Note from Mindy: In another contribution to Rewarding Health, Amy Kramer, Healthcare Sector Strategist at Maritz, addresses the correlation between hospital employee satisfaction and patient satisfaction. At Maritz, Amy provides industry expertise in the areas of healthcare and wellness and works with clients and account teams in addressing business challenges

The rising costs of healthcare our crippling our nation. Our health system is in desperate need of reform in order to help us mitigate these costs. The push for electronic records is one way that Congress is attempting to curb these costs. Technology is very much a part of the US population’s culture. From music downloads to virtual worlds where people can interact, people are adapting their lives to the changing technology that is available to them. Hospitals have also been early adapters to technology and have been some of the first segments within the healthcare industry to adopt electronic records and use this as a cost savings tool within there organizations and are seeing some great benefits. First and foremost it is much more timely and effective to communicate with patients, physicians and other healthcare personal digitally. It provides real time information from patient history, test results, prescribing medications and linking to other healthcare professionals. The use of this technology in hospitals has decreased medical errors, due to illegible handwriting and better accuracy filing prescriptions and diagnosis. It provides physicians and other hospital personnel with all the information they need about the patient they are treating without having to connect the dots. It has also streamlined the billing system and created one central database for payment. This allows hospitals to better track their financials and encourage better follow up on unpaid bills.

Congress has been talking about placing a mandate on e-records for the health industry. I still think we are a ways off from a nation wide push to e-records, but President Obama has recommended this as part of the 2009 stimulus package. Not only will e-records promote better practices in the hospitals, but this will also equate to a better patient experience and better patient care and wellness overall.

Note from Mindy: In another contribution to Rewarding Health, Amy Kramer, Healthcare Sector Strategist at Maritz, addresses the correlation between hospital employee satisfaction and patient satisfaction. At Maritz, Amy provides industry expertise in the areas of healthcare and wellness and works with clients and account teams in addressing business challenges.

Long hours, nights, weekends, holidays, strenuous physical and mental workload…such are the demands of nurses and allied health professionals. And demanding it is. As healthcare utilization continues to increase and focus on service delivery begins to take center stage, the healthcare industry is continuously looking to acquire new talent and retain their current workforce.

At current utilization rates, demand outpaces availability of these skilled professionals. In an environment of high stress and high burn-out health systems are challenged with providing enough benefits to be perceived as a profession and employer of choice. According to the American Association of Colleges of Nursing the United States could face a shortage of up to 500,000 nurses. With an aging population, the need for nurses and allied health professionals becomes even more critical to our health system.

Hospitals are initiating strategies geared at acquiring and retaining their top talent. In the past these new recruits have been tossed into new jobs with little experience and been told “sink or swim.” This has caused many new comers to the professions to leave and seek other careers thus adding to the number of vacancies in nursing and allied health.

Hospitals are now offering residency programs and flex schedules for the nursing staff and allied professionals. They are also offering training programs, mentoring programs, and recognition programs to help build confidence with new employees. These programs are driving a more supportive culture and have been proven to decrease turnover and increase employee satisfaction. They also help ease the stress in this exhaustive industry. These are just a few examples of how some hospitals are implementing retention strategies, but much more needs to be done to ensure that hospitals and healthcare systems have the necessary staff to operate and serve patients. Recognition and appreciation for the effort and skills of nursing and allied help professional is critical in this industry. Since we are amidst an aging population the demand for these professions will continue to increase hospitals need to continue to investigate opportunities to increase their retention of key staff.

There was an interesting article in Health Leaders entitled A New Kind of Growth Strategy and it focused on the three strategies that hospital CEOs are taking to drive revenue growth:

- expanding outpatient services
- focusing on promising business lines
- implementing a strategic marketing campaign

Carrie Vaughan raises an interesting point regarding the fact that hospitals seem caught up in the mentality that they have to continue to be big buildings where people come when they are sick. Given the focus on prevention and wellness, I wonder if this isn’t a question that all healthcare entities should be considering - How do I change to deliver on prevention? How does my revenue growth model change to deliver on value? How do I envision my future services?

The complexity of our health system not withstanding, I try to look at the problems in healthcare more simplistically - what are root cause issues for a system that is essentially backwards. Healthcare providers ultimately develop their strategy based on how to achieve the highest amount of reimbursement. So wouldn’t it behoove us as a healthcare system to figure out a more compelling reimbursement strategy that promotes more strategic initiatives around prevention. Wouldn’t accomplishing this task open up the opportunities for hospitals, physicians, pharmacists and even pharma to begin to focus their strategies on innovative prevention methods and services? I know it won’t be easy, it never is but it is my thought for the day.

Note from Mindy: In her fourth contribution to Rewarding Health, Amy Kramer, Healthcare Sector Strategist at Maritz, addresses the correlation between hospital employee satisfaction and patient satisfaction. At Maritz, Amy provides industry expertise in the areas of healthcare and wellness and works with clients and account teams in addressing business challenges.

If you have not heard HCAHP (pronounced H-CAPS) scores have gone public! March of 2008 marked the first publically shared scores that provide consumers with insight into patient satisfaction ratings hospitals receive. HCAHP stands for (Hospital Consumer Assessments for Healthcare Providers and Systems) and they represent the patient’s perspective of the care they received while in-stay at a hospital.
In May of 2005, CMS and NQF formally endorsed the HCAHPs process and worked together to develop a system-wide standardized assessment and reporting structure to ensure that every hospital that participates can be measured by the same patient satisfaction ratings. Hospitals that participate in the survey must follow the guidelines outlined by CMS and NQF. This was positive for hospitals with high scores because it validated a high patient satisfaction with services and can ultimately encourage more health plans and physician referrals, and drive more admissions and profits for the hospitals. However, hospitals with lower scores were immediately highlighted and now exposed to the public. Every hospital must participate in the assessments if they want to receive their IPPS payment. Those who don’t participate not only suffer from the financial element of not being reimbursed, but it also raises the question “What are you trying to hide?”
What does this mean for hospitals? I think that as characteristics of consumerism slowly creep into the healthcare market that these types of data points (satisfaction, cost, quality) become increasingly prevalent and more readily accessible. I also think that hospitals have an opportunity to place more emphasis on how to deliver a better patient experience. Beyond the health outcome, which is obviously an important factor in assessing a patient’s experience, there are more subtle drivers such as empathy, humanity, responsiveness, and all of these attributes that will be rated lead back to one common place – the touchpoints that a hospital has with the patient and the employees that engage in those touchpoints. Since HCAHP scores are accessible to the general population on the Health and Human Services site hospitals need to be considering what message those scores deliver to consumers who have become more active in their choice for care.
Reshaping the patient experience starts with those who touch the patient through their stay. Research shows that patient satisfaction is driven by employee satisfaction. Recognizing the top performers in an organization is only the beginning. For hospitals to achieve consistently high patient satisfaction they have to create a culture that inspires care givers to focus on the patient experience. A key element to success will be a hospital’s ability to “Move the Middle” essentially leveraging the strengths of their average employees and motivating them to higher performance standards. Employee engagement is critical within hospitals and health systems. Hospitals need to implement a robust employee engagement and customer experience program to encourage better performance in delivering outstanding customer experience. This will prove to be successful not only for the hospital and their satisfaction scores but for better patient health too.

Note from Mindy: In her third contribution to Rewarding Health, Amy Kramer, Healthcare Sector Strategist at Maritz, addresses the correlation between hospital employee satisfaction and patient satisfaction. At Maritz, Amy provides industry expertise in the areas of healthcare and wellness and works with clients and account teams in addressing business challenges.

Most people think of hospitals as a place to go when you’re sick. Once there, you feel miserable and have strangers taking care of you. It’s a sterile environment with a funny smell. When you’re at a hospital, the only place you want to be is home. Nevertheless, people need hospitals, and there can be much more to the experience than drafty gowns and longing for home. Maritz studies discovered hospitals with happy, satisfied employees who live and breathe the culture of wellness and carry a positive attitude, tend to have satisfied patients and a healthy pocketbook. Hospitals with superior customer service see patients with fewer adverse events, less hospital visits and shorter lengths of stays. Patients are also more likely to return to a hospital with excellent customer service, even if a physician tells them to go somewhere different.

A friend recently told me an interesting story. Her mother had a heart attack. She lived in a rural area and they were forced to take her to a small remote hospital without state–of-the-art equipment or technology. She considered driving a few extra hours to get her mother to the “premium” hospital, but after walking through the doors of the smaller hospital, and experiencing the compassion, care and knowledge of the staff and physicians, my friend was ultimately relieved. Her mother was too. She was very fearful she was going to have a complication, but was reassured by the quality of care at the hospital.

My friend later found out the hospital had earned a “Magnet Status.” From The Healthcare Management Council wiki:
A Magnet hospital is a hospital that delivers excellent patient outcomes, has a high level of employee job satisfaction, and where there is a low turnover rate and appropriate grievance resolution due to the collaboration of data collection and decision-making in patient care delivery through open communication between nurses and other members of the health care team, which attracts the best physicians and specialists as well as high and satisfied patient volumes. Magnet status has been attained by 180 hospitals around the country out of the 4,200 total hospitals.

My friend’s story and the validity of “magnet status” are solid proof that employee satisfaction can equal patient satisfaction. Engaging employees into the culture of hospitals and treating employees well can (and does!) drive revenue.

Note from Mindy: I welcome Amy Kramer, Healthcare Sector Strategist at Maritz, for her second post. With Amy’s 10 years of experience in the healthcare industry, ranging from pharmacy, hospitals, managed care, and pharmaceuticals, Amy’s thoughts are both detailed and contain real-world applications. Enjoy!

We all know nurses and physicians as the direct respondents to our care as patients. Whether we’re in a doctor’s office, or in the hospital, everyone is working on the same side, right? Not in all cases. There’s definite tension between some nurses and doctors. Nurses tend to call on patients’ needs more than the patient’s physician (as much as five times more). Physicians are under-staffed, but the nurse is counted on to be readily available to answer questions, serve the patient, serve the family and communicate back to the doctor. It could be argued in many cases the nurse may know more about the patient than the actual assigned doctor. There is also the new a new trend of “hospitalists,” an on-site doctor assigned to all “in-patients.” The hospitalist completes rounds on behalf of the patient’s actual doctor, who doesn’t see the patient until after discharge. This trend at first seems incredibly convenient, but we’re learning it’s also damaging the patient experience at times. Not all patients want to see a slew of people. They want direct access to their doctor, and when they don’t get it, it’s the frontline nurses generally taking the disgruntled heat.

In order to deliver optimal patient care, nurses and physicians must collaborate. However, more often than not, physicians see a distinct difference in their roles for caring for patients. There’s an apparent level of hierarchy, and nurses tend to receive the short end of the stick. We hear of a lack of respect, recognition and appreciation for each others’ contributions to patient care. Physicians and nurses need to find a balance in their roles and set expectations to make sure each delivers equal and agreed upon care for the patient.

It’s also imperative for physicians to recognize the strengths and skills nurses bring to the healthcare profession. Nurses have a direct impact on patient health outcomes too. Physicians need recognition for their approach to patients, as well as feedback on ways to make the healthcare environment better for everyone.

At the end of the day, both nurses and physicians want the best treatment and care for their patients. To achieve this shared goal, they need to realize they have to work through their differences and appreciate each other’s contributions. When the working environment is better for the people providing the care, patients ultimately win with a better experience and care.

Note from Mindy: I’m pleased my colleague, Amy Kramer, Healthcare Sector Strategist at Maritz, will contribute her expertise to Rewarding Health with a series of posts focusing on the impact of hospitals and hospital staff on patient wellness and satisfaction. Amy’s role at Maritz is to build strategy and business solutions to help healthcare companies meet business requirements for growth and sustainability. Her posts will be particularly insightful to hospital management, public health officials, wellness managers and anyone who has had an extended hospital stay (or may have one in the future).

In an October post, Mindy touched on the issue of physician shortage, and its impact on our healthcare system. I’d like to discuss another significant shortage trend in healthcare impacting the delivery of quality care and patient wellness – the lack of nurses.

The American Hospital Association reports a 400,000 shortage of nurses by 2010. This is an astonishing gap, especially when you consider the nurse is essentially the full-time caretaker of most inpatients. Nurses interact with patients more than the doctor. They treat the patient, dispense medications and provide a compassionate, comfortable and optimistic environment. Nurses are overworked, under compensated and under appreciated. Combine these factors with intense physical labor and an emotional environment, and you end up with an increasing burnout rate. Adding to the problem, it’s also increasingly difficult to recruit new nurses and retain high-performers.

The end result of the nursing shortage directly impacts the quality of patient care. When employee satisfaction is poor, the quality of care decreases and patient satisfaction suffers. Also, the limited number of nurses means there are a limited amount of resources available to treat patients. Both situations elevate the possibilities for undesirable situations, , such as longer waiting times, care complications and more hospital visits. Ultimately, a nursing shortage negatively impacts the patient experience, one of the key factors in a hospital’s Joint Commission on Accreditation of Healthcare Organizations (JACHO) scores. Lower JACHO scores could cost a hospital millions of dollars.

To help address the nursing shortage, hospitals first need to develop an employee engagement strategy specifically for nurses. The strategy should incorporate recognition, as well as focus on building a stronger culture with better work/life balance. Many hospitals only recently started to consider offering recognition programs to employees. Some even listed recognition as a line item on P and L sheets. This shift towards recognition is a great step to help patch the tainted feelings of nurses. However, much more needs to be done to get the nursing profession back on track. If the nursing shortage improves, expect to see overall wellness and patient satisfaction improve as well.

You can read more about this in a recent Forbes magazine article, which showcases the patient satisfaction issues U.S. hospitals face.

This is an interesting article regarding how hospitals may benefit under President-elect Obama’s health reform plan. would be interested in hearing your perspective on this topic.