Patient satisfaction must start with nursing satisfaction


Ever since the U.S. government decided to link Medicare reimbursement dollars to patient satisfaction scores, hospital administrators have been obsessed with improving the quality of care for patients visiting their emergency departments. While the motivation may be partly financial, the goal of improving the patient experience during emergency department and hospital visits is an admirable one.

Unfortunately, many of the tactics used by administrators have done little to achieve that goal. Hiring national “experts” on customer service to give lectures to the hospital staff, or introducing catchy mnemonics like AIDET (which stands for Acknowledge, Introduce, Duration, Explanation, and Thank You) to guide physicians in conducting more compassionate patient interviews, have been equally ineffective in markedly improving patient satisfaction.

If we aim to better the patient experience in the emergency department (and the rest of the hospital), we need to shift our focus from the patients to the nursing staff. After all, the people who spend the most time with patients are not the physicians but the nurses. If nurses are dissatisfied at work, patients will inevitably be dissatisfied with their experience.

Recent discoveries in the field of positive psychology have demonstrated that being successful in any endeavor (including improving patient satisfaction in emergency departments) requires happiness as a prerequisite. If we truly want to improve the safety, care, and experience of our patients, then we need happier people at work. In his book, The Happiness Advantage, Shawn Achor highlights the link between success and happiness. “Studies show that simply believing we can bring about positive change in our lives increases motivation and job performance; that success, in essence, becomes a self-fulfilling prophecy.”

Ensuring we have happier nurses won’t just improve patient satisfaction; it will, more importantly, improve the safety and well being of anyone being treated in the emergency department. Happier people are more aware of their surroundings, they take more pride in their work, and they’re less likely to make mistakes. In the ER, this is imperative. A happier, more engaged nursing staff will be able to recognize red flags (including physician error), identify septic patients, and stay on top of their workload.

Ultimately, success in the emergency department means many things: taking good care of patients, looking after their best interests, and ensuring they do not have a life- or limb-threatening illness. Being successful isn’t just about improving patient satisfaction scores. It also means taking care of patient anxiety, treating their pain, and making them comfortable. It means that nurses (and physicians) are in a state of flow, can handle stress, and are aware, in the moment, and conscious of what they’re doing. This will help them work better as a team. Being happy at work also provides nurses with self-confidence and self-esteem. “The more you believe in your own ability to succeed, the more likely it is that you will.”

If our nursing staff is happy, they are likely to see working in the ER as a calling rather than a job. In other words, “people with a calling view work as an end in itself.” Achor makes a case that happy employees have different priorities beyond just earning a paycheck: “Their work is fulfilling not because of external rewards but because they feel it contributes to the greater good, draws on their personal strengths, and gives them meaning and purpose.”

When nurses view their work as a calling, they can see more clearly the benefits they provide to patients, such as alleviating pain and suffering, quelling anxiety, diagnosing illness, and providing compassionate care.

I recently became the director of the emergency department at Desert Springs Hospital in Las Vegas. As soon as I took over the position, my mind reeled with the changes I wanted to make to ensure that patients were adequately taken care of, treated with respect, seen in a timely manner, and that their pain, anxiety, and questions were addressed quickly and effectively. I soon realized the most effective way to bring about such changes is to make sure that the people spending the most time with those patients — the nursing staff — are adequately taken care of.

I’ve started asking nurses about their goals and frustrations. I don’t schedule meetings with a bunch of doctors to figure out how to best improve patient satisfaction, but rather I ask the nurses themselves, individually and in real time:

  1. What is your overall satisfaction working at our hospital?
  2. What is the most stressful thing about your workday?
  3. What can we do to improve your workday?
  4. Do you feel rested? Do you have enough breaks?
  5. Do you enjoy working with your colleagues? Is there anyone here who drives you down?

I’m not sure what changes will come out of this. Maybe we will mandate an 8-hour workday, or provide a better schedule. Maybe we will increase our staff, or make sure nurses don’t waste time on non-clinical chores like finding equipment. Maybe we will promote more social events, or have more discussions in real time, especially after traumatic experiences like the death of a pediatric patient or a major resuscitation, to ensure hospital staff deal with the grief inherent in treating dying patients.

Regardless, I’m starting the process where I should: focusing on the people at the heart of patient care.


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