With Federal Funding at Risk, Hospitals Focus on Hospitality

In an effort to retain crucial federal funding, some New York City hospitals are spending millions of dollars training staffers to be more gracious and to insert into conversation such patient-friendly phrases as "privacy," "security," and "safety."

The emphasis on customer service comes as the federal government prepares to publicize for the first time the results of patient satisfaction surveys taken at hospitals that receive Medicare reimbursement. In anticipation of seeing how they measure up against their competitors, hospital administrators – long concerned with improving patient care and satisfaction — are under the gun to succeed, and in some cases are taking cues from outside consultants.

"I think everybody's feeling the pressure because everybody's extremely concerned about the talk of proposed budgetary cuts," the vice president of clinical services at Montefiore Medical Center, Dr. Peter Semczuk, said. "We're in such a competitive environment that we're fighting to survive."

While participation in the study, known as the Hospital CAHPS survey, is not mandatory, a portion of each hospital's Medicare reimbursement is contingent upon it. As of last October, hospitals that fail to submit survey results to the Centers for Medicare and Medicaid Services stand to lose 2% of their inpatient Medicare reimbursement. For fiscal year 2007, inpatient Medicare reimbursement for hospitals in New York is projected at $8.9 billion, meaning each hospital could lose millions of dollars each. "Were a hospital not to comply, it would be a significant blow to their bottom line," a spokesman for the Healthcare Association of New York State, William Van Slyke, said.

The survey contains 27 questions that range from how courteous doctors acted to how quickly staff responded to calls for help. Data from the survey is to be published online by the end of the year.

Acutely aware of the impending publication of results, hospitals are stepping up efforts to boost patient satisfaction, hospital officials and outside observers said. Several hospitals in New York City are working with consulting firms, such as the Florida-based Studor Group, which Lenox Hill Hospital hired this past summer. "I think we recognized just how critically important it is to improve patient satisfaction," the hospital's vice president of medical affairs, Dr. Marc Napp, said.

In a new campaign, the hospital is asking all staff members to focus on hospitality, and for employees to use phrases such as "privacy," "security," and "safety," during interactions with patients, those associated with the hospital said.

"You want to make sure your hand is not on the door when you're talking to a patient because they will think you don't have time for them. You don't want your arms crossed because it makes them think you don't want to answer their questions," Dr. Napp said.

Some New York City hospitals have invested "tremendous amounts of money" in an effort to implement such practices, the vice president for quality and patient safety at the Greater New York Hospital Association, Terri Straub, said. In June, she said, the association rolled out the Quality Coaching Fellowship, a program that trains front-line hospital employees in patient satisfaction. While hospital staffers in New York City are uniquely challenged by a diverse patient population, she said the publication of survey results would prompt front-line employees to "be more proactive to make their hospital look better."

However, some hospital administrators said prioritizing patient satisfaction is nothing new. "Apart from the HCAHPS process, this is something that we have been working at for some time," a spokeswoman for New York-Presbyterian Hospital/Weill Cornell Medical Center, Myrna Manners, said. "Sometimes it's not even big things, it's little things like making eye contact, like addressing a patient by his or her name, like knocking on a door."

Montefiore's Dr. Semczuk said his hospital, which has worked with the Studor Group for nearly three years, is likely to perform well on the survey thanks to extensive staff training. "We have spent an inordinate amount of time focusing on customer service training for all of our staff," Dr. Semczuk said.

Dr. Semczuk pointed to Montefiore's Children's Hospital, which opened in 2001, as an example of the hospital's effort to meet patients' clinical and other needs. Each room is equipped with a pullout couch for the patient's parents, as well as a shower and a refrigerator. Laundry service, free meals, and tutoring are also available. Because nurses spend the most time with patients, the hospital emphasizes their interaction with patients and requires nurses to make hourly rounds.

The challenge for many hospitals, Dr. Semczuk said, is that they are not traditionally known as service institutions. "They are complicated places, busy places," he said. With the impending publication of HCAHPS data, he said, "It's going to force them to pay attention to patient satisfaction and service because no one wants lousy scores in anything."