Quality Control and Patient Satisfaction

Grady Memorial Hospital opened its doors in 1892 and is today is listed as the fifth largest public hospital in the United States possessing a 918 bed capacity (LeValley & Page, 2010). Grady is designated as the public hospital for the city of Atlanta and noted for housing the only Level I Trauma center within 100 miles of metro Atlanta (Grady Health System, 2012). Since its opening, Grady Memorial Hospital has grown into Grady Health System, which includes, Grady Memorial Hospital, Children’s HealthCare of Atlanta at Hughes Spalding, Crestview Health, and Rehabilitation Center, and nine neighborhood health centers (Lee, 2008).

Grady Health System employees over 5,000 employees and in addition to offering emergency services it provides services for the treatment of asthma, burns, sickle cell, and strokes. Grady Health system operates in the hospital and health care industry and provides services under the category acute short-term care. While Grady possess a wealth of facilities and services, it has experienced issues that plague many hospitals, Grady deals with issues in the areas of efficiency, overcrowding, and struggling to maintain patient satisfaction, and quality scores (Shaw, 2011).

The intent of the paper is to focus on the correlation between customer satisfaction and quality score. The first part of this paper introduces the problem of discussion; the next part introduces a literary review that offers differing views on how to improve quality and customer satisfaction in the healthcare field. The fourth section offers an in-depth analysis of the problem statement, followed by recommendations and personal reflections. Introduction to the Problem According to the HCAHPS (U. S.

Department of Health & Human Services, 2012) (Hospital Consumer Assessment of Healthcare Providers and Systems) a national survey produced by the U. S. Department of Health and Human Services Grady Memorial Hospital ranks the lowest in customer satisfaction compared to two other major metro Atlanta Hospitals( Piedmont Hospital and Northside Hospital). Among the questions listed on the survey one asked if nurses always communicated well, Grady scored 66% whereas Northside and Piedmont scored 77% and 79% respectively.

Out of the ten areas of customer satisfaction addressed Grady consistently scored the lowest of the three hospitals. As customer service is one of the cornerstones of successful healthcare organizations (Cape, 2000), this paper aims to identify the root causes of these low than normal scores and the correlation between quality management and customer perception and satisfaction. Answering these questions will aim to prove that improved internal quality (efficiency, culture, etc… ) has a direct impact on customer service and perception of the health care provider.

Literary Review

Views on Methodology A Duke University hospital case study by Silow-Carroll (2008), sought to identify the connection between strategies and factors that contributed to high customer satisfaction. The research was conducted through the gathering of data through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. The survey captured the responses of patients about their overall experience while at the hospital, communication with staff, and the hospital environment among other things. The results of the survey measured the success of patient satisfaction initiatives.

Duke University Hospital recognized that satisfaction is achieved through organizational and tactical strategies. Those strategies include Patient Satisfaction University for the staff of the hospital, which provides training on how to identify those ideas that contributed to patient satisfaction. One interesting aspect of the hospital’s quality management program used a balanced score card to measure the effectiveness of customer service. The balanced score card measured the following areas, Clinical Quality and Internal Business; Customer Service; Work Culture; Finance.

Another aspect of the Hospital’s quality management program consisted of training staff members of the Six-Sigma DMAIC process from solving process. The result of using this process resulted in identifying patient’s priority concern with respect to their daily care. The result of the implementation of Six-Sigma processes and balanced score cards included an increase in patient satisfaction scores and a willingness of patients to recommend the hospital to others. The use of these tools reinforces the earlier hypothesis that changing the internal culture of the organization does reflect in customer satisfaction.

Poole, Hinton, Kraebber (2010) offers a contrasting approach to improving the internal culture of healthcare organizations by transforming the culture into a lean workplace. The reasoning behind becoming a lean organization resides in the fact that healthcare is trending towards payment for quality versus quantity coupled with the rising cost of services, healthcare services will demand proven methodologies such as lean six-sigma(Poole et al. , 2010). Lean methodology aims to identify the value adding steps that contribute to the desired outcome as determined from feedback by patients (Trebble & Hydes, 2011).

Resulting interpretation of the research indicates that if healthcare organizations adopt lean methodologies, it will reduce cost to the organization as well as the patient, therefore raising the customer perception of the hospital, which is a critical factor in patient satisfaction. Happy Employees make happy customers Further strengthening the correlation that customer (patient) satisfaction is dependent of quality, Dennis J. Scotti, Ph. D. (2007) submitted from the Veterans Administration on the linkage between high-performance work systems (HPWS) and customer satisfaction.

This study was conducted from two perspectives, the first being from the employee point of view and the second the customer orientated perspective. In order to get an understanding of workplace performance, employees were asked to rate on a scale from 1 to 5 factors such as goal alignment, communication, empowerment, teamwork, etc. There was only one question asked of the patient, on a 1 to 7 scale, “All things considered how satisfied are you with you healthcare in the VA? (Scotti, Ph. D, 2007)”

The results of the study proved that 1.HPWS has a direct link to employees’ perception of their ability to quality customer service. 2. Employees perception of customer service is linked to patient’s perception of high-quality customer service. 3. Customer satisfaction is linked to perceived levels of service quality. These results prove that when employees perform at a higher standard, it translates into the patient’s view of the organization, and when patients are satisfied with the quality of their interaction with the staff, the more likely they are to recommend the provider to their relatives and friends (Chahal, 2008). Analysis.

Now that explanations have been offered indicating the linkages between performance and perception, I will now explore the root causes of the problems that beset Grady Memorial Hospital. The HCAHPS compiled a list of ten questions directed towards the patient accessing specific individual aspects of customer satisfaction (Appendix 1). Among the questions asked dealt with nurse and doctor communication with patients, timeliness of staff response for help, cleanliness, and overall hospital satisfaction. In all of the aforementioned areas, Grady Hospital scored below both the Georgia and National average.

From the research, some of the underlying symptoms of the problems include, enormous workloads for nurses, and wait time for beds. In addition to these problems, the hospital was a paper based organization (Shaw, 2011), which decreased both quality and efficiency. The diagnosis of the problems that were systemic of the specific issues were as follows: based on the results of the HCAHPS, nurses only communicated well with their patients 68 percent of the time (Appendix1). The main contributing factor of this problem was that agency-based nurses compose over half of the nursing staff.

The underlying problem with this is that there is no incentive to do more than the job requires, because there is no incentive to do more, no sense of teamwork. Teamwork is significant component of an organization that exhibits total quality (Evans & Lindsay, 2010). Another problem decreasing the efficiency of the hospital was the overwhelming number of patients that the emergency department sees on a daily basis. The hospital exhibits an inability to divert those patients with non- emergency issues to services that can assist that patient in a more efficient manner.

This problem serves as the basis for the perception of patients when it comes to bed wait times in addition to the increased workloads of the nurses. Recommendations Grady Hospital has a long road ahead to obtaining customer service ratings that meet or exceed state and national averages. For the intent of this paper, I recommend that Grady Hospital implement a Total Quality Management (TQM) with a health care emphasis.

According to Talib, Rahman, & Azam, (2011) TQM for healthcare is defined as the satisfaction of patients, doctors, nurses, and suppliers (i. e., social shareholders) and other interested groups, achieved by implementing effective planning, programs, policies and strategies (i. e. , hard issues), and human and all other assets (i. e. , soft issues) efficiently and continually within a hospital context. Under TQM, the hospital would have the ability to address the eight categories that affect customer satisfaction, which are as follows: Leadership; Teamwork and Participation; Process Management; Customer focus and satisfaction; Resource management; Organizational behavior and culture; Continuous improvement; Training and education.

To monitor the progress of the TQM process, Grady should implement the use of the balanced score card similar to Figure 1 (Silow-Carroll, 2008) that is in use by Duke University Hospital to measure the impact that of their programs have on the perceptions of its patients and their satisfaction with the hospital. Clinical Quality & Internal BusinessGOAL: Foster enhanced clinical care and new program development to improve quality, patient safety, and efficiency. | Customer ServiceGOAL: Continuously improve customer service for both internal and external customers.

| Work CultureGOAL: Continuously improve the work culture consistent with the DUHS value proposition. | FinancesGOAL: Generate sufficient resources to reinvest in people, technology, buildings, research, | Figure 1 Duke University Health System Balanced Scorecard Reflections Upon completion of this research paper, I have learned several things. For one, I have more of an understanding of why people refer to Grady as the hospital you go to if you want to die. It is based on the customer perception that the staff at Grady does not have very good bedside manner and health care professionalism.

Secondly, I have learned that TQM can truly reinvent healthcare organization into a model of efficiency. When I think of a hospital, I think of complex diagnosis, saving lives, operations and so forth, but never have I really stop to think about how the actual processes are executed and how their quality is by inefficiency. I think going forth, I will be more conscience about the processes of the organization that is associate with and how it, as well as myself can benefit from the processes and best practices of quality management.


Cape, C. (2000, July). Learning from our customers. Healthcare Financial Management. Chahal, H. (2008, October-December). Predicting Patient Loyality and Service Quality Relationship: A Case study of Civil Hospital, Ahmedabad, India. The Journal of Business Perspective, 12(4). Evans, J. R. , & Lindsay, W. M. (2010). Managing for Quality and Performance Excellence (8 ed. ). Mason, Ohio: South Western Educational Publishing. Grady Health System. (2010). Quality at Grady. Retrieved on May 12, 2012 from Grady Health: http://gradyhealth. org/quality/ Grady Health System. (2012). About Us.

Retrieved on May 12, 2012 from Grady Health System: http://www. gradyhealth. org/about. html Lee, C. (2008, December 3). Grady Health System. Retrieved on May 12, 2012 from The New Georgia Encyclopedia: http://www. georgiaencyclopedia. org/nge/Article. jsp? id=h-1216 LeValley, C. , & Page, L. (2010, August 31). 20 Largest Public Hospitals in the United States. Retrieved on May 11, 2012 from Becker’s Hospital review: http://www. beckershospitalreview. com/lists-and-statistics/20-largest-public-hospitals-in-the-united-states. html Poole, K. , Hinton, J. , ; Kraebber, K. (2010, April).

The Gradual Leaning of Health Systems. Industrial Engineer, pp. 50-55. Scotti, Ph. D, D. J. (2007, March/April). Links Among HIgh-Performance Work Enviroment, Service Quality, and Customer Satisfaction: An Extenstion to the Healthcare Sector. The Journal of Healthcare Management, pp. 110-123. Shaw, G. (2011, April). Case Study| Grady Health System. Healthcare Leaders Media Breakthroughs: The Coordinated ED, pp. 15-19. Retrieved June 13, 2012, from http://content. hcpro. com/pdf/content/265482-3. pdf Silow-Carroll, S. (2008, December).

Duke University Hospital: Organizational and Tactical Strategies to Enhance Patient Satisfaction. The Commpnwealth Fund. Talib, F. , Rahman, Z. , ; Azam, M. (2011). Best Pratices of Total Quality Management Implementation in Health Care Setting. Health Marketing Quarterly, pp. 232-252. Trebble, T. , ; Hydes, T. (2011). Redesigning services around patients and their doctors: the continuing relevance of lean thinking transformation. Clinical Medicine, pp. 308-10. U. S. Department of Health ; Human Services. (2012, April 19).

Hospital Compare. Retrieved on May 11,2012 from U. S. Department of Health ; Human Services: http://www.hospitalcompare. hhs. gov/hospital-compare. aspx? hid=110079,110083,110161;lat=33. 69856499999999;lng=-84. 54318669999998;stype=GENERAL;;stateSearched=GA Appendix 1 Measure Description| GRADY MEMORIAL HOSPITAL80 JESSE HILL, JR DRIVE SE ATLANTA,GA 30303 (404) 616-4252| Patients who reported that their nurses “Always” communicated well. | 68%| Patients who reported that their doctors “Always” communicated well. | 81%| Patients who reported that they “Always” received help as soon as they wanted. | 45%| Patients who reported that their pain was “Always” well controlled.

| 64%| Patients who reported that staff “Always” explained about medicines before giving it to them. | 56%| Patients who reported that their room and bathroom were “Always” clean. | 57%| Patients who reported that the area around their room was “Always” quiet at night. | 58%| Patients at each hospital who reported that YES, they were given information about what to do during their recovery at home. | 76%| Patients who gave their hospital a rating of 9 or 10 on a scale from 0 (lowest) to 10 (highest). | 58%| Patients who reported YES, they would definitely recommend the hospital. | 63%|.

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