Healthcare overhaul leads hospitals to focus on patient satisfaction

SAN FRANCISCO — For years, the check-in process in the urgent care center of this city’s large, downtown hospital was reminiscent of a visit to the DMV. The ailing and sick walked in, pulled a number, took a seat and waited to be called. Many grew impatient and exasperated.

Now, patients at San Francisco General Hospital are greeted by a smiling face and a helping hand to guide them along the path to getting care. It’s one of a series of customer-friendly touches being added at the 156-year-old institution by a newly named “chief patient experience officer.”

“Saying ‘number 32' versus ‘Mr. Jones’ is dramatically different,” said Baljeet Sangha, who holds the new position. “We have to remind ourselves these are people.”

Under the national healthcare overhaul, patient experiences matter. Federal payments are being tied to surveys that gauge patient attitudes about such things as a hospital’s noise and cleanliness, communication and pain management.


If patients are happy, hospitals get more money. If they aren’t, hospitals get less. That’s prodding hospital executives to make changes to improve the patient experience. Televisions are being upgraded, cafeteria fare improved and patient call signals answered more promptly, officials say.

“The goal is not to turn hospitals into hotels,” said Patrick Conway, chief medical officer for the federal Centers for Medicare & Medicaid Services, “but to ensure that every patient and family has the best possible experience when they are hospitalized.”

Positive patient experiences can affect medical outcomes and a hospital’s bottom line, Conway said. If nurses clearly communicate discharge instructions, for example, patients better understand what they need to do to stay healthy and avoid costly readmissions.

Competition is partly responsible for the transformation. People have access to hospital patient satisfaction and quality scores, empowering them to make informed choices about where to seek care. Public hospitals, particularly, risk losing large numbers of newly insured patients.

“It’s not good enough to be the safest or the highest quality,” said Bridget Duffy, chief medical officer at Vocera Communications and an expert on patient experience. “You have to connect with people on an emotional level to get them to be loyal.”

One example: The first questions patients are asked shouldn’t be whether they are insured and have an advance directive for end-of-life treatment, said Duffy, who works with San Francisco General and dozens of other hospitals. “It just takes one person to destroy great outcomes,” she said. “It’s often the apathetic, rude person at check-in.”

Bay Area facilities were among the pioneers in the movement to make hospitals more patient-friendly, in large part because of Duffy’s work.

To help make patients feel more welcome, San Francisco General created the position of director of first impressions. An oversized stoplight dubbed the “yacker tracker” was installed next to a nurses’ station that switches to red when noise levels rise too high. Yoga classes for patients and staff have been added and new signs posted to make it easier for people to find where they’re going.


At a recent management meeting at the hospital, patients shared their stories, saying they were pleased with their care but frustrated by customer service.

David McClure, 65, said doctors have saved his life twice — after a stroke and cancer. But he has encountered “abrupt, curt and insulting” employees, he said. Vivian Lusky, 43, said her stays at the hospital have been “bittersweet.” The doctors are amazing, she said, but staff members don’t always communicate well and wait times are too long.

Chief Medical Officer Todd May said inviting such candid patient feedback is difficult but can lead to better care. “You have to have the courage to do this at the risk of hearing the good, bad and ugly,” he said.

The federal government began publicly reporting the results of hospital patient surveys in 2008. Reimbursements were linked to responses beginning last year. The surveys include questions such as: After you pressed the call button, how often did you get help as soon as you wanted it? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for?


In California hospitals, 74% of patients reported that their nurses always communicated well, 51% reported that the area around their room was always quiet at night, and 70% of patients reported that their room and bathroom were always clean. All three were below the national averages.

The new patient satisfaction incentives are part of a push under healthcare reform to tie hospital payments to performance. Nationwide, about $1 billion in payments will be based on patient satisfaction scores and other clinical quality measures.

The money won’t make or break hospitals, but the scores could affect whether patients return, said Jason Wolf, president of the Beryl Institute, which works to improve the patient experience. Wolf said hospitals need to treat patients with respect and address the entire customer experience. “You can’t just change one tire on a car and expect the car to run better,” he said. “You have to be aware of all the pieces and parts.”

Los Angeles County hospitals are addressing patient satisfaction by cutting the time it takes to respond to patient call buttons and delivering meals more quickly so they don’t get cold. Some hospitals use volunteers as “patient ambassadors” to check on patients throughout the day and relay concerns to nurses. Others make follow-up calls to patients after their release.


Lucile Packard Children’s Hospital at Stanford University recently hired its own “patient navigators” to assist patients and families with whatever they need: getting to the pharmacy, connecting with a social worker, scheduling appointments. Chief Operating Officer Anne McCune said the goal is to forge strong relationships with patients and help them through what is often a trying time.

“If somebody walks in with a sick child into a complex medical center, they don’t have a healthcare GPS that helps steer them around,” she said. “The patient navigator … is that GPS.”

One of the most effective ways to improve patient satisfaction is by improving conditions for the staff, Duffy said. When nurses and doctors are content, she said, they are more likely to work together and provide better care.

At San Mateo Medical Center, staff members recently organized several social events to foster cooperation. The hospital also started morning “huddles,” at which nurses, doctors, physical therapists and others discuss patients’ needs and progress.


The huddles have helped everyone start the day on the same page, said nurse Azucena Zeledon. “We’re all helping each other,” she said, “and that helps the camaraderie.”

The hospital has begun its own mini-surveys to identify problems that can be addressed before patients are discharged. “This is so much more effective,” said Chief Executive Susan Ehrlich. “They can address it as it is happening.”