Mark Miller, DO, FACEP, serves as American Physician Partners’ medical director for the emergency department (ED) at Ascension Borgess-Pipp in Plainwell, Michigan. His team was recently recognized for undergoing a number of initiatives that made a significant improvement on the ED’s patient satisfaction scores. Following is an interview with Dr. Miller to spark ideas for other leaders seeking to improve their ED satisfaction scores.

Borgess Pipp

  • What is the volume/acuity mix of the ED at Ascension Borgess-Pipp?
    We have an average daily census of approximately 30 patients, but some days we can see as many as 40-45. We essentially function as a free-standing emergency department (FSED) and transfer all of our admissions. We “admit”/transfer only about 6% of our patients, and the balance are ultimately treated and discharged home. However, unlike most urgent care facilities, we do full emergency care workups, including chest pain, abdominal pain, shortness of breath, etc.
  • What were some of the challenges your ED was facing with regard to patient satisfaction?
    Most of our challenges are associated with being a smaller-volume FSED:
    • First, the smaller patient volume means a smaller survey sample size, which can cause significant variability in our scores. This can be a challenge when comparing performance over time.
    •  Another challenge is that, given our size, we are typically known for having a door-to-provider time of under 10 minutes. When patients have to wait longer than that due to peaks in volume, it can be a dissatisfier.
    • Lastly, as a FSED, we offer limited services. We don’t have social workers, and we cannot offer ultrasound on nights and weekends. Any time we have to transfer someone for an inpatient stay or further testing, they often don’t understand why they can’t be admitted here, which can cause some dissatisfaction.
  • Which patient satisfaction metrics do you track on a regular basis?
    We outsource our satisfaction surveys to PRC, which tracks a number of your standard patient satisfaction metrics. We monitor all of those, but we pay particular attention to the overall “Net Loyalty Score,” which asks if the patient would recommend Borgess-Pipp to a friend or family member. We also track whether the physicians give meaningful instructions at time of discharge. I also feel it’s important to share all patient comments with our staff. This often provides more details on challenging areas that we can improve upon and allows us to celebrate the positive comments.
  • What steps did your team undertake to help improve your scores?
    We embarked on a number of key initiatives to help improve our scores:
    • One of the most impactful practices was developing scripts for the physicians and all staff members. This allowed us to provide better communication throughout the entire ED stay regarding what is happening next for patients and their families.
    • We utilize white boards as an in-room communication aid
    • We practice “pull-to-full” triage—if there is a room available, no one sits in the waiting room. They immediately get pulled back into an exam/treatment area.
    • Finally, we have made customer service a priority for our entire team, and it’s something we regularly discuss. We continually try new ideas and test the results. Then try some more…
  • Did your initiatives also involve others outside APP providers (nursing? Etc.)?
    Yes, we realize that it takes the entire team to make the experience a positive one for the patient. Everyone, including the physicians, nurses, radiology, lab, respiratory therapists, housekeeping, unit secretaries, EMS, etc., all play a critical role. It’s often someone other than the physician that can make the biggest impact on someone’s care experience.
  • What results have you experienced from these efforts?
    There can be a lag in getting our scores – we officially get the full scores quarterly, and we receive some limited data monthly. Overall, though, we have been trending upward, and I am pleased to share that our team achieved a 100% on our Net Loyalty Score for the month of June
  • What is your plan to maintain high scores now that you’ve achieved them?
    I believe great scores aren’t a single event—it’s an ongoing effort to maintain them and continuously improve. Some actions toward that effort include:
    • We maintain an ongoing focus on customer service for our entire team. We share ideas in our monthly staff meetings and develop new strategies together. We encourage new ideas from everyone.
    • I provide a monthly “Team Update” newsletter that provides easy-to-read bullet points that keeps important information current and accessible to everyone.
    • As I mentioned earlier, we read all written patient comments and respond accordingly when appropriate.
    • When we’re not too busy, we are trying to find a way to do bedside triage rather than have patients wait in the triage area at all.
    • We focus on hiring the right people with the right mindset. For example, we just added a tech position and are taking our time identifying the right person that shares our focus on service.
    • We are always experimenting with new scripting.
    • We recognize that customer service, as measured by surveys, is a dynamic and continually moving target. While we are celebrating our 100% score this month, we are keeping our eyes on the months ahead in order to maintain true excellence throughout the inevitable service industries’ ups and downs.
  • Do you have any final tips to share with other ED leaders?
    I truly believe that a happy staff—without even thinking about it—will deliver better customer service. This is something that we—and all healthcare organizations—need to be mindful of. The single most important driver in patient satisfaction, beyond truly good care and service, is STAFF SATISFACTION.