QI Spotlight: Addressing What Matters Most to Patients

Successful applicants to the ASGE Endoscopy Unit Recognition Program (EURP) submit a summary of a recently conducted quality improvement (QI) project as part of the application process. The QI project in the spotlight this month looked at its performance relative to addressing what matters most to patients.

TOPIC
Patient Satisfaction: What Matters Most

PURPOSE
To increase the endoscopy department’s patient satisfaction score, specific to the question “Did we spend enough time to discuss what matters most to you?”

DEFINE
The health system has a strategic goal of increasing the ratings on the NRC “What Matters Most” question in patient satisfaction surveys to 66.9% for all departments. Prior to this goal being established, no specific efforts were made to make sure the patient’s most pressing concern was addressed in the appointment.

MEASURE
Real-time NRC surveys were collected using the current survey. Results can be accessed through the NRC website. The baseline time period selected was February through March. For purposes of this project only, the “What Matters Most” question was evaluated. The scores were reviewed and documented. The percent positive for that time period was 75%, above the current goal.

Endoscopy has three total locations. For project purposes, we used [Location A] which has the highest patient volume. The location has six total procedure rooms that complete both inpatient and outpatient endoscopic procedures. Staff rotate covering procedures at all locations, so all endoscopy staff were involved in this improvement initiative.

ANALYZE
Although for the baseline period the goal for “What Matters Most” was being met in the department, looking at the results weekly, a fairly sharp decrease occurred during mid to late March. Therefore, it was decided that further work was needed to make sure patients’ biggest concerns were being met.

IMPROVE
In discussions with the team, it was decided that patients would be given a half sheet of colored paper, asking what mattered most to them during this visit. The goal was to place a stronger emphasis on what was important to them and to ensure staff in all areas of endoscopy, including pre-op/intra-op/post-op, were looking at and addressing what mattered most to patients during procedures.

The improvement began on April 11. It was decided to use May and June as a comparison period for evaluating the improvement. The May percent positive was 72%, indicating the decline in the scores had stabilized. Results for June are incomplete, but preliminary results indicate a percent positive of 79%. Although not a statistically significant increase, the sharp decline in scores was stabilized.

The project gained immediate support from the physicians. They were able to see and hear what mattered most during that visit to the patient and address it in real time. Some even requested this form be used in their office with the clinic patients to help increase those scores as well. Overall, the staff were open and willing to participate. We did run into a few obstacles where patients mentioned items unrelated to their visit. Staff felt compelled to take on some of those requests, causing a disruption in normal workflow. We did edit our scripting after these to better reflect what was most important during this specific encounter.

CONTROL
The green sheets will continue to be used for all patients, with appropriate one-on-one follow-up by the nurse and provider assigned to the case. The department nurse manager reviews the “What Matters Most” results monthly. If a drop of more than 0.5% is seen, then the process will be reviewed with the staff, gaps will be identified and countermeasures will be implemented.

We hope sharing this project summary will be useful to you and your practice. Learn more about gaining honoree status in the ASGE Endoscopy Unit Recognition Program. EURP honoree units may use the ASGE Quality Star logo in promotion of their units, receive premium educational content bimonthly via an exclusive e-newsletter The Huddle and enjoy a range of additional benefits. Questions should be directed to EURP@asge.org.