RD 5 Results of the Patient Satisfaction Survey over the last four years. Describe trends, interventions implemented and the impact on nursing practice.

From 2001 through December 2006, Massachusetts General Hospital (MGH) contracted

with Press Ganey, for patient satisfaction surveys. Press Ganey is a research-based, nationally

recognized survey that uses scaled responses to a uniform series of questions. The tool, which has

been demonstrated to be both valid and reliable, focuses on multiple aspects of the patient

experience. The tool is available in both English and Spanish.

On a monthly basis, about one-half of the patients discharged from MGH were randomly

selected to receive the survey. On a quarterly basis, MGH-wide responses were analyzed and

reported to leadership across the hospital. In addition, clinical and operational directors and teams

received specialized analyses related to their specific areas. These results were used to identify

opportunities for improvement and to address any problem areas.

Attachment RD 5.a contains Press Ganey hospital-level quarterly reports for the final

quarters of calendar years 2004, 2005 and 2006. Full reports for all quarters, including unit-level

reports, will be made available on-site.

Overall, the scores have remained relatively stable over this three-year period. MGH patients

consistently expressed high loyalty to the hospital with the likelihood of patients recommending

MGH being higher than for 98-99% of the 600 + bed hospitals in the Press Ganey database.

Patients rated their doctors and nurses highly, with physicians’ skill and nurse’s skill rating better

than for 90% of the 600+ bed hospitals.

Over the three-year period the surveys also indicated opportunities for improvement. Some

specific areas in which patients were relatively less satisfied were:

♦ Meals

♦ Waiting times for tests and treatments

♦ Promptness of response to call

♦ Rooms

Based on Press Ganey performance, MGH focused performance improvement efforts on

patient meals. The departmental leadership for Nutrition and Food Services undertook a process of

honest evaluation of its program and pursued feedback and collaboration from the Department of

Nursing, the Nutrition and Food Service staff, hospital administration, and patients. The service

improvement plan includes systematic feedback from nurses and patients, changes in the patient

menus, the introduction of a dedicated customer service response phone extension called 4-FOOD,

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and the implementation of a training program for staff. The process and progress to-date has been

gratifying, and the commitment to ongoing evaluation is shared across disciplines involved.

Patient ratings of meals improved steadily, reflecting the ongoing focus in this area. MGH

Press Ganey scores rose for seven consecutive quarters, moving from the 18th to the 50th percentile

for all 600+ bed hospitals.

Promptness of response to call lights is also an area where patients reveal that they are less

satisfied. On the 2004 report, the mean score for this indicator was 82.9, which placed MGH in the

56th percentile when compared to hospitals with 600+ beds. Concern regarding this performance

prompted the Department of Nursing to successfully pilot and then fully implement the use of cell

phones for nurses. The cell phones were implemented over a three-year period from 2004 to 2007

and replaced overhead and intercom systems for on-unit communication. They allow immediate

contact with the patient’s Staff Nurse anywhere in the hospital, improving accessibility and

facilitating timely communication. Phone messages from outside the hospital can also be forwarded

directly to the Staff Nurse from the nurse’s station, reducing time spent traveling to and from the

central phones. MGH has also installed new nurse call systems on all inpatient units. This five-year

project extended from 2002 through 2007. The cell phone and nurse call projects also had the

added benefit of noise reduction at the patient bedside.

The Press Ganey scores showed an improvement in patient response to the question about

promptness of response. By late 2006 the mean score had increased to 85.0, which placed MGH in

the 83rd percentile (hospitals with 600+ beds).

Two orthopaedic nursing units specifically identified this as an opportunity for

improvement. The unit leadership and staff wanted to improve response time and identify/meet

individualized patient needs. Performance improvement efforts identified some contributing

factors, such as length of report and patient assignments. The units implemented a multi-pronged

approach that included raising awareness about the issues and patient perspectives, providing

education about strategies to enhance time management, an increased focus on assessment and

communication skills, and patient visits by the Nursing Director to better communicate with

patients and families about their experiences.

The indicators related to rooms and accommodations (e.g. décor, cleanliness, noise) have

frequently pointed to opportunities for improvement, with MGH performance at times below the

50th percentile. MGH leadership appreciates the challenges around attempting to maintain a clean

and pleasant environment when many patient care units are housed in aging buildings. Efforts are

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on-going to identify appropriate clinical space and reconstruct new patient units to expand/improve

space and better meet the needs of patients and families. For example, RD 13 describes the

construction and relocation of the Pediatric Intensive Care Unit and the Neonatal Intensive Care

Units to more attractive clinical space in 2005 and 2006.

In addition to new unit construction, there is a focus on improvement of existing space

through on-going renovation. Again, this is a constant challenge as the units/rooms that most

require attention are often those with the highest patient occupancy. The commitment to this work

involves creative strategies and collaboration with both clinical staff and the MGH Buildings and

Grounds Department. In the past few years, the Patient Care Services Systems Improvement

department has coordinated these efforts for all of the MGH inpatient rooms. When patient beds

need to be closed for other reasons, repair, repainting and floor maintenance are accomplished at

the same time. The recent installation of ceiling lifts offered this opportunity and 173 rooms were

refurbished during the project on the same day that the lifts were installed. Likewise, seven units in

2006 and four units in 2007 had rooms closed for installation of new nurse call systems and these

rooms were painted, repaired, and floors were stripped and polished at this time. Corridor walls

were also repaired and painted recently which was coordinated with a program for installing

improved signs in the corridors of inpatient units.

Patient room furniture was updated for all inpatient rooms, Labor and Delivery, the

Emergency Department and the Post Anesthesia Care Unit in 2006, in an effort to improve the

bedside environment. Attachment RD 5.b includes the coordinated, six-month furniture delivery

schedule for over 4,700 patient beds, overbed tables, bedside cabinets, patient and visitor chairs.

Press Ganey scores improved slightly in 2006. For example, patient responses for room décor went

from the 39th to the 62nd percentile and scores for cleanliness of rooms improved from the 44th

percentile in October-December 2005 to the 69th percentile in October-December 2006.

Patient Care Services (PCS) remains concerned about this performance area and will

continue to target future performance improvement efforts in this area. At the September 2007

Patient Care Services Strategic Planning Retreat, the PCS leadership team conducted a series of

activities to determine the Strategic Goals and Tactics for 2007-2008 (see Force 1.1 attachment

1.1.b.) The six dimensions of healthcare performance included in the Institute of Medicine’s Quality

Chasm Report (i.e. safety, effectiveness, patient centeredness, timeliness, efficiency, equity) were

used to guide the selection of major areas of focus for the year. Strategic Goal #4 is to “Provide a

clean and clutter-free environment for our patients and staff.” Tactics that were suggested to attain

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this goal include establishing a Unit Service Associate Advisory Group and developing best practices

and standards for clean and clutter free environments. In addition, Strategic Goal #2 is to “Seek the

patient’s voice to improve the care experience” which includes the plan to “conduct an assessment

of the care environment to identify sources of noise and create a plan to minimize/alleviate

unnecessary noise”.

As described in RD 14, MGH discontinued use of Press Ganey at the end of 2006 and is

now using the Consumer Assessment of Healthcare Providers and Systems (HCAHPS) tool, as

required for acute care hospitals for 2008 by the Centers for Medicare and Medicaid (CMS).

Attachment RD 5.c includes an internal hospital level report with three quarters of data for

2007. Although national benchmarks are not yet available, the report produced in September 2007

indicates that patients are not satisfied with the response to call lights. This will most likely be a

focus for performance improvement in 2008 as PCS strives for safety, efficiency and patient

centeredness.

In an effort to provide front-line Nursing Directors with key and timely data pertaining to

their units, members of the Patient Care Services Financial Management Systems team and 16

Nursing Director volunteers, built upon the information presented in the Nursing Director

Leadership Development Program, “Evaluating the Health of Your Unit”. They developed a

methodology to provide unit-based dashboards that are relevant, dynamic and tailored to unit needs.

The group selected three Press Ganey indicators for the dashboard; overall satisfaction with nursing

care, preparation for discharge and attention to personal needs. In 2007 the group came together

again to update the dashboard and in the process identified five of the HCAHPS indicators that will

replace the Press Ganey measures. Nursing Directors, along with their leadership and clinical staff,

critically review this data and identify strategies to address identified issues.

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Attachment RD 5.a

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Attachment RD 5.a continued

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Attachment RD.5.b

Patient Room Furniture Integrated Delivery Schedule

Date Day of

WkDelivery Location

Bedside Cabinet

Marco Chair

Olivia Glider

Foot Stool

Visitor Chair Beds

Overbed tables

Items to floor

Items delivered

1/31/06 Tues Blake 14 13 12 132/16/06 Thurs 130 1302/23/06 Thurs Ellison 12 36 36 0 22 43 137

White 12 24 24 0 14 29 91 2282/28/06 Tues White 8 26 26 0 16 31 99

White 9 25 25 0 15 30 95 1943/2/06 Thurs White 10 20 20 0 12 24 76

White 11 24 24 0 14 29 91 Bigelow 11 25 25 0 15 30 95 262

3/6/06 Mon White 6 30 30 0 18 36 114Bigelow 14 27 27 0 16 32 102Blake 14 12 0 0 0 14 26 242

3/7/06 Tues White 12 25 24 253/8/06 Wed Ellison 3 0 0 8 0 0 8

Ellison 4 0 0 0 0 24 24Ellison 9 0 8 0 3 19 30Ellison 10 36 36 0 22 43 137 199

3/9/06 Thurs Ellison 13 20 20 20 12 24 96Blake 13 21 21 21 13 21 97White 13 8 8 0 4 10 30 223

3/13/06 Mon Blake 7 0 9 0 3 22 34Blake 8 0 0 0 0 22 22Ellison 8 34 34 0 20 41 129 185

3/14/06 Tues 1353/15/06 Wed Ellison 6 36 36 0 22 43 137

Bigelow 7 18 18 6 11 22 75 2123/16/06 Thurs 1303/20/06 Mon Blake 6 21 21 0 13 25 80

Bigelow 13 18 18 0 11 28 75 1553/21/06 Tues Ellison 12 36 36 453/22/06 Wed Blake 11 24 24 0 0 29 77

Ellison 11 36 36 0 22 43 137 2143/23/06 Thurs White 7 27 27 0 16 32 102

Ellison 7 36 36 0 22 43 137 239

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Attachment RD.5.b continued

Patient Room Furniture Integrated Delivery Schedule (continued)

Date Day of

WkDelivery Location

Bedside Cabinet

Marco Chair

Olivia Glider

Foot Stool

Visitor Chair Beds

Overbed tables

Items to floor

Items delivered

3/29/06 Wed Ellison 16 36 36 0 22 43 137Ellison 19 30 30 0 18 36 114 251

3/30/06 Thurs Ellison 17 20 10 10 3 24 67Ellison 18 24 12 12 4 29 81Ellison 23 5 11 9 4 49 78 226

4/4/06 Tues White 8 26 26White 11 24 24 45

4/6/06 Thurs 1914/11/06 Tues Bigelow 14 27 27

Bigelow 7 18 18 454/13/06 Thurs 2004/18/06 Tues Ellison 10 36 36 454/20/06 Thurs 1574/25/06 Tues Ellison 14 26 26

Bigelow 11 25 25 455/2/06 Tues Ellison 11 36 36 455/9/06 Tues Ellison 16 36 36

Ellison 13 20 20 455/16/06 Tues Ellison 21 20 20

Ellison 22 19 19 455/23/06 Tues Ellison 19 30 30

Ellison 20 20 20 455/30/06 Tues White 7 27 27

Bigelow 13 19 19 456/6/06 Tues Ellison 8 34 34 456/13/06 Tues Ellison 7 36 36

Blake 6 19 19 456/20/06 Tues Ellison 6 36 36

White 13 8 8 456/27/06 Tues White 6 30 30

Blake 13 21 21 457/5/06 Wed Ellison 17 12 12

Ellison 18 18 18E23 ESD 14 14 45

7/11/06 Tues PACU 8 8ED 16 16Training 5 5 29

7/18/06 Wed Blake 11 25 24 25

Total Pieces 743 736 86 415 1045 810 943 4778

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Attachment RD 5.c

Please note: The scores on this dashboard have been rounded to the nearest whole number 1 Preliminary data from Quality Data Management (QDM); percent surveys completed; unshaded if less than 50% complete 2 Agency for Healthcare Research and Quality

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