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 page 7) 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, 2007
13 "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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