American Society of Clinical Pathology recognizes top-performing clinical pathology labs
When it comes to patient satisfaction rankings in hospitals, the clinical pathology laboratory is often ranked at the very bottom of the 10 clinical service categories measured by patient survey systems such as Press Ganey Associates. This bottom-tier ranking is undeserved, but happens for a logical reason.
For most patients, their only interaction with the hospital’s laboratory is when a phlebotomist sticks them with a needle to collect blood. Most patients find needle sticks to be uncomfortable and unpleasant. Further, a significant number of patients are afraid of needles.
It was THE DARK REPORT which first brought this situation to the attention of pathologists and medical laboratory scientists. In its November 19, 2007, issue, it interviewed Matt Mulherin, Director of Corporate Communications at Press Ganey, who explained why the clinical laboratory service was often ranked toward the bottom of the 10 clinical service categories typically measured in patient satisfaction surveys. (See TDR, “Phlebotomy Is Closely Linked To Hospital Satisfaction Scores.”)
In that interview, Mulherin described how the national data compiled by Press Ganey pointed to a significant reason for the lower ranking of clinical laboratory among the services ranked in patient satisfaction surveys. He said “…while a blood draw might be routine for hospital and lab professionals, among patients there’s a lot of fear and anxiety. Many patients are uncomfortable with needles, and these factors make the interaction between clinicians and patients critical.”
Growing numbers of hospitals and health systems are recognizing that this is an unaddressed opportunity for improving patient satisfaction. There are examples where the clinical pathology laboratories in these institutions have taken effective steps to raise their patient satisfaction scores.
Recently, the American Society for Clinical Pathology (ASCP) recognized these accomplishments. Four of its nine winners in a recognition program called the “Lab Professionals Week Pizza Party” were cited for implementing patient care activities that centered around the patient’s phlebotomy experience and, after implementation, boosted patient satisfaction with the hospital’s medical laboratory service.
The improvement projects ranged from leaving a simple calling card with the patient inviting feedback about the phlebotomy service to providing explanations of the laboratory tests administered. These activities increased hospital laboratory scores on the Press Ganey patient satisfaction survey and led to reduced complaints. There was also a boost to the morale of the laboratory employees. Here are snapshots of the four hospital laboratories which improved patient satisfaction rankings and were recognized by ASCP.
Marcus Daly Memorial Hospital
The clinical laboratory at Marcus Daly Memorial Hospital in Hamilton, Montana, was the Northwest Region winner. In 2007, it initiated a Culture of Excellence and thereafter its Press-Ganey score skyrocketed from 4% to 90%. Lab Department Head Michele Adams noted that the Culture of Excellence program is based on principles taught by the Baptist Leadership Group, a consulting practice owned by Baptist Health Care.
She explained that the change involved learning to take a patient-focused approach. One element was for phlebotomists and other lab staff to recognize that patients’ perception of services is based on what they hear, touch and feel. As the organization developed a new hospital mission and vision statement, it helped create a culture of communication within the laboratory. Laboratory staff were educated about how patients perceive them and their attitudes. Scripts for interaction with patients were developed and put into use.
At Marcus Daley Memorial hospital, medical laboratory employees who interact with patients keep a log of notes for patients who return because they are undergoing treatments in the hospital, such as chemotherapy, that may require follow up laboratory tests. Adams noted that this helps laboratory staff be proactive in ensuring each patient’s specific issues are addressed and that their needs are met.
Adams also instituted monthly department meetings in the laboratory to review the latest Press Ganey patient feedback. “This is an ongoing process,” she said, noting that scores dip a little here and there each month because many patients will fill out and return the survey form only once. That is why “our lab staff has to encourage patients to respond to the survey each time care is provided [to them],” observed Adams.
Wright Medical Center
Wright Medical Center in Clarion, Iowa, was ASCP’s North Central Region winner. Its clinical laboratory consistently sustained a 92% score for outpatient services on the Press Ganey patient survey during the years 2002 and 2005. Laboratory Leader Rayne Premo said the lab team, however, wanted to raise the bar and improve “things on our score that were consistently less than stellar.”
An analysis of patient satisfaction survey responses revealed that the medical laboratory’s two weakest areas were: 1) explaining lab tests or lab test procedures to patients; and, 2) addressing the patient level of comfort or pain. The improvement team at Wright’s laboratory developed protocols for patient contact aimed at improving patient satisfaction in these two areas. Once changes were implemented, Premo noted that the laboratory’s Press Ganey score shot up to 95%.
“Following a laboratory procedure on a patient, we now go over what the physician has ordered, give a layman explanation of what each test is used for, ask if the patient has any questions, and take the time—to do our best—to answer their questions fully,” said Premo. Use of scripted interaction with patients now helps patients clearly understand that minimal pain is unavoidable and, importantly, that the phlebotomists and lab employees do care and are sorry to have to inflict pain.”
Sutter Roseville Medical Center
The Southwest Region winner was Sutter Roseville Medical Center in Roseville, California. It was recognized for its bright yellow “Dandy Card.” When a phlebotomist draws a patient’s blood they leave a Dandy Card with the phlebotomist’s name on it and a confidential phone number for patient feedback. The card also thanks patients and wishes them a “dandy day.”
It turns out that the Dandy Cards are overwhelmingly popular with patients. “Some patients collect them their whole stay,” said Mary Steele, M.T. “We have found that using the cards makes people [employees] more aware of how they present themselves and the laboratory, as well as distinguishes our presence from other hospital staff that draw samples.” She also noted that the Dandy Card is also a hit with nurses because it lets them know a patient’s blood has been drawn.
Dandy Cards are just one of several strategies used by the Sutter lab to build respectful and caring relationships with patients, according to Regional Laboratory Director Christine Flaherty. “Recognizing that most patients are anxious when it comes to having their blood drawn, we focus on presenting ourselves to patients as courteous professionals who care,” she said. “Lab assistants are coached on ways to connect with patients when they collect blood and have come to realize that it doesn’t take much extra time to be courteous.”
With introduction of the Dandy Cards, the supervisor listens to the message line daily and posts patient messages on a bulletin board, so “lab assistants know they did a great job…and are motivated to provide the same extraordinary care to every patient, every time,” suggested Flaherty.
Additionally, results of the Press Ganey survey are shared weekly with lab assistants, so they can see the excellent result of a consistent focus on patient satisfaction, she added. The lab went from the 46th percentile in the first quarter of 2009 to the 81st percentile by the third quarter of the same year.
South Austin Medical Center
It seems the “card after phlebotomy” is an effective technique. The clinical laboratory at St. David’s South Austin Medical Center in Austin, Texas, uses an “Ambassador Card” to invite patient feedback. The cards, which are in English and Spanish, provide a telephone number where patients can call to leave a message about the phlebotomist’s skill or courtesy, said Linda Coover, Director of Laboratory Services.
“This has had a positive effect on patients and lab morale,” she noted. The lab receives four to 10 mostly positive calls daily from patients, which is considerable for a facility with 250 beds, Coover noted. Suggesting that phlebotomists are among the least appreciated clinical employees, she said that the Ambassador Cards have helped to boost their sense of importance, because they are viewed as “the lab” by patients.
As for the laboratory’s rating on the Press Ganey, Coover says it fluctuates with nursing morale. “If the nurses are happy, our score goes up,” she stated, adding that all patient-care employees wear scrubs, color-coded to distinguish the type of services provided. Nurses wear navy blue; non-nurse, clinical employees wear green; and non-clinical employees, like patient transportation, wear tan. “I think this has helped with our laboratory’s patient satisfactions scores,” said Coover. “It helps patients identify the nurses, and they appreciate that.”
In each of the four hospital laboratories described above, a proactive program to address patient discomfort and fears about needle sticks and phlebotomy procedures generated improved patient satisfaction. That translated into higher rankings for the hospital laboratory relative to the other clinical services measured in the ongoing patient satisfaction surveys.
These examples can inspire pathologists and clinical laboratory managers to organize similar patient-centered improvement projects in their own laboratories. Importantly, these examples show how innovative hospital laboratories are raising the competitive bar for other laboratories. Once patients have a “champagne experience” with phlebotomy at one hospital, they are likely to notice an inferior experience with the phlebotomists at other hospitals and laboratories in their community. —P. Kirk