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Q&A:
Financial Returns and Patient Satisfaction:
Making the Connection
Hardwired Results® interviews Studer Group coach Brian Robinson...
HR: Can you explain how patient satisfaction delivers ROI?
BR: There are many ways patient satisfaction
links with ROI. For instance, patients who are
satisfied also tend to be loyal—which increases
volume through referrals. They are also clinically
compliant because they trust their caregivers.
This improves patient outcomes. And best of
all, the same tools we use to increase service to
patients are also those that improve clinical quality
and reduce costs.
HR: Some examples?
BR: Falls cost a hospital about $22,00012 in care
and 18 days of hospitalization while decubitus
(skin breakdowns) cost almost $16,00013 per
incidence. Hardwiring hourly rounding on
patients (see Reduce Falls, Overtime and Lost Charges
with Hourly Rounding) raises patient satisfaction
and gives nurses back more time when patient
use of call lights drops. It also reduces falls and
decubitus because nurses are at the bedside more
frequently. When you consider the fact that onethird
of Americans over 65 years old will fall at
least once per year, hourly rounding is clearly a
tactic that will help hospitals meet patient needs
in the future and avoid unnecessary costs.
HR: How does this fit with the concept of
"evidence-based" leadership?
BR: Evidence-based leadership is much like evidence-
based medicine. As the HCAHPS survey
rolls out and transparency increases, leaders are
increasingly standardizing actions and behaviors
that drive outcomes in People, Service, Quality,
Finance and Growth...what Studer Group calls
the Five Pillars.
HR: Isn’t it challenging to standardize
human behaviors?
BR: Not if you align expectations and accountability
across the organization. The best way to
do that is to use an objective leader evaluation
tool. For instance, the organization may set a
goal to reduce avoidable inpatient days by a
number that would positively impact patient care
and the bottom line. At the operational nursing
level, nurses would have a goal to reduce the
missed treatments or medications that contribute
to avoidable days, while radiology could set a
goal to reduce delays for performing procedures.
By cascading goals and tracking performance at
the departmental level, leaders gain control over
both the clinical outcomes of their patients and
operational performance of the organization.
HR: Final thoughts?
BR: I think it's important to understand that
nurses who deliver quality clinical care to
satisfied patients are more satisfied themselves,
and therefore also more loyal to the organization.
Employee loyalty reduces turnover. And
the literature suggests that organizations with
turnover below 12% also see substantial gains
in length-of-stay (LOS) and mortality14. As a
result, we can take that money15 we would have
spent to recruit and orient a new RN and invest
it back into clinical care advancements instead.
Everybody wins.
As a 20 year CEO veteran, Studer
Group coach Brian Robinson is an
expert at improving patient satisfaction
and delivering clinical and operational
outcomes. He has run small rural
hospitals, large urban teaching facilities and Las Vegas'
busiest health system. His facilities have been named
in America’s "Top 100 Hospitals" eight times.
12 "Preserve Independence with Fall Prevention Strategies",
Nurse.com,
Jan. 29, 200713 “Payments for Adverse Events,” AHRQ 2005.14 Business Case for Work Force Stability, VHA Research
Series 2002, Vol. 7.
15 Assuming turnover cost equals 100% of an individual’s
salary, the average
replacement cost of a medical/surgical nurse is $46,000 nationally per Business Case
for Work
Force Stability, VHA Research Series 2002, Vol. 7. However,
the Journal of
Nursing Administration has estimated
costs at 1.2 to 1.3 times a nurses salary. See
"The Costs
of Nurse Turnover", Parts I and II, Journal of Nursing
Administration Dec.
2004 and Jan. 2005.
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