customer satisfaction in the er

[ensense]

I have been an ER nurse for 22 years now and this has to be one of the hardest parts of my job, customer satisfaction and Press Ganey. I work in an ED that sees 135 patients daily with the highest volumne during my shift 7p-7a. The problem I am having as well as many of my co-workers is that the hospital has decided for the last two years to use the Press Ganey survey company to evaluate our hospital. That in its self isn't much of a problem but when they start staying on us to the point it is interfering with our jobs it gets to be quite a head ache.

We as an ER have an average wait time of 2 hours or so. I think that is very good considing there are only 5 nurses on each shift . We have 2 doctors during peak times with a fast track open on weekends for even higher volumne.

My question is if anyone else has similiar problems keeping patients happy while still covering the TRUE emergencies. Even when I have a great day and don't let anyone fluster me I still can't seem to make the majority of patients happy. They get mad about the wait time, the lab wait time, the doctor attitude and the list goes on. Has any one out there got any ideas that I can take back to my ED customer satisfaction comittee to improve our scores. This is getting so old and it definitely takes the little bit of fun out of a very demanding job.

Thanks for any help any one can provide.

[athomas91]

pamela - i think you all should be really honest w/ your management and remind them of the nursing shortage........

we have a tracking system in our ed which tracks times - it helps - that way pt's cannot convey misinformation about their "4 hour visit" when it was really a 2 hour visit....

when pt's complain to me i simply explain that the ed's across the us are jampacked and it is a free country - if they feel they could get better/faster care elsewhere - then good luck -

i think you all need to stand up for yourselves - you all take care of the pt's - management should take care of you!!!

[fab4fan]

pamela: No, this is a hospital in PA.

I don't work ED anymore; had to give it up last year d/t an injury, and I do miss it, but that 15/30 rule was extremely stressful.

[flashpoint]

I don't disagree that we do need to keep our patients happy, but we should only have to do that thorugh good care, timely care, keeping the patient informed, etc...things that are pertinent to their medical problem...things that affect them medically.

We've honestly had people call to complain that they couldn't watch what they wanted in the waiting room (only one TV and if someone else is watching something...), that the nurses didn't offer them a snack (less than one hour from admit to dismiss and the ER was swamped), that the nurses didn't change the babies diapers or rock them to sleep (neither the parent or the baby was the patient), and that the patient who came in by EMS in full arrest got care before the girl who just wanted a pregnancy test (I missed my period and I'm on Medicaid, so I shouldn't have to pay for any of my medical care)...sigh.

Most of our patients are wonderful and very understanding and simply use good common sense...the ones that don't sure make it rough! :)

[harry Krishna]

Originally posted by MAGIK GIRL

ensense: i feeeeeel your pain!

could you rate your pain on a scale from 1 to 10 for me please????????????????????

[Geeg]

How did the docs respond to the impostion of the 30 min rule on them? I have found (anecdotallly of course) that docs play a very small role in customer service/satisfaction.

[marcicatherine]

Our ER has employed customer service reps. They walk around and talk with patients, get blankets, hand our coloring books and crayons to kids and most importantly explain wait times. I think it has helped a little in relations, but the Press-Ganey scores still suck. Press-Ganey, however doesn't take in to accout the sheer volume that we and other ER's do. We see well over 100 patients on a daily basis. Our patient to nurse ratio is 8-1. With numbers like that, it is nearly impossible to think we can please every one. I think on the other hand that pts seen in my ER get damn good care. You would be hard pressed to find a more caring group of people.

[ensense]

Thanks to all for the advice I got. Alot of the things we already do, such as have a patient liason that keeps them updates and get warm blankets and ice. The irony of that is that is one of our worse press ganey score times.

Like every one else I begining to think that staff moral might be hurting us some. I mean we are told constantly that we aren't doing a good enough job, need to do better.

I did some research on the internet and found that hospitals with consistently high press ganey are the hotel Hilton meets ER. They provide tv's in all patient rooms(yes , exam rooms), they provide snacks for patients that aren't npo. the list goes on and if you want the articles for yourself they are on elibrary under "emergency room satisfaction" search.

I am armed with them and plan on lowering the boom on the big wigs at our next meeting. If high scores are what they want it looks like they are going to have to open their wallets and increase monies to the ER to pay for the nurses so patients won't have to wait so long,as well as making more room to put patients in , then we need more doctors so ours aren't stressed by keeping up with this load of patients , then there is the all out education campaign that we need to do to educate people about the difference between a virus and an infection, an emergency vs urgent medical status, and again the list goes on.

Once again thank you all, I am going to take your comments to this committee and let them know that it isn't only "OUR" ER that is having the same problems. I feel that with all every has told me so far it will show so moral problems in our ER also. THANX.!!! " AND YOUR EMERGENCY IS?"

[teeituptom, BSN, RN]

Keep them satisfied. Give them blankets, coffee sandwiches and lots of drugs and they are happy.

doo wah ditty

[erjulie]

We also have Press Ganey- what a crock that is!

First, I'd like to comment on the poor person whose ED sees 135/day and fast track only on weekends...we see about 130/day and fasttrack is open from 1000-2200 and we still are swamped!

Press Ganey is the same as JCAHO: an arbitrary scoring system that garners the inventors LOTS of money. WE are not the inventors! We don't have ANY input into how the thing is scored! We have no control over the things they score on! Yet, our yearly "raises" are based on our scores.

I am totally against scoring systems that have nothing to do with the medicine/nursing that is delivered. One of the questions asks if the nurse was skilled. What do they mean "skilled"? that I didn't KILL you inadvertently? There was much ado in our first meeting with the Press Ganey folks about "if your nurses don't like it, or accept it, then fire them". That shows you how grounded in reality they are, ED nurses are apparently a dime a dozen in Press-Ganey world.

However, our administration paid beaucoup bucks, (instead of opening mre telemetry beds and hiring more nurses), so we are saddled with their bad decision.

The thing I find the most helpful is letting people know what the wait times are, what they're waiting for, and being able to blow off their anger at "having to wait". I have asked them when their PMD appt was, and when they say "I can't get an appointment for a week", I say- well 2 -3 hours is better than a week, isn't it? That usually either really makes them mad, while I think "at least I tried", or they understand...

The difficulty with Press Ganey is that the stuff that irks the patient reflects on the department. Did you have to wait for a bed? Hell yes, they answer, I spent 24 hours in the ED! OOOPS! our score just went down. Like I want these folks to lay on cots in the ER glaring at me. No raise!

Sorry, this is a big rant...

Just try to explain, and if they can't deal with the explanation, at least you tried.

Our ED did put TVs in the rooms, so at least they have something to watch besides the staff.

[veetach]

we also use the "Press Ganey" survey system. All we ever get in return are complaints. The wait is too long in the waiting room, that emergent sore throat (for 3 weeks) didnt get back to be seen before the pediatric asthma attack etc etc.

they complain about the wait to see the doc, the wait for labs results to come back. They complain if they see a nurse or a tech laugh. OMG that is unheard of!! If we are laughing we must be wasting time .... we remind them that they need to CALL THEIR DOCTOR if they want to be seen in a reasonable period of time, but it doesnt help...

We dont put too much emphasis on the press ganeys. Our average wait is 2-3 hours door to door and we point out to them that the average in our area is 6 hours, so if they are in and out in 3 then they are lucky. I used to live in California, we had a transient live in our ER for 3 days and no one knew it!!! LOL

We dont have a fast track so those patients are seen in the Observation beds, taking up even more valuable space for people who are really sick. It is a catch 22 situation.

[flashpoint]

We don't use Press-Ganey, but we do send out a "customer satisfaction" survey. It mostly questions whether the patient was admitted in a timely manner, whether they understood their discharge instructions, whether anyone was especially helpful...all things that should be expected and that sometimes can be improved upon. Our biggest complaint is the waiting time...people complain about waiting as little as fifteen minutes to as long as eight hours. It's rare to get a valid complaint about treatment from the nurses, doctors, lab, etc. However...the CEO wants every complaint addressed, so...some of the more interesting ones lately..."The nurse wouldn't let me sit in the comfortable chair at the the nurses' desk so I could use the computer to check my e-mail." "When I was in x-ray (after I punched a wall), the nurse made my husband change my son's diaper because he (my son) wasn't 'her patient.'" "It took over 30 minutes to see the doctor, have a be tested for strep throat, and get my medications!" (36 minutes triage to discharge for this patient!) "All I needed was one more stamp, so I could get my invitations sent out! Don't nurses carry stamps in their purses?"

Do I have a point here? LOL...maybe not. I guess the things that we are getting complaints about have nothing to to with the patient's actual care...the fact that we're not letting people at sit at the desk to check their e-mail has no effect on how well they are going to recover from their gastroenteritis! Not having a stamp to give to a patient is not going to prolong her recovery time...sigh. I think we give good care and I'll bet that patients are getting good care from most nurses everywhere! I think the public needs a little education about what good nursing or medical care is...when we ignore their medical complaints or don't attend to their medical needs, they can complain...when we deny them access to their e-mail for a couple hours, they can cowboy up and check their mail when they get home.

[mailners]

I would recommend those using press gaineys contact them and have a rep come speak to your staff. They do present a levelized play field based on hospital size, pt load, and setting. They do measure what the patient feels about their visit. Better than 90% you will find repond positively. Blows your mind but less than 5% just complain. We all have them so they are muted. I used to complain but after taking a whopping 30 minutes to understand them I am no longer fearful of them. Also, just like an SAT test, a small increase of 1 or 2% jacks your score heavily (remember levelized play field or handicap for you golfers). Honest, check out your rep.

Jeff