3 proven ways to boost patient satisfaction
Patient satisfaction has become increasingly important in healthcare delivery. Aside from boosting hospital and facility reviews, studies have shown that patient satisfaction is critical when it comes to how patients recover in a hospital setting.1 Even more importantly, patient satisfaction is being integrated as a metric for pay-for-performance programs.2 One of those is from the Patient Protection and Affordable Care Act, which will tie Medicare reimbursement to, among other things, patient satisfaction. At this juncture, it is critical to start implementing measures to boost patient satisfaction, making it a non-negotiable priority. Here are three proven ways that the anesthesia department can do so. 
1. Revisit the "no drinks after midnight" standard the day before non-emergency surgery. For years, patients have been told that they cannot eat or drink anything after midnight the day before an elective procedure. NPO is still critically important, but the American Society of Anesthesiologists has defined preoperative fasting guidelines that determine the amount of time a patient must fast. Patients must abstain from solids eight hours prior to a procedure and avoid clear liquids two hours before surgery. The ASA has set guidelines for other fluids as well.
Too many times, it's easy to tell a patient to start fasting at midnight, but for patients who are scheduled for later in the day, it can be more than an inconvenience. Dehydration and hypoglycemia are just two of the problems that may arise. Patients who are accustomed to a morning cup of coffee may find themselves cranky and with headaches. These factors send an already unhappy patient into a procedure, which may immediately start lowering patient satisfaction.
Additionally, pre-operative hydration assists with recovery. It reduces pain during and after the procedure, as well as decreasing post-operative nausea and vomiting, leading to happier patients in the recovery room.
2. Provide excellent communication and bedside manner with patients. Physicians who speak with patients clearly, politely and empathetically have been known to receive higher patient satisfaction scores. The first part is letting patients know what to expect matter-of-factly.
For example, most patients will want to know if they are going to be staying overnight. They will also need to know what to expect post-operatively, everything from pain management to what the first few days after the procedure will be like. Patients need to be told honestly about the level of pain they can expect, as well as what will be done to manage pain during and after the procedure. From the anesthesiologist's point of view, this can include everything from the type of anesthesia to how the patient will be situated in the recovery room.
Caregivers are also extremely important in a patient's recovery, and it's necessary for them to have realistic expectations, as well as practical advice for assisting the patient after the procedure. For example, caregivers can be tasked with filling pain medicine prescriptions during the procedure at the hospital's pharmacy so that when it's time to take the patient home, the prescription goes home, too.
As for post-operative information, the patient and caregiver both need to know what's ahead. Many times, patients and their caregivers are unaware of the limitations imposed by what sounds like a simple surgery. They may not know that, for example, something as simple as brushing their teeth, picking up a television remote or getting out of bed to use the bathroom may require assistance. The more both the patient and caregiver know before they get to the hospital for the procedure, the better prepared they will be for the post-operative period — and the happier they will be.
3. Give patients a voice. Hand-in-hand with improved communication is providing patients with the outlet they need to understand what the procedure entails and what to expect. Although the surgeon is conducting an invasive procedure and the anesthesia is taking away physical control from the patient, patients want to regain some control, which they can do if they feel like they are being listened to and their concerns are being addressed.
However, physicians often forget that they speak quickly and in medical terminology, and patients need terms explained in a way they understand. For example, an anesthesiologist might say, "I'm going to do a nerve block to help with the pain." The patient may nod agreeably but not know quite what that means. Instead, the patient can be told that a needle will be inserted in an area around the nerve, and a local anesthetic will be used to numb the area. That kind of clear language avoids talking down to the patient but puts the procedure in terms that a layperson can understand.
Listening to the patient is important, as is gauging patients' facial expressions to determine if they understood the explanation. Many times, we as physicians speak to them but don't let the patient get out complete answers. A basic bedside manner may lead patients to ask more questions so that they better understand the procedure. Physicians need to take the time to ask, "Did I explain that in a way you understood?" and/or "Do you have any questions about pain management, nausea or what to do when you get home?" Encouraging the patient to speak and ask questions makes patients feel empowered, and empowered patients are satisfied patients.
However, it is important to avoid open-ended questions like, "Do you have any questions for me?" When patients are under stress, they often forget what they wanted to ask. Once the provider walks away, the patient will have questions, but by then, it may be too late.
Ultimately, these three things have a common ground: communicating with patients and setting expectations. Patients are often unsatisfied because of unrealistic expectations, which set everyone up for failure. Simply letting the patient know, 'yes, you will be in pain, but we will give you medicine for it,' can improve satisfaction. Using up-to-date pre-operative guidelines, particularly for food and drink, and communicating that to the patient can help mitigate pain. Empowering the patient with a voice and listening to the patient helps them process the information given to them. And at the end of the procedure, the patient is satisfied, not just with the actual surgery performed but with the entire experience.
Dr. Adam L. Blomberg is the national education director for Sheridan Healthcare's Anesthesia Division. Dr. Blomberg also serves on the Anesthesia Quality Committee at Sheridan as the chair of the Provider Education Subcommittee, and he is the director of clinical education at Memorial Regional Hospital, Sheridan Healthcare’s flagship anesthesia practice in Hollywood, Fla. Dr. Blomberg completed his training at Brigham & Women's Hospital, a teaching affiliate of Harvard Medical School in Boston in the Department of Anesthesiology, Perioperative and Pain Medicine. During his final year of residency, he served as chief resident. He is a graduate of the University Of Miami School Of Medicine.
1 Morris, M.D., Brent J.; Jahangir, M.D., Alex A.; Sethi, M.D., Manish K. “Patient Satisfaction: An Emerging Health Policy Issue.” AAOS Now, June 2013. Retrieved on June 23, 2014 from http://www.aaos.org/news/aaosnow/jun13/advocacy5.asp.
2 Press I, Fullam F. Patient satisfaction in pay for performance programs. Qual Manag Health Care. 2011 Apr-Jun;20(2):110-5. doi: 10.1097/QMH.0b013e318213aed0. PMID: 21467898 [PubMed - indexed for MEDLINE]