Satisfaction is the pivotal problem for Piney Woods Hospital to address. Satisfaction across all stakeholders has a substantive impact on the other key challenges the hospital is facing. When customers are satisfied with the service and care they receive at hospital, they let others in the community know about it. When hospital employees are satisfied, they provide superior hospital services. When physicians are satisfied, they provide excellent medical care. It is an obvious and intractable cycle. Further, levels of satisfaction are indicators of other symptoms or successes regarding the operations of the hospital and its relationship to the community. This paper will focus on the challenges of increasing patient and employee satisfaction within the Emergency Department at Piney Woods Hospital.
The health care industry has in common with other service industries the pivotal importance of employee engagement on the customer-facing -- or patient-facing, as the case may be -- transactions (Peltier, et al., 2009). Populations in developed countries are ageing at astounding rates and the healthcare industry must determine how to adjust accordingly (Peltier, et al., 2009). In 2009, the healthcare industry represented 17% of the Gross Domestic Product (GDP). In concert with the increasing demand for healthcare services, there is a substantive global shortage of health care professionals (Peltier, et al., 2009). Hospitals, in particular, are finding it difficult to consistently deliver high quality care (Peltier, et al., 2009). The issues of employee engagement and levels of job satisfaction present complex challenges to hospital administrators on a number of fronts (Peltier, et al., 2009). First and foremost is the quality of patient care, which is measured in terms of health problem resolution and outcomes, fiscal expenditures, and patient satisfaction ratings and reports (Peltier, et al., 2009). All of these outcomes come to bear on the tasks or recruitment and retention of healthcare professionals, and community perceptions about the kind of hospitals they have in their midst (Peltier, et al., 2009). All of these considerations occur against a background of global shortages of nurses (Newman, et al., 2001). With managed health care being commoditized, healthcare organizations wishing to competitively differentiate themselves are increasingly focused on measures of quality -- financial performance measures are taking a backseat as savvy hospital administrators know that the bottom line follows quality ratings (Love et al., 2008). The increasing concern for delivering high quality care characterized by patient satisfaction and employee satisfaction -- and a strong fiscal environment -- represents a departure, or at least a shift, from the management theory that dominated the 1990s when cost-cutting was the norm and the bottom-line concerns were the primary measure for a healthcare industry monumentally influence by stockholders (Brown, 2002).
In a recent study of patient ratings, interpersonal relationships with the primary care providers, and satisfaction with health care quality, the patient ratings were found to be positively associated with the quality of care (Meredith, et al., 2001). This study used factor analysis and multi-trait scaling to evaluate the psychometric properties of multi-item constructs, and analysis of covariance to evaluate associations between quality of care and patient ratings (Meredith, et al., 2001). The patient ratings demonstrated high internal consistency and they also met criteria for discriminant validity as they linked to descriptions of unique aspects of medical care (Meredith, et al., 2001). Significant differences were found between satisfied and unsatisfied patients (Meredith, et al., 2001). Patients who reported receiving quality care rated their interpersonal relationship with their physicians 27% higher of a standard deviation, and responded that they were 34% of a standard deviation more satisfied than patients who reported that they had not received quality care (Meredith, et al., 2001).
Attribution theory, when applied to responses given to a survey by a large number of respondents, suggests a need to examine the characteristics of patients that might contribute to certain patterns of responses (Hargraves, et al., 2001). It is important to determine what patient characteristics and what hospital characteristics may be associated with reports and ratings of hospital care (Hargraves, et al., 2001). A telephone survey conducted with a patient sample across 22 hospitals in a city and a statewide survey mailed to hospitalized patients examined the association of patient and hospital attributes with quality of care ratings and reports (Hargraves, et al., 2001). Patients were surveyed about the coordination of care, the exchange of information between patients and medical care providers, their preferences as patients, transition and continuity issues, how emotional support was addressed, and how patient's families and friends were involved (Hargraves, et al., 2001). The strongest and most consistent relationships were evidenced between age, reported health status, and patient-reported problems (Hargraves, et al., 2001). Patient gender and level of education had some predictive power over ratings and reports (Hargraves, et al., 2001). However, modeling indicated that only 3% to 8% of the variation could be attributed to these patients and hospital attributes (Hargraves, et al., 2001). The researchers concluded that the impact of adjusting for patient characteristics was small, but suggest that more impact is likely when comparisons include more variability in patient type and hospital type (Hargraves, et al., 2001). The researchers also suggest that data from patient ratings and reports be segregated for groups of patients where variability between groups is anticipated to be greatest -- such as obstetric patients, surgical patients, patients with chronic health problems, and patients with acute health problems -- as this disaggregation of data is likely to facilitate interpretation of the data and result in more accurate and meaningful quality improvement efforts (Hargraves, 2001) (Hargraves, et al., 2001).
Hospitals conduct their work in a people-centric industry (Peltier, et al., 2009). Patients consume healthcare services in relation to their physical bodies or mental states (Peltier, et al., 2009) People provide services and treatment (Peltier, et al., 2009) People are central to the administration and operations of a hospital (Peltier, et al., 2009) The hospital environment is complex and inherently presents management challenges as the array of services it provides extends well beyond medical care and treatment to patient education, employee training, monitoring the certification and licensing of professionals, the provision of food, housekeeping, and hospitality (Peltier, et al., 2009) There is common agreement that the hospital environment is stressful for employee and for patients (Peltier, et al., 2009) There is less agreement about the extent to which and how employee satisfaction relates the quality of patients' perceptions and experience (Peltier, et al., 2009) A substantial body of literature indicates that there is "a direct and positive relationship between the satisfaction of employees and the quality of the patient experience" (Peltier, et al., 2009).
Employee engagement is very low at Piney Wood Hospital. There appear to be several key indicators for why this is so.
Physicians at Piney Wood Hospital. Physicians were not consulted and apparently had no voice in the adoption of electronic medical records by the hospital. Physicians are fiscally rewarded according to patient satisfaction, levels of which have been steadily dropping. Hospital leadership has experienced high turnover and physicians have not felt supported, motivated, or listened to, nor have they established solid relationships with the new hospital Chief Executive Officer, Zach Porter.
Nurses at Piney Wood Hospital. Wards and the Emergency Department are overcrowded. Nurses don't appear unified, transactions are contentious, and relationships are poor. Nurses often have to work overtime and the nursing schedules are inflexible. Patients are often angry or do not understand hospital procedures and the requirements associated with insurance, payments, and treatment regimens because of language barriers. Interactions between physicians and nurses are strained. Nurses also have experienced the impact of continuously changing leadership at the hospital helm and across departments.
Other staff at Piney Wood Hospital. Patient care and non-patient care staff experience mirror-image stresses of their superiors and associates in the hospital setting. Overcrowding, angry and confused patients, demanding schedules, deteriorating interactions with other employees, and a lack of leadership all impact the satisfaction of workers in this category. And since many of these workers touch the daily work lives of everyone else in the hospital (laboratory workers, cafeteria workers, custodial workers, payroll and benefits workers, parking lot attendants), high levels of dissatisfaction ratchet up in what appears to be an unstoppable updraft of ever higher levels of dissatisfaction.
Suggested Alternatives (use of literature to support)
Changes to logistics and operations consist of four main components. (1) Revamp the configuration of the physical hospital entrance and reorganize the registration procedures; (2) Provide education and training to physicians regarding the benefits of electronic medical records; (3) Establish an electronic medical records review team; and (4) Establish a Hospital Leadership Council with representation from all stakeholder groups.
Action 1. Revamp the configuration of the physical hospital entrance. The three registration desks will be moved to a position directly opposite and parallel to the Emergency Room walk-in entrance. The registration desks will be immediately visible to anyone coming through the walk-in entrance -- and to outpatients upon making a right-turn as indicated by signage.…