Beyond Disney and Tinkerbell: Moving the needle on stuck patient satisfaction scores

Tools

I've heard countless hospital executives say it: They worked their butts off to improve patient satisfaction scores at their organization and those efforts paid off. They moved the needle … until the needle got stuck.

If you want to go (if you'll pardon the business cliché), from good to great, the key is not to focus primarily on patient satisfaction or service excellence, argues Fred Lee, a patient relations and service consultant and author of "If Disney Ran Your Hospital."

You read that right: The author of one of the best-known books on service excellence in the healthcare industry says you should not focus solely on service excellence in your quest to improve patient satisfaction scores.

Lee, who spoke at the College of Healthcare Information Management Executives at its CIO forum in New Orleans earlier this week, said hospitals that "hardwire" patient satisfaction and service excellence and concepts such as courtesy have maxed out the potential of these efforts.

"A service of courtesy is not enough in our business if we are not also meeting people's emotional needs," Lee said.

We're all stuck in the same paradigm of the courteous hard-wired behaviors patients have come to expect, he added. Once something is expected, you have to do it. But doing so doesn't make the patient a fan--rather, "you've only avoided disappointment [and] dissatisfaction."

Think about it: Any fast food chain worker can follow a service excellence script. Greet the customer, look him or her in the eye, smile, ask them how you can best serve them today, thank them for their business. Burger King and its employees do just as good a job at following a script as you and your employees do. Maybe even better.

But ordering a burger and getting your blood drawn, for example, are two very different experiences. A nurse can come into a patient's room, look the patient in the eye, smile and call him by name, introduce herself and explain why she's there. She's followed the script perfectly.

But that's not enough.

"Patient perceptions are based on nonverbal cues that the patient doesn't even know they're picking up on," Lee said. A nurse who's frowning as she concentrates on finding a vein? That tells the patient that if this nurse finds a vein it will be pure luck.

A nurse who lets silence fill the room after the script is delivered? That just gives the patient time to start thinking about everything that could go wrong. "No one can stop that thought unless someone distracts you," Lee said.

On the other hand, a nurse who comes in and, as she's looking for that vein, assures the patient that she's accomplished and that although it might hurt a bit she's going to be as gentle as possible? That patient's perception will be quite different--and his outcome and experience will be more positive, too.

"The best nurses tend to say something just before an invasive procedure such as a blood draw--it reduces the anxiety of the patient, which affects their pain threshold," Lee said. "They don't have to gush the whole time--just the instant before."

Sometimes, Lee said, nurses are a little skeptical of the whole Tinkerbell thing.

"But I didn't get that from Disney, I got it from clinical trials," he said. "There's a high correlation between lower pain ratings with your best nurses than with average nurses and they're doing they exact same thing … How can there be that big a difference in pain perception when they're all doing the exact same thing in the same way? You can see the results but you don't know what caused it unless you have it on video."

To that end, Lee said, one study took a group of nurses who frequently receive patient compliments and a group of nurses who either get no compliments or get complaints. They all gave patients shots using the same technique. Afterwards, the patients rated their pain on a scale of 1-5. Guess who had the lowest pain scores? The higher-rated nurses were not more technically competent. They didn't have more experience. And they certainly didn't just follow a script. But their patients' perception of pain was lessened.

"Your best nurses didn't learn that in a textbook," he said. "They wanted to be true blessing to patients."

If you want to move your stuck patient satisfaction scores, Lee said, do not read your satisfaction surveys. Emotions are the key to healing.

"A hospital without compassion is like Disney without fun," he said. - Gienna (@Gienna and on Google+)

Related Articles:
How leaders can foster better patient experience
4 ways to engage patients, staff to improve satisfaction and quality
Improve patient satisfaction with leadership, frontline support
Time to make patient experience surveys matter
Poor patient satisfaction: The easiest thing to fix
Patient satisfaction pressures may prompt unnecessary care
Fierce Q&A: NYU Langone VP on why a hospital is not a hotel
Does HCAHPS help or hurt?