The majority of my 27 years of nursing have been in the field of gastroenterology. I've lived through many technological advances including videoendoscopy, endoscopic ultrasonography, and most recently, the small bowel video capsule. I've experienced a period of nursing surplus (believe me -- it existed!) as well as the nursing shortage. I've watched reimbursements reach a height, then with time decrease and have adjusted my practice accordingly (limit those non-essential accessories!).
Change, change, and more change! What, if anything, has stayed the same? I would say that the need to satisfy our customers has remained constant. Though the term "customer service" in healthcare has become more refined, the very basics of treating our patients kindly, respectfully and with the aim to please has been and continues to our aim. As caregivers we are also nurturers -- by nature we seek to please.
Customer service/satisfaction has become an entity of its own. In fact, some hospitals have dedicated full-time employees to this focus solely. Our hospital has a customer service steering committee that oversees the hospital's organized program. They have developed mandatory educational programs for staff, including role-playing endeavors. Staff begin the program on day No. 1 of their employment, and failure to adhere to the established 10 standards of excellence may result in termination of employment.
The hospital utilizes a company, National Research Corporation, to conduct our satisfaction surveys. We receive compiled results on a quarterly basis and also "service alerts" between surveys that address expressed patient concerns on a more timely basis. Each of our in-patient nursing units receives a score, and our outpatient departments are also scored individually. Our endoscopy unit is considered an outpatient department.
The two key indicators for our outpatient departments are: "would recommend for OP services" and "overall quality of OP care." A number of the questions are standardized by our health system so that equal comparisons between the hospitals in the system can be made. Other questions are "our own" and are those considered by us to be most important to our operation. We have taken a step further and have developed a tool we give to all our outpatients.
Our endoscopy unit has enjoyed satisfaction scores above "the norm" for our health system for both of the two key indicators. However, in response to some specific concerns trended by our internal tool, we selected our unit's 2002 performance improvement (PI) project efforts to improve our patient satisfaction scores. The areas of concern involved the post-procedure phone calls as well as patient education. Post-procedure phone calls weren't being done consistently within 24 hours of the procedure. Patients reported not having been given educational materials consistently prior to their discharge.
We expect all staff in the department to become involved in the PI process, RNs and techs alike. Level III RNs became responsible for directing the PI initiatives. Level II RNs became team leaders. Level Is and Techs selected a team in which to participate.
The two teams selected were the education team and the post-procedure phone team. The teams began to meet independently and have been expected to give a report at each monthly staff meeting. The educational team has compiled new educational material, including procedural education and disease specific information. The committee purchased acrylic holders for the procedural education and placed them in the waiting/registration area. They placed wall pockets with multiple dividers on the recovery room walls, making the disease-specific information available to the patients post procedure.
We knew an additional educational opportunity existed. The in-patients who were coming to our department for diagnostic and therapeutic studies offered an opportunity to increase their satisfaction with us and with the hospital in general. We found they received very little education prior to the procedure (from the physician or from their nursing unit). We also found that we knew very little about the patient prior to his/her arrival in the department, and the best time to discover this information was not minutes before the arrival of the physician! Last but certainly not least, the event of a visit to our department presented for many patients an anxiety-ridden adventure.
We developed an in-patient teaching program. We developed a tool that included information we hoped to uncover about the patient that would improve our care efforts. We noted presence or absence of required consents. We learned about our patients' personalities and any special needs. We took procedural information to the patient and further explained what would transpire, answering any questions the patient might pose. We hoped to shorten the time in actual patient preparation as well as to increase the patient's as well as the staff's satisfaction.
Visits are made the afternoon prior to the scheduled procedure day. The "on call" staff nurse for the day is assigned to make the visits. Recorded information is made available to the staff who will care for the patient the following day.
Challenges in the visitation program include the high-volume of add-on cases daily. These patients are not seen the day prior to the procedure. We have attempted to print the schedule later in the day in order to capture these, but they most often do not become added until the evenings.
Patients have expressed high satisfaction in receiving the visit. We have not found a decrease in the patient preparation time thus far, however. We are looking at possibly adding a post-procedure visit portion to our initiative.
The post-procedure phone call team has been working to ensure that the calls are made within 24 hours of the procedures. They uncovered some prohibitive issues, such as the fact that they didn't have ready access to the long distance code. Action was to make it available but secure by keeping it in the Pyxis medication machine. Staff in the room with the fewest procedures scheduled for the day is assigned the post procedure phone call task.
The need for customer satisfaction does not change, but the needs of the customer continue to change. We will continue to stay in tune with our patients' needs and to adjust our processes to accommodate.
Betty McGinty, RN, BS, CGRN is director of GI services at Saint Joseph's Hospital of Atlanta, Atlanta, GA.