Improving Customer Service on a Medical Surgical Nursing Unit Quality Improvment Project-Customer service on the nursing unit

The hospital medical-surgical nursing unit is usually referred to as the "catch-all" department for different types of patients. This is because it includes renal patients, cancer patients, cardiac and surgical patient. It also includes other patients who do not particularly fall into any of these specialized units. The medical-surgical nursing unit is a conglomeration of all kinds of adults with all sorts of health problems and thus the nurses in this unit need to be dynamic, quick to respond and are almost on their toes at all times. Patients in the medical-surgical nursing unit are likely to develop changes in their condition quite rapidly and therefore they become more unstable even though they may have been admitted in a stable condition. This is because most patients in the medical-surgical nursing unit have unpredictable conditions and even though they may be predictable, the degree of predictability is quite low.

A lot of care in health care units is given in hospital medical surgical nursing units. There is an estimated 35-40% rate of unexpected deaths that occur in these medical surgical nursing units. Additionally, the staff retention rate of medical surgical nursing units is quite low as a result of the heavy input required from the members of staff often with very low income levels. Therefore, they hop on any new opportunity that gives them the slightest improvement in their working conditions, be it higher pay or an improved working environment. The minimum nurse-to-patient ratio for medical-surgical units is 1:5 but in most health care organizations, the ratio stands at 1:15. This is because of low staff retention rates. Therefore, it is essential for the management of the health care organization to institute drastic measures for the improvement of the care that is provided to patients in medical surgical nursing units. These measures will also help to improve the satisfaction levels of the members of staff and thus increase the staff retention rate.

Nursing indicator

The nursing indicator being looked at here is the patient satisfaction rate. Patient satisfaction is referred to as the perception of the patient regarding the health care received as compared to the care that they expected to receive. It is an important predictor of the overall satisfaction rate of patients with the hospital and the hospital staff and it is an important goal for each health care organization. Dissatisfaction with the care provided with patient leads to lower utilization of the services provided by the hospital and thus decreases the revenue for the hospital. For this reason, patient satisfaction rate is not simply referred to as a measure of quality. Rather, it is the major goal of delivery of health care.

There are four levels of this indicator. The first is patient satisfaction with overall care, second is patient satisfaction with management of pain, third is patient satisfaction with educational information and the last is the satisfaction of the patient with the nursing care provided. All these four levels of this indicator will be analyzed.

In a study conducted by Al-Mailam (2005) on a sample of 420 inpatients in order to determine the extent to which they were satisfied with the care provided to them, it was found that the maximum patient satisfaction levels were the highest scored. 91.9% of the patients reported a satisfaction level of "excellent" while 3.9% reported a satisfaction level of "very good." The study also found that there a positive correlation between the perception of the patients towards the nursing care provided and their overall satisfaction with the health care that they received.

Many governments are also prioritizing the satisfaction of patients with the health care they receive in government hospitals. In the UK, the government placed the patient satisfaction rate as the highest priority indicator and that all accident and emergency departments should strive to achieve a 95% level while the other hospital departments should strive for a 98% level.

Quality improvement model to be used

The lean thinking model will be applied to the improvement of this patient satisfaction indicator. Lean thinking is a way to decrease the waste and increase the efficiency of processes. It is a way to do more work using less effort, equipment, time and space while at the same time giving the patients exactly what they need. Lean thinking in the medical-surgical nursing unit can be applied to optimize the processes involved in delivery of health care to make sure that the nurses involved in provision of health care use the limited resources such as time, money and other supplies to provide the highest quality of health care to the patient. By learning to effectively manage the available resources which are limited, the organization can limit waste and improve the efficiency of provision...

Ensuring that the decisions are based on a long-term philosophy even though this may be at the expense of the short-term financial goals of the organization.
2. Creation of a continuous process of flow which brings about the problems of the organization to the surface.

3. The use of "pull" systems which help to avoid any kind of overproduction.

4. Leveling out of the workload.

5. Building a culture which stops to fix the problem while getting the patient satisfaction right at the first instance.

6. Standardizing the tasks in the organization which form a foundation for the continuous improvement of the processes and also empower the nurses.

7. The use of visual control to ensure that there are no problems that remain hidden.

8. The use of a reliable and thoroughly tested technology which serves both the patients and the processes.

9. Growth of leaders who have a thorough understanding of the work and culture and are ready to teach others.

10. Developing exceptional teams and people who follow the philosophy of the health care organization.

11. Respecting the extended network of partners and suppliers through giving them challenges that help them to improve.

12. Getting a first-hand view that the nurses have a thorough understanding of the situation and the organization's philosophy.

13. Making decisions through general consensus which have a thorough consideration of all the options available and implementing the decisions made rapidly.

14. Becoming a learning organization through reflecting relentlessly and a process of continuous improvement.

Primary measurement to be utilized

The primary measurement to be used is the processes involved in the attainment of health care. The table below shows a comparison of these measurements for our organization as per other organizations. The goal is to optimize the processes that they achieve the same values as those of other organizations.

Our organization

Other organizations

Steps in provision of health care

25

9

Value-added steps

4

4

Total time spent on each patient per day

70 minutes

20 minutes

% of value-added time

9%-17%

32-42%

Number of patients in each queue

11

3

Handoffs to other health care providers

10

5

Variation in health care provided

High

Low

Ethical dilemmas arising

Ethical dilemmas that can arise in this situation of trying to improve the satisfaction rate of patients to the health care provided involve violation of the ethical principles. First is that the nurses may be unable to exercise veracity since they may feel that it is more beneficial to withhold some information from the patient. Another violation is that of respect for autonomy where the nurse may feel that the patient is unable to make a decision based on informed consent thus violate this ethical principle. These ethical dilemmas will be solved through the use of an ethical decision-making model which ensures that the decision made does not violate any of the ethical principles. There are seven steps of the ethical decision-making model to be followed.

The first step is to identify the problem itself. This is where the nurse tries to get clarity on the situation and to outline the facts, assumptions and hypotheses or suspicions related to the situation. Secondly is the application of the code of ethics that governs the health care providers. For counselors, this is the ANA (American Nursing Association) code of ethics. This helps the nurse to apply the code of ethics. The third step is to determine the nature of the dilemma and to consider which moral principles are violated and which ethical theories describe the dilemma. There is also the review of literature to find ways which have been used in the past to resolve such dilemmas. This is called evidence-based practice Shortell et al., 2001()

The fourth step is to find the potential courses of action and to brainstorm on them to find the most creative way to resolve the dilemma. Fifth is to consider the consequences of all options present and to determine the appropriate course of action. Sixth is to evaluate the course of action that is selected for its ethicality and whether it is appropriate for the situation. It is also evaluated to check its sense of fairness and that it is not a violation of any of the ethical principles. The last step is then to implement the chosen course of action.

The Team

The team which will lead this improvement in patient satisfaction rate will consist of…