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Courtesy equals cash at Whidbey General
It won’t be long until patient surveys will have a financial impact on critical access hospitals like Whidbey General Hospital, according to Teresa Fulton, director of quality and patient safety at the hospital.
This inevitability has pushed hospital officials to give even more emphasis to an ongoing effort aimed at teaching personnel to communicate effectively and courteously with patients and their families.
“It’s about meeting the patients’ needs before they have to ask for help,” said Jan Maham, manager of the hospital’s critical care unit. Her department has received especially good survey responses, which she believes are due to the department’s tireless system of patient rounding and a communication method known by the acronym AIDET.
Under the new health care law, Medicare will soon starting cutting payments to most hospitals in the nation, the so-called “prospective payment system” hospitals, and financially reward others based, in part, on how patients say they were treated.
The new payment system won’t immediately affect critical access hospitals, but Fulton expects that it will soon.
“It just makes sense that Medicare is going to do that with us, too,” Fulton said.
Critical access hospitals normally receive a higher level of reimbursement from Medicare under a federal program created to reduce hospital closures, especially in rural areas.
The Hospital Consumer Assessment of Healthcare Providers and Systems survey, known as HCAHPS and pronounced H-Caps, is “the first national, standardized, publicly reported survey of patients’ perspectives of hospital care,” according to the Centers for Medicare and Medicaid website.
The survey contains 18 core questions about aspects of patients’ hospital experiences, specifically covering communication with nurses and doctors, the responsiveness of hospital staff, the cleanliness and quietness of the hospital environment, pain management, communication about medicines, discharge information, overall rating of hospital, and whether they would recommend the hospital.
One of the questions, for example, is “How often did nurses communicate well with patients?” The patients offered a range of responses, from never to always. But only the “always” response counts as positive for the hospital’s average.
Like everything involving Medicare, the formulas and factors are complicated. But in general, Fulton said hospitals with low scores will receive less than the normal Medicare payment and those with especially high scores will get bonuses.
Fulton said the hospital has long contracted with the national health care firm Press Ganey to survey patients. Medicare collects the results and makes them public on the website www.hospitalcompare.hhs.gov. In addition to the questions required by Medicare, the Whidbey General surveys include other inquiries about issues that officials are focused on.
The results show that Whidbey General’s scores are higher than both the state and national averages on all but two questions.
The hospital tied the national average of 70 percent in the number of patients who reported that they would definitely recommend the hospital, while the average in the state was 72 percent. Only 56 percent of Whidbey General patients reported that the area around their rooms was “always” quiet at night, while the national average was 58 percent and the state average was 51 percent.
Trish Rose, Whidbey General’s public relations manager, pointed out that the hospital doesn’t have private rooms outside of the critical care unit.
“People have come to expect private rooms because most hospitals have them now,” she said.
The hospital scored highest, 87 percent, on a question about whether patients were given information about what to do during their recovery at home. In addition, the hospital scored higher than both the state and national average on questions about how well nurses and doctors communicate with patients.
Fulton said the patients who are chosen to receive the surveys often write comments on the questionnaire; they are shared with administrators and staff members.
In the past, hospital officials asked Press Ganey for survey results that compare Whidbey General to other hospitals in the region, but she’s changing it so that ratings will compare the facility to hospitals nationwide. Fulton said it’s a tougher measure.
Fulton said she’s generally pleased with the survey results, but there’s room to improve.
“I definitely hope we get better,” she said. “The general upward trend is improving, but again everybody else is getting better also because we’re all in the same boat.”
Fulton said the monthly survey results show that there’s a lot of inconsistency in how hospital employees follow protocols.
In fact, “consistency” was the message that hospital CEO Tom Tomasino emphasized in a recent email briefing to staff. He stressed how tools like AIDET have “a profound impact on our patients’ perception of us and their care.”
Tomasino reminded hospital staff about what AIDET stands for.
“Use your AIDET to successfully manage that relationship: Acknowledge the patient, make eye contact, smile; Introduce yourself, explain what you do or manage up a teammate; Duration, explain how long the wait will be or how long the test will take; Explanation, what’s happening and why, listen for questions, ask for understanding and show empathy; Thank them for choosing us, or waiting, or their understanding, and ask if they have any additional questions. It only takes a minute to turn a poor experience into a great experience.”