Care Delivery

January 30, 2019

A W.I.S.E. Approach to Patient Satisfaction

Why should patient satisfaction matter to a hospital? The simple answer is because it has to.

The reasons are several:

It’s key to fulfilling clinicians’ professional responsibility;
Healthcare consumerism means customer service has become a business strategy;
It reduces staff stress and improves job satisfaction;
Positive patient satisfaction correlates with clinical quality;
Negative patient satisfaction is correlated with higher risk of malpractice lawsuits
There is a fiduciary duty since a portion of a health system’s revenue is tied to CAHPS scores.

Higher patient satisfaction can lower the risk of lawsuits, increase patient loyalty and lifetime value, improve patient outcomes, and reduce readmissions.

Given those facts, Kenneth J. Heinrich, MD FACEP, SVP and Group Medical Officer at Schumacher recommends hospitals take a “W.I.S.E.” approach to patient satisfaction, a structure he learned from one of his mentors – Dr. David Thompson.

He defines the acronym this way:

“W.I.S.E. refers to the four primary drivers of patient satisfaction: Wait Times, Information Delivery, Symptom Reduction, and Expressive Quality.”

According to Dr. Heinrich, satisfaction results from meeting or exceeding patient expectations – especially in the four drivers of patient experience, something he refers to as the “disconfirmation paradigm.”

“If you expect a certain level of service and perceive that you received better service, you will be satisfied,” he says. “Conversely, if you expect a certain level of service and your perception of that service fell short of expectations, you will be dissatisfied.”

The question then becomes, what can hospital medical directors and clinical staff do to implement this W.I.S.E. patient satisfaction approach?

Dr. Heinrich recommends the following:

Wait Times

Manage expectations to improve perceptions.

“Regarding wait times, give realistic expectations and over-estimate rather than underestimate,” he says. “Do not make statements such as ‘The doctor will be with you in one minute’ or ‘I will go check and be back in five minutes to let you know.’ Set yourself up for promises you can keep, not those you can’t.”

Information Delivery

Share as much information as possible.

“Information delivery is a strong determinant of patient satisfaction,” Dr. Heinrich says. “The lack of information magnifies a patient’s sense of uncertainty and increases their psychological distress.”

He lists these items as essential:

Delays, if they occur;
Types and reasons for tests;
Diagnosis (in layperson language);
Reason for admission;
Discharge instructions;
What you are doing now (e.g., performing an EKG) and what will be happening next (the doctor will read the EKG).

Symptom Reduction

Recognize that symptoms are subjective.

“Each patient experiences pain and other symptoms in their own way,” Dr. Heinrich says. “Poor symptom relief can be perceived by the patient as lack of caring.”

He recommends providers take the following steps:

Document pain and other adverse symptoms;
Address pain, fever, vomiting, and other unpleasant symptoms;
Re-document the response;
Discuss treatment options with the patient;
Explain your approach without personal judgment (including if you are unable to relieve adverse symptoms at the time of the visit).

Expressive Quality

Understand that faster is not necessarily better.

“Take time with the patient, be courteous, and express genuine concern,” he says. “Patients are poor judges of the technical aspects of care and, therefore, more affected by the expressive (caring) aspect of treatment than the technical (curing). They desire ‘high touch’ over ‘high tech.'”

Patient Complaints & Service Recovery

One last piece of advice from Dr. Heinrich regards ways to manage patient complaints as an element of service recovery to help ensure satisfaction. He says:

Own the complaint. Take full responsibility for fixing the problem;
Listen to the patient. Use active listening skills. Be empathic. Put on your Teflon overcoat;
Use blameless apology;
Assess the problem and develop an action plan. “That involves demonstrating a sincere commitment to fixing the problem and giving extra attention afterward,” he says;
Consider a follow-up contact. Contact the patient again while he or she is still in the ED, or phone him or her at home.

Conclusion

There are many reasons to promote positive patient satisfaction in the hospital.

To make it a possibility, implement a W.I.S.E. approach: manage patient expectations regarding wait times, share information freely, recognize that patients perceive symptoms differently, and understand they care more about the expressive aspects of a physician’s interaction than the technical.

Add to that a willingness to take complaints seriously, address them proactively, and follow up quickly, and you are well on your way toward reaping the benefits of better patient experience, lower risk of liability, greater patient loyalty, better clinical outcomes, and reduced readmissions.

It’s pretty “W.I.S.E.” advice indeed, wouldn’t you agree?

Interested in learning more about anticipating patient needs to build patient loyalty, check out our white paper The Lifetime Value of Patient Loyalty: Transcending episodic patient satisfaction.

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