7 Tips for Post-Visit Phone Calls that Get Results
with COO Art Gladstone, ED Medical Director Dr. William Lee, and ED Nursing Director Sally Kamai at Straub Clinic and Hospital, Honolulu, Hawaii
"Post-visit phone calls create valuable patient loyalty because they are closely correlated with a patient's likelihood to recommend," explains Straub's Studer Group Coach Julie Kennedy-Oehlert, RN. (In "The One Number You Need to Grow," Harvard Business Review, December 2003, the authors find that "likelihood to recommend" is the best predictor of organizational growth, across all industries.)
The ED team at Straub Clinic and Hospital, Honolulu, Hawaii (one of four medical affiliates with Hawaii-Pacific Health System) has increased ED patient satisfaction from the 77th to 99th percentile in the past 12 months, primarily by hardwiring post-visit phone calls to their discharged patients and their families. The ED has a volume of 21,000 patients annually.
Here are some tips from the team:
1. Get organized. "In the beginning staff were reluctant to make the calls and fearful of hearing complaints," explains ED Nursing Manager Raylene Nolan. "We'd find call back papers all over the place when they got busy." But by computerizing a call log and encouraging some friendly competition, staff got on board and heard mostly good news. One nurse has already made 5,000 calls!
2. Make calls within 72 hours post-discharge. A recent article in the Annals of Emergency Medicine3 found that 78 percent of ED patients do not understand at least one area—and 50 percent do understand two or more areas—of their care plan, diagnosis, treatment, instructions for home care, and warning signs of when to return to the hospital.
In fact, Dr. Lee, the ED medical director, notes that many patients were confused about follow-up care and medications. Today at Straub, the number of patients who rate the ED as "very good" on information about home care has moved up from 58 percent to 71 percent. Doctors keeping patients informed about their treatments at Straub is ranked at the 98th percentile in a national database.
3. Follow up on trends and opportunities. Through the calls, staff learned that many patients had trouble getting access to primary care physicians for follow-up appointments. Now the ED schedules the appointments before patients leave. This practice assists patients who have been seen in the ED to obtain the appropriate level of follow-up care instead of returning to the ED, and improves access for patients who really need emergency care.
4. Engage your middle performers. "When fence-sitters in the ED saw high performers really getting into the fun competition of making the calls, they got engaged," notes COO Art Gladstone. "Post-visit phone calls are an excellent mechanism for moving performance."
5. Ensure accountability and transparency. At Straub, the goal is to contact 100 percent of eligible discharged patients within 24 hours. Straub believes that every patient deserves follow-up care through a post-visit call. Result? The ED is ranked in the 99th percentile for "cares about me as a person" on patient satisfaction surveys. Leaders track accountability for making the calls by users, to reward and recognize those who reach patients.
6. Make it easy. "It's helpful to have one person launch it," suggests Gladstone. "And make the process easy," adds Dr. Lee. "Straub uses automated software that each staff and physician can access for patient names and contact information. By asking the nurse or physician who took care of the patient to look at a screen with a list of patients, you take away the barrier of complexity."
7. Manage Up! "Nurses might have certain perceptions about their colleagues that change when the patient tells them what wonderful care they received," explains ED Nursing Director Sally Kamai. "We ask everyone who makes calls to pass on those compliments to the manager or charge nurse so they can be recognized for living our values." "The more calls you make, the less fearful you are," Nolan adds. "You get a thank you after every call. It's a great part of the day!"
3 Annals of Emergency Medicine, “Patient Comprehension of Emergency Department Care and Instructions: Are Patients Aware of When They Do Not Understand?” 53 (4): 454-461.
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