Surgical Services: 5 Ways to Improve Patient Satisfaction

Introduction

The number of surgeries in the U.S. on an annual basis is staggering. There were nearly 22 million surgeries performed in inpatient and outpatient settings in 2014, according to a recent report sponsored by The Agency for Healthcare Research and Quality—a part of the U.S. Department of Health and Human Services (Steiner et al. 2017).

For the patient, any surgical experience is an encounter ranking high for anxiety and potential risk. Many surgeries carry inherently high risk of negative outcomes, and it is reasonable to believe that the accompanying stress level and apprehension the patient and his or her family experience are proportional.

For the hospital provider, the sheer volume provides incredible opportunities for healthcare professionals to study and improve upon patterns and policies concerning patient satisfaction in the surgical suite, which carries significant weight with HCAHPS scoring.

Delivering patient-centered care in the surgical suite, for example, is an intrinsic element of a quality healthcare system and important for hospital profitability.

A recent study concluded that U.S. hospitals with the highest patient satisfaction scores were associated with more efficient care and higher surgical quality (Tsai, Orav, and Jha 2015).

Many surgeries carry inherently high risk of negative outcomes, and it is reasonable to believe that the accompanying stress level and apprehension the patient and his or her family experience are proportional.

Of the 2,953 US hospitals that perform one of these 6 procedures, the median patient satisfaction score was 69.5% (interquartile range, 63%–75.5%). Length of stay was shorter in hospitals with the highest levels of patient satisfaction (7.1 days vs 7.7 days, P < 0.001).

Adjusting for procedural volume and structural characteristics, institutions in the highest quartile of patient satisfaction had the higher process of care performance (96.5 vs 95.5, P < 0.001), lower readmission rates (12.3% vs 13.6%, P < 0.001), and lower mortality (3.1% vs 3.6%) than those in the lowest quartile. Hospitals with high patient satisfaction also had a higher composite score for quality across all measures (P < 0.001).”

To understand why certain hospitals receive higher patient satisfaction scores, we need to conduct a deep dive into the processes that these organizations employ relevant to the surgical suite.

Chapter 1

Take Advantage of Big Data Insights

Although the use of data collection, data sharing, and data analytics has been embraced by most industrial sectors, its adoption by the healthcare industry has been much slower.

One of the primary roadblocks encountered using data analytics is that it is more difficult to transform healthcare into a strictly data-driven culture because of the nature of the industry. The delivery of services is much more personalized than in other industries.

However, one recommendation that promises to yield improvements in the surgical suite is the Healthcare Analytics Adoption Model:

A framework for evaluating the industry’s adoption of analytics
A road map for organizations to measure their progress
toward analytics adoption
A framework for evaluating vendor products

This model enables healthcare organizations to better understand and leverage the capabilities of analytics toward the goal of improving the quality of care.

One major healthcare institution discovered, through the use of analytics, that the top concerns of patients were:

RESPECT. Although providers are generally trained to be objective and unemotional, patients want to be treated as individuals and

engaged personally.

COMMUNICATION BETWEEN CAREGIVERS. Patients want to know that their conversations with doctors are being communicated to nurses and vice versa. The typical hospital’s surgical services arena is composed of multiple departmental silos. The topic of common administrative problems, along with proposed improvements, is highlighted in “Optimizing your operating room: Or, why large, traditional hospitals don’t work” (Girotto et al. 2010)

“However, the current leadership structure in most large teaching hospitals is one of traditional ‘silo’ organizations comprised of nursing services, anesthesia, materials processing, administrative support, and surgery. It focuses on the components of patient care and not on the patient. Consequently, each faction is prone to maximizing individual utility and excellence rather than patient centered, team care. Our findings illustrate these inadequacies. Ultimately we want to improve the experience and outcomes for our patients who require surgical care and simultaneously enhance the work environment in a cost effective fashion.

The operating room needs to become a single service area where multiple professionals provide coordinated care, identify strategic priorities, and share the risks/rewards.”

HAPPY PROVIDERS. Patients want to see providers who appear more approachable and interested in answering their questions. The adoption of these principles carries over to the surgical suite, where outcomes can be less certain and patient anxiety tends to be high. Analytics also can provide valuable insight into overcoming poor planning and scheduling conflicts—major concerns in the surgical suite for many reasons.

Of the 2,953 US hospitals that perform one of these 6 procedures, the median patient satisfaction score was 69.5%

Resources

eSignature for Informed Consent: It’s a Numbers Game

The Cost of a Lost Minute in the OR

How Does Patient Satisfaction Impact Reimbursement?

Chapter 2

Leverage eForms and eSignature Technology

From the patient satisfaction perspective, EMR software generally has improved diagnosis and treatment and resulted in fewer errors within personal health records—a crucial requirement before scheduling a patient for surgery.

From the provider perspective, faster care and decision-making responses result from EMR integration into the hospital procedural environment, especially when eForms and eSignatures technology is part of the process.

Paper can wreak havoc on any form process, and informed consents, which serve as a “green-light” or “red-light” precursor to all surgeries, are no exception. Paper informed consents are often lost come the day of surgery, and according to “Missing Consent Forms in the Preoperative Area” (Garonzik-Wang et al. 2013), 14 percent of operative cases are delayed as a result of missing consents. There is no question that this delay will result in additional stress to the patient in an already stressful situation. Furthermore, the new informed consent that is collected to remedy the lost one is often rushed.

When consents are missing at the time a patient arrives at the hospital, it is common that the informed consent process is conducted by a resident as opposed to the surgeon.

A recent JAMA study found that 66 percent of patients were missing signed consent forms at surgery, resulting in delays for 14 percent of operative cases.

Last-minute consent capture also means that the physician spends little time on the process as opposed to when the surgeon does it in advance.

Furthermore, as stated in the Garonzik-Wang study, “When called to the preoperative area to obtain consent, 78.9% of residents spent only 5 minutes obtaining consent, and no respondents reported spending more than 10 minutes.” The study goes on to reveal an interesting statistic regarding the faculty’s impression of patients: “More than 70% of faculty members felt that patients preferred being asked for their consent by an attending surgeon.” This also can easily result in a misunderstanding by the patient of potential outcomes, which can lead to less than satisfying outcomes and expose the

hospital to legal risk.

Electronic informed consents also can be presented to the patient on a tablet, which allows the patient to see the form in its entirety. Patients and surgeons alike can easily review and electronically sign the form directly on a tablet, providing a positive patient experience. These electronically signed informed consents eliminate the potential issues that stem from losing paper forms.

14 percent of operative cases are delayed as a result of missing consents.

Resources

How eForms Give Surgeons and Patients What They Want

Paper Consent Forms Can Delay Surgeries. Here’s How Electronic Signatures Can Help Your Hospital Avoid This

Chapter 3

Ensure Best Practices at Every Patient Care Touchpoint

The patient experience in the surgical suite starts when the care provider and the patient mutually come to the resolution that surgical intervention is the best course of action. There are many aspects of patients’ surgical experience that occur well before they arrive at the hospital the day of their surgery.

There are a lot of moving parts to ensure optimal surgical outcomes. Staff involved in pre-admission and pre-anesthesia testing, along with surgeons, nurses, and other personnel, are key players.

During the presurgery phase, the extent to which the patient is educated and prepared concerning expectations and outcomes will be a key factor determining how the patient reports the overall experience. Once more, a proper informed consent process built upon solid communication skills by the surgeon is critical in educating and preparing the patient for what lies ahead.

This phase can easily go awry. Should less than ideal communication occur, this opens opportunities for surprises and unanswered questions from the patient. Furthermore, hospital staff supporting the surgery must ensure that all pre-admission testing and clearances have been completed and evaluated before surgery to make the process run as smoothly as possible for the patient.

The day of surgical intervention involves many moving pieces critical to a positive patient experience.

It starts before the patient is wheeled into the operating room. The patient is likely anxious, so focusing on building trust during reception, check-in, and patient preparation is important.

This phase is also where unnecessary delays and hiccups have negative consequences on patient perception of the facility and team as a whole.

The certified registered nurse anesthetist, anesthesiologist, and surgeon should ensure that all of their evaluations and directions are clearly communicated, with little duplication that may add stress to the patient.

The aforementioned study “Optimizing your operating room: Or, why large, traditional hospitals don’t work” (Girotto et al. 2010) highlights opportunities for hospitals to optimize their operating rooms by mapping out the following explanation of patient flow on the day of surgery:

Check-in to moving into surgery center: 19 min.
Patient waits in surgery center: 1 hour
Patient transferred to the pre-anesthesia unit wait time: 48 min.
Enter into OR and time credited to anesthesia induction: 13 min.
Surgical prep and position time: 13 min.
Operative time: 66 min.
Anesthesia reversal: 11 min.

Should delay occur during any portion of this timeline, a cascading array of negative impacts can affect not only the surgery at hand but also subsequent surgeries through the day that are scheduled for the same OR. The ramifications of these delays in the OR are substantial financially because the highest-paid people in the hospital are not being properly utilized, one of the highest revenue-producing areas of the hospital is stagnant, and unexpected overtime payments can proliferate. Of course, patient satisfaction and employee morale are adversely affected by these delays.

It is estimated that 60 to 70 percent of all hospital admissions are because of surgical interventions, accounting for over 40 percent of total hospital expenses, according to a 2016 Wolter Kluwer Health analysis of the effects of operating room delays.

Because surgical interventions represent a significant portion of the hospital operating budget, delays can significantly bump those expenses up. When consents are missing at the time a patient arrives at the hospital, it is common that the informed consent process is conducted by a resident as opposed to the surgeon.

To better evaluate how well your facility’s OR procedures are congruent with best practices enabling better patient satisfaction, ask yourself:

Was the patient offered all options, including laparoscopic and other less invasive surgical procedures, during consultations?
How seamless was the transition from surgery to a postsurgical recovery area?
Did the patient’s hospital discharge go smoothly?
Did the patient leave with adequate post-discharge follow-up instructions?
Was the patient discharged with medications or with other pain management regimens? Most patients won’t remember their surgeries, but they will remember how comfortable they were afterward.

This last question is an especially important component of the patient satisfaction process given that, starting in January 2018, three new questions on the HCAHPS Survey focus on communication between hospital staff and patients about pain.

As of July 2017, approximately 4,315 hospitals publicly reported HCAHPS scores from more that 3.1 million surveys—a potential gold mine of data from which to assess patient satisfaction regarding surgical intervention.

A study in the International Journal of Surgery on how hospitals can create a more patient-focused operating room recommended the following:

“We propose that elimination of the traditional department structures in the surgical suite will lead to a restructuring that is more patient focused and outcome driven. … The first step is to establish a managerial team with primary leadership recruited from outside the hospital. This chief operating officer cannot be perceived as ‘belonging to’ one of the traditional silos or departments of nursing, anesthesia, or surgery. His/her direct reports will include representation from these groups and also an information technology officer. This last member is essential as operations become ‘online’ but also because evaluation of outcomes/data will guide strategy decisions. We cannot overstate the importance of this objective position.”

It is estimated that 60 to 70 percent of all hospital admissions are because of surgical interventions

Resources

Top 5 Reasons for Surgical Services Delays

Understanding the Economic Factors of Surgical Services and the OR

Chapter 4

Leverage Newer Surgical Technologies

After the surgical experience, the patient must go through a recovery and healing process. Generally, there is a proportional relationship between the degree of invasiveness of the procedure and the amount of recovery and healing the patient must undergo. To reduce the amount of time spent healing, look at ways to reduce the invasiveness of the procedures. One of the most important innovations in recent years involves the use of robotics to assist surgeons in the operating room.

According to some estimates, some 4,000 robots globally assisted with 750,000 operations in 2016.

The benefits of these newer technologies are manifold:
Robotic arms allow the surgeon to operate tremor-free.
Surgery is accomplished through smaller, less invasive incisions.
Recovery and healing time is shorter.
Patient spends less time under anesthesia.

First-generation versions of these robots such as the da Vinci employed arms, were originally meant for industrial applications, on a single base. They cost about $2 million per unit.

Next-gen robots such as the Versius will employ arms independently placed on their own base and feature three joints per arm, corresponding to the surgeon’s shoulder, elbow, and wrist. This is a more natural configuration mimicking a human arm, allowing more precise movement. They are also expected to come with a lower price tag as more players enter the market.

Fortunately for hospital budgets and purchasing departments, the monopoly enjoyed by da Vinci’s manufacturer, Intuitive Surgical, is about to come to an end due to its patents recently expiring.

Innovations in image-guided surgery (IGS), cytoreductive surgery, and targeted muscle reinnervation (TMR) have been revolutionary in the art of surgery and have proven to save lives and result in positive outcomes.

IGS systems, for example, use cameras and electromagnetic fields to allow the surgeon to view the patient’s anatomy three-dimensionally on computer monitors and relay the surgeon’s precise movement in real time.

Technologies such as IGS help surgeons perform safer, less invasive surgical procedures once considered impossible. Less invasive procedures generally are linked to safer surgeries resulting in shorter recovery times, which can contribute to greater patient satisfaction in the surgical suite.

One of the most important innovations in recent years involves the use of robotics to assist surgeons in the operating room.

Resources

Why Every Hospital Needs an eForm Management Solution for Surgical Consent

When Paper Informed Consents Bring Surgeons to a Hard Stop

Chapter 5

Never Underestimate Patient-Provider Communication

In many ways, surgical patients are similar to other consumers receiving goods or services in exchange for payment, but there are exceptions. In many cases, life and death are on the line, creating a highly emotional centerpiece to the patient-caregiver relationship. Naturally, a patient wants to feel heard and genuinely cared for by the provider. In turn, providers want to feel the patient’s trust with the heavy responsibility they carry. Having their patient’s faith in their abilities can help them perform with the highest level of confidence and care.

Recognition, understanding, and appreciation—the nuanced dynamics of this relationship can uncover opportunities that can ultimately improve the patient experience in the surgical suite.

Focusing on these factors is a step in the right direction:

The care team’s genuine concern and compassion
The amount of time providers spend with patients
The level of respect shown to patients
The ability of providers to listen to patient questions and concerns
The skill of the providers to communicate and work as a team

Of these points, teamwork and the ability to communicate are perhaps the best ways to improve patient satisfaction during and after a surgical intervention.

Teamwork starts with a top-down mentality that encourages a workplace culture of trust, respect, and communication―the goal of which is to drive positive outcomes for patients and providers. To do otherwise can be devastatingly costly.

One estimate pointed out that breakdowns in communication accounted for about $12 billion in waste annually in U.S. hospitals and contributed to 210,000 to 400,000 deaths annually.

By focusing on the quality of the patient-provider relationship as part of the organization’s culture, you get a better idea of how to improve all aspects of the patient experience, especially in the surgical suite, where poor communication can lead to poor decisions with potentially harmful outcomes.

Approximately 4,315 hospitals publicly reported HCAHPS scores from more that 3.1 million surveys—a potential gold mine of data from which to assess patient satisfaction regarding surgical intervention.

Resources

How do eForms Improve the Patient Intake Process?

Enhancing the Patient Experience with a Better Informed Consent Process

Chapter 6

Conclusion

The surgical suite is where hospitals and physicians build their reputations and also where hospitals generate much of the revenue that keeps them in business and supports the organization’s mission. Surgical suites are critical sources of revenue that make it easier to fund other areas such as chronic care, mental health, and public health.

Still, all the presurgical due diligence in the world won’t improve patient satisfaction if outcomes are not successful or expected, or if it doesn’t expedite healing.

But when surgical suites are managed efficiently and strategically, patient satisfaction marks are generally higher and everybody wins.

5 Ways to Improve Patient Satisfaction in the Surgical Suite

Introduction

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5 Ways to Improve Patient Satisfaction in the Surgical Suite

Introduction

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