Improving Patient and Employee Satisfaction at Piney Woods Hospital

Introduction

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 a hospital, they let others in the community know about it. When hospital employees are satisfied, they provide superior services. When physicians are satisfied, they provide excellent medical care. It is an obvious and self-reinforcing cycle. Furthermore, levels of satisfaction serve as indicators of other symptoms or successes regarding the operations of the hospital and its relationship to the community. This paper focuses on the challenges of increasing patient and employee satisfaction within the Emergency Department at Piney Woods Hospital.

The healthcare industry shares with other service industries the pivotal importance of employee engagement in customer-facing — or patient-facing — transactions (Peltier et al., 2009). Populations in developed countries are aging 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 increasing demand for healthcare services, there is a substantive global shortage of healthcare 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 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 bear on the tasks of recruitment and retention of healthcare professionals, as well as community perceptions about local hospitals (Peltier et al., 2009). These considerations occur against a background of global shortages of nurses (Newman et al., 2001). With managed healthcare being commoditized, healthcare organizations wishing to differentiate themselves competitively are increasingly focused on measures of quality — financial performance measures are taking a backseat, as savvy hospital administrators recognize that the bottom line follows quality ratings (Love et al., 2008). The increasing concern for delivering high-quality care characterized by patient and employee satisfaction represents a shift from the management theory that dominated the 1990s, when cost-cutting was the norm and bottom-line concerns were the primary measure in a healthcare industry monumentally influenced by stockholders (Brown, 2002).

Literature Review

In a recent study of patient ratings, interpersonal relationships with primary care providers, and satisfaction with healthcare quality, patient ratings were found to be positively associated with 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 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 by standard deviation, and reported being 34% of a standard deviation more satisfied than patients who said they had not received quality care (Meredith et al., 2001).

Attribution theory, when applied to survey responses from a large number of respondents, suggests a need to examine the characteristics of patients that might contribute to certain response patterns (Hargraves et al., 2001). It is important to determine what patient and 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, along with 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 coordination of care, information exchange between patients and medical care providers, patient preferences, transition and continuity issues, emotional support, and the involvement of patients' families and friends (Hargraves et al., 2001). The strongest and most consistent relationships were found 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 patient and hospital attributes (Hargraves et al., 2001). The researchers concluded that the impact of adjusting for patient characteristics was small, but suggested that greater impact is likely when comparisons include more variability in patient type and hospital type (Hargraves et al., 2001). They also suggested that data from patient ratings and reports be disaggregated for groups where variability is anticipated to be greatest — such as obstetric patients, surgical patients, patients with chronic conditions, and patients with acute health problems — as this disaggregation is likely to facilitate interpretation and result in more accurate quality improvement efforts (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, while staff provide services and treatment, and 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 include patient education, employee training, monitoring of professional certification and licensing, and the provision of food, housekeeping, and hospitality services (Peltier et al., 2009). There is common agreement that the hospital environment is stressful for both employees and patients (Peltier et al., 2009). There is less agreement about the extent to which, and the ways in which, employee satisfaction relates to the quality of patients' perceptions and experience (Peltier et al., 2009). Nevertheless, 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 Woods Hospital. Several key indicators help explain why this is the case.

Problem Statement

Physicians at Piney Woods Hospital. Physicians were not consulted and apparently had no voice in the hospital's adoption of electronic medical records. Physicians are financially rewarded based on patient satisfaction scores, which have been steadily dropping. Hospital leadership has experienced high turnover, and physicians have not felt supported, motivated, or heard, nor have they established solid relationships with new hospital leadership.

Nurses at Piney Woods Hospital. Wards and the Emergency Department are overcrowded. Nurses do not appear unified — interactions are contentious and relationships are strained. Nurses often work overtime, and nursing schedules are inflexible. Patients are frequently angry or do not understand hospital procedures and the requirements associated with insurance, payments, and treatment regimens, in part due to language barriers. Interactions between physicians and nurses are also strained. Nurses have additionally experienced the impact of continuously changing leadership at the hospital and across departments.

Other staff at Piney Woods Hospital. Patient care and non-patient care staff experience mirror-image stresses compared to 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 diminish the satisfaction of workers in this category. Since many of these workers — laboratory staff, cafeteria workers, custodial workers, payroll and benefits personnel, and parking lot attendants — touch the daily work lives of everyone else in the hospital, high levels of dissatisfaction compound in what appears to be an unstoppable, self-reinforcing cycle.

Conclusion

Quality of healthcare is supported by a constellation of variables, and investments in infrastructure and technology can certainly have a large impact on healthcare quality (Peltier et al., 2009). However, a substantial body of research indicates that the "most dramatic improvements" can be achieved by the people who work in the field of healthcare (Peltier et al., 2009). Research has found that dissatisfied healthcare employees can have a profoundly negative effect on the quality of care that patients receive (Peltier et al., 2009). This, in turn, affects levels of patient satisfaction and ultimately community loyalty to the hospital (Atkins et al., 1996; Fahad Al-Mailam, 2005). Conversely, the research indicates that increasing employee engagement leads to improved employee satisfaction and, consequently, to improved patient care and higher patient satisfaction ratings (Peltier et al., 2009).