Patient satisfaction made simple: foundations Recovery Network finds that treatment patients seek the simple things - relationships, trust and fun.
Subject: Patient satisfaction (Research)
Patient satisfaction (Management)
Pub Date: 04/01/2011
Publication: Name: Behavioral Healthcare Publisher: Vendome Group LLC Audience: Academic; Trade Format: Magazine/Journal Subject: Health; Health care industry; Psychology and mental health Copyright: COPYRIGHT 2011 Vendome Group LLC ISSN: 1931-7093
Issue: Date: April, 2011 Source Volume: 31 Source Issue: 3
Topic: Event Code: 310 Science & research; 200 Management dynamics Computer Subject: Company business management
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 256281567
Full Text: Some years ago, upon his appointment as CEO of a psychiatric hospital, Rob Waggener's first act of leadership was to get himself admitted for a week. He wanted to understand the patient experience.

So, in 2008, when Foundations Recovery Network (FRN, Nashville, Tenn.) committed to improving "customer experience management" as a means of improving satisfaction, outcomes, revenues, and referrals, it was no surprise that Waggener, who now serves as FRN's CEO, was on board.

This time, however, research was conducted by a college-age intern who--as a patient at every FRN facility--completed what FRN executives now call "Ted's Excellent Adventure."


Through eye-opening "moments of magic and misery" (see Figure 1), the intern captured the customer experience and convinced FRN execs that changes were needed. At the same time, execs studied the details of customer experience management as explained in Fred Lee's book, "If Disney ran your hospital."

FRN's leaders saw the value of improving the customer experience, says Waggener. At that point, "we moved from thinking about what patients want to actually finding out."

The customer's view of treatment

Another driving force behind FRN's effort was to better address the motivation level of customers (patients) at the beginning of treatment. Noting that FRN's treatment approach utilizes the "five stages of change" model (SAMHSA, TIP 35), Waggener says few patients arrive in the "action" phase. That, he says, "is the phase where they accept that they have a problem and are motivated to change." This phase is considered the key to effective, patient-driven treatment.

Instead, he says that "the vast majority arrive in earlier phases--the 'precontemplation' or 'contemplation' phases--when they're just beginning to consider that they may have a problem. They're showing up because they want to get the family off their back."

To get the treatment process started, "we've got to meet them where they are and tap into the limited amount of motivation they've got," says Waggener. That means making the treatment experience as attractive as possible--from the first call to post-discharge follow-up--because "people who don't want to be in treatment will complain about everything. They just want out."

Research defines the challenge

To better tap into, then define, these powerful elements of customer expectation and experience, FRN leaders hired Diane Schmalensee--a former Malcolm Bald ridge Quality Award examiner--to outline FRN's quality-improvement effort, starting with research. Ultimately, the research encompassed some 30 "customer" focus groups including program alumni, current patients, families, and referral sources, as well as some 70 percent of FRN staff from every location.

The research also:

* identified five major phases of the treatment process (pre-admission, admission, clinical treatment, daily experiences, and pre- and post-discharge);

* identified the most significant or important expectations in each phase and how they are experienced, satisfied, or struggled with, by the patients;

* identified which FRN employee function(s) were involved in fulfilling the expectation; and

* suggested procedures that could be used to ensure expectation fulfillment.

Teams convert research to process

Next, FRN execs joined with facility directors and their staffs to develop cross-functional and cross-locational teams. These teams would compare the suggested procedures to actual (and varied) work processes at each location, then hammer out "ideal" work processes--customized to specific employee functions--so that each functional process could be standardized at each site.

The team process resulted in development of:

* a large "Policies and Procedures" manual containing the broad collection of internal processes;

* a series of small function-specific (physician, nurse, counselor, etc.) Process Manuals focused on delivery of the customer experience in each role, and;

* a series of customer/family/referral questionnaires that would be completed at intervals from admission through post-discharge to measure overall impacts on the customer experience relative to objectives.

Pilot testing

In the fall of 2009, the entire customer experience management process--renamed the "Patient Centered Care" initiative--was then piloted at FRN's The Canyon in Malibu, Calif.


The 2009 pilot tests drove practical insights that were essential to further customizing site-specific materials and processes, simplifying the proposed online questionnaire process (ultimately, paper forms proved simpler), standardizing patient forms across sites, and sharpening the most valuable elements of staff training.

Program rollout and results

After these improvements, the entire PCC initiative was rolled out, starting with staff-wide training, in April 2010. A "before" and "after" comparison, based on year-over-year results, shows the positive trends (Figure 1).

Critical to the program's success were the Process Manuals, which succinctly blend customer-satisfaction goals for each phase of the program with role-specific employee process steps, insights to customer expectations during that phase, and examples of what Waggener calls "the look, the sound, the feel" needed to create a satisfying customer experience.

The manuals themselves are just a few pages, "not crazy long," says Waggener, but they're powerful.


Waggener says that "happy patients stay longer," a phenomenon that drives revenue by increasing recommendations and referrals, increasing average length of stay, and increasing average daily census. While those findings are no surprise, what FRN didn't expect was the impact on staff. Turnover is down and the staff feels empowered. "They love it," says Waggener.

Another surprise was found in what FRN calls the "drivers" of patient satisfaction. "As clinicians, we always like to think that our impact, our clinical interventions are always what makes the difference," says Waggener. He adds that such thinking leads treatment center executives to think that costly new treatment modalities are critical to success.

"Yet, we found that what matters most to people, next to consistent and fair handling of program rules, is 'What do you do for sober fun?' That was one of the biggest drivers of satisfaction each week in treatment, something that they remember and carry with them. And, it really doesn't cost anything!"


James W. West, MD, Quality Improvement Awards

By Dennis Grantham, Editor-in-Chief

Established in 2001, the James W. West, MD, Quality Improvement Awards recognize NAATP-member addiction treatment organizations that improve the quality and effectiveness of their services and document their results along the way.

The award is named in honor of James W. West, a longtime quality-improvement advocate and medical director emeritus at the Betty Ford Center. The 2011 award recipients will be honored at the National Association of Addiction Treatment Providers' (NAATP) annual conference, held May 14-17 in Phoenix.

This, the 11th annual award, recognizes two programs whose efforts demonstrate comprehensive approaches to quality improvement. Foundations Recovery Network (Nashville, Tenn.) is recognized for its Patient Centered Care initiative, while Memorial Hermann PaRC (Prevention and Recovery Center, Houston, Tex.) is recognized for a body of work comprised of four quality improvement efforts. Congratulations!
Program metric                 Before PCC             After PCC
                           (April-October 2009)  (April-October 2010)

Patient satisfaction              3.8                   4.2
(1-5 scale)

Willingness to recommend     [left arrow]          [up arrow]
(trend)                      [right arrow]

Average length of stay           29.4                  31.1

Average daily census         [down arrow]          [up arrow]

Staff turnover (percent)          4.0                   2.8

Figure 1: Before and after PCC initiative.
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