medicine, 17(1), 79–81. http://doi.org/10.1046/j.1525-1497.2002.11132. [1] Patient satisfaction in the Emergency Department: a review of the literature and implications for practice Boudreaux, Edwin D. et al. Journal of Emergency Medicine, Volume 26, Issue 1, 13-26. [2] Philips. Interim healthcare leadership leads to improved employee engagement in the ED. Retrieved from: http://www.usa.philips.com/healthcare/articles/consulting/interim-ee-leadership [3] Philips. Interim healthcare leadership helps to improve patient satisfaction and throughput metrics in the ED. Retrieved from: http://www.usa.philips.com/healthcare/articles/consulting/process-improvement.html [4] Goold, S. D. (2002). Trust, Distrust and Trustworthiness: Lessons from the Field. Journal of General Internal Medicine, 17(1), 79–81. http://doi.org/10.1046/j.1525-1497.2002.11132.
