Of the four healthcare service areas for which Â鶹´«Ã½AV tracked patient satisfaction data as part of its 2003 healthcare database, the emergency department (ED) is the area that received the lowest average scores. In fact, the ED has been the lowest-rated area since Â鶹´«Ã½AV began compiling its aggregated database in 2000, and mean satisfaction scores have remained virtually flat during that period (see "Patient Satisfaction Stable Among Unstable Conditions" in Related Items).
What can be learned from the best-performing hospital EDs -- those scoring in the 80th percentile of Â鶹´«Ã½AV's database -- to help other EDs improve? Emergency departments must follow a simple progression in order to achieve higher patient satisfaction scores:
Before anything else, EDs need to ensure their performance on patient satisfaction items relating to speed and efficiency is as strong as it can be. Â鶹´«Ã½AV describes such items as "process" issues -- those relating most to operations rather than human interaction. If these "process" issues are not adequately addressed, the ED's most important assets -- its employees -- will not even have the opportunity to perform to their full potential.
What Do Best-Practice Emergency Departments Do Best?
So where do the best-practice EDs (those in the 80th percentile of the database) score better than the average EDs (those in the 50th percentile of the database)? Our analysis turned up the six questions that most differentiate hospitals in these two groups. Interestingly, five of the six items are "process" items, relating to speed and efficiency, while only one is a "people" item.
Notably, the differences between best-practice and average ED facilities on these six items are significantly larger than the differences between best-practice and average facilities in the highest-scoring service area, outpatient surgery (see "Where Do the Best Outpatient Surgery Facilities Excel?" in Related Items).
Also of note, five of the six items are highly correlated to overall patient satisfaction in the ED (the only exception is "cleanliness").
Process and People Items
The data show that what differentiates best-practice EDs most is their ability to successfully perform the most basic functions -- such as holding down wait times, showing a sense of urgency, and providing quick and efficient service. Higher scores on these "process" items, all of which fall within the category of speed and efficiency, are likely brought about by strategies such as bedside registration, physician triaging, and fast-track minor emergency services.
Only one "people" item -- "the ability to get help or assistance at any time" -- differentiates best-practice EDs from average EDs. Even this item is influenced by speed and efficiency -- it relates closely to the "sense of urgency shown by staff" item. Best-practice EDs excel at convincing patients that they can quickly respond to unanticipated problems that may arise.
Bottom Line
The nation's emergency departments are in a crisis brought about by overcrowding and staff shortages. But best-practice EDs have been more successful than average hospitals at making operational improvements, which help set their employees up for success. Simply put, by improving their processes, the best EDs are helping their staff members survive the current crisis.
But the success of these best-practice EDs has been limited. While their "process" scores already set them apart from other departments, they have yet to meet the threshold at which they begin to differentiate themselves on the key "people" items, such as satisfaction with nursing care and ED physicians. It appears that even the best EDs still need to continue improving their processes in order to allow their people to excel.