Enhancing your everyday activities is essential in our rapidly changing healthcare environment. We must consistently challenge ourselves to improve patient and employee satisfaction and serve as role models to our staff. Moreover, hospitals are accountable for providing community care and remaining financially viable while adapting to the demands regulatory bodies and health insurance agencies habitually create. Temple University Hospital (TUH), Philadelphia, Pa., recently scrutinized its procedures regarding these responsibilities and used nine guiding principles to revitalize nurse practices and patient satisfaction within the facility.

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In 2003, TUH was a 36-bed cardiothoracic unit with 72 employees, which included unit secretaries, monitor technicians, nursing assistants, and registered nurses. Employees spanned the width of all generations on the unit, from new staff to more experienced staff. Patient satisfaction scores were in the 10th percentile, per the Press Ganey inpatient healthcare patient satisfaction survey. There were eight different physician services caring for patients on the unit. The last five nurse managers within a 2-year period lasted 6 months to 2 years. There was a 14% vacancy rate. Finally, the staff had limited knowledge and/or interest in patient satisfaction.

Since the unit was the premier unit for TUH, little time was available to make improvements. Initially, ADPIE (assessment, diagnosis, planning, implementation, evaluation) was used to map out the problems and plans. Itemized barriers included high staffing vacancies, limited tools and equipment, and ineffective service delivery. Patient satisfaction was viewed as a nurse-driven process, and each endeavor was met with a lack of participation and mistrust from all levels of management.

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Once you match passion and purpose, you're bound to see quick, long-lasting change. To facilitate this, TUH developed the following nine guiding principles designed to improve patient and staff satisfaction.

1. Commit to excellence. Develop unit-based goals and objectives pertinent to your facility. These could include quality, growth, people, and finance. Don't overcompensate in areas you feel comfortable in, as this creates vulnerability in other areas. Involve staff in capital budget planning and interviewing candidates.

2. Measure the important things. Display patient satisfaction scores on the bulletin board weekly, along with completed patient satisfaction surveys. Teach staff members how to read surveys, interpret scores, understand the percentile ranking, and trend and track priority index questions.

3. Build a culture around service. Help staff members to connect outcomes and results through role modeling and rounding with them daily. Have them conduct callbacks to all patients 24 to 48 hours after discharge. Develop a form to assist in obtaining results in relation to patient concerns and perceptions, clinical outcomes, staff reward and recognition, and institutional process improvements. Celebrate each holiday with a community-based activity as a unit. These initiatives help to establish trust on all levels.

4. Create and develop leaders. Always expect continuous improvement. Recruit high performers on the unit to lead committees, task forces, in-services, and classes. Meet with all staff members one-on-one every 3 months and review their level of performance. Motivate high performers to a higher level and work with them consistently on their plan for development. Give middle performers a 3-month timeline to reach a higher level of aptitude. Finally, offer low performers 30 days to come up with a plan and implement how they can advance their performance. Clearly describe what the issue is, explain how their performance and/or attitude affects the team, and provide them with ways to improve. Also, let them know the consequences for improvement or lack of improvement.

5. Focus on employee satisfaction. Conduct rounds with staff members daily, including weekend and nights, until they feel that what they do serves a purpose. Perform unit-based employee satisfaction surveys, clinical skills surveys, and management surveys every 6 months, and review results at staff meetings. Create employee comforts, such as a coffee lounge, for staff members to relax and discuss in a group the tentative action plans to resolve issues.

6. Build individual accountability. Everyone is accountable for being a part of the team and is responsible for modeling performance standards. Never lower the bar-when we expect more, we tend to get more.

7. Align behaviors with goals and values. Hold all staff members accountable for their behavior and attitude. Reward those who consistently exhibit team values. Ultimately, the best way to align behaviors with goals and values is to live them consistently.

8. Communicate better. Role model all disciplines and maintain open and positive communication. Many times we're focused on the problem of the patient and tend to carry these feelings into our relationships with each other. Reprogram your team's thought process to see the positives before the negatives, as this allows open and compassionate communication.

9. Recognize and reward success. Teach staff members to be comfortable and confident in their abilities. Individualize rewards based on results and provide rewards that best fit the individual. Also, send out thank-you cards and provide praise, gifts, incentives, and recognition as appropriate.1

Better outcomes

At the end of a busy 2-year period, TUH reached the 90th percentile for patient satisfaction and had a waiting list of staff applying to be members of its team. In conducting this journey, we learned that there's an extraordinary quality of spirit that can lead one to conquer rather than simply survive. Discover that spirit in yourself along your journey and reap the benefits of staff and patient satisfaction.

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