RUNNING HEAD: FIVE STAR SERVICE EXPECTATIONS & PATIENT SATISFACTION
Best Practice - Christus Santa Rosa Five Star Service
Expectations and Patient Satisfaction
LCDR J.T. Amon
14 Aug 2013
Army-Baylor Graduate Program in Health and Business Administration
FIVE STAR SERVICE EXPECTATIONS & PATIENT SATISFACTION
2
Executive Summary
In 2002, Christus Santa Rosa Health System launched an initiative to measure their patient
satisfaction scores. Initial results indicated that patient satisfaction scores were at the 18th
percentile, a score far below expectations. Taking an aggressive stance to improve the patient
experience, Christus Santa Rosa completed a correlation study to identify key drivers that
affected patient satisfaction, formed a patient advocacy team, collaborated with a commercial
vendor to assist with their strategic plans, and implemented a comprehensive training program
for all their employees. Within seven years, Christus Santa Rosa was able to raise their overall
patient satisfaction scores over the 75th percentile. As of 2013, Christus Santa Rosa made
significant strides regarding patient satisfaction and received a financial bonus from the Hospital
Value-based Purchasing (HVBP) created under the Patient Protection and Affordable Care Act
of 2010. Christus Santa Rosa earned a reimbursement bonus of 0.17% in 2013 partly due to their
ability to meet Centers for Medicaid and Medicare Services’ patient satisfaction metrics.
Overall, Christus’ forward thinking initiatives have increased patient satisfaction for their
empanelment, helped improved outcomes, and provided a means to secure resources in a
constrained budgetary environment.
FIVE STAR SERVICE EXPECTATIONS & PATIENT SATISFACTION
3
Background
Founded in 1869 by the Sisters of Charity of the Incarnate Word, Christus Santa Rosa
health system is the only faith-based, not for profit health system in South Texas. The mission of
the organization is to “extend the healing ministry of Jesus Christ.” Currently, Christus Santa
Rosa health system includes five hospitals (1,159 licensed beds), two freestanding emergency
rooms and two ambulatory surgical centers (Christus Santa Rosa, 2013).
Christus Santa Rosa is committed to serving the populous and has been providing the best
possible care for over 140 years. Like all healthcare institutions, Christus health system is
concerned with patient satisfaction as it known to affect the experience of care and health
outcomes. An indication of the system’s commitment to improving the health of their patients is
their promise of excellence. Under this promise, Christus Santa Rosa espouses a promise to
provide quality medical care, be concerned about patient comfort, openly communicate with
patients, treat all with courtesy and respect, and create an environment of healing (Christus Santa
Rosa, 2013). This pledge of excellence is a likely reason why the organization initially made a
substantial commitment to improve patient satisfaction in 2002.
Best Practice
Early in 2002, Christus Santa Rosa began using an in house survey to measure patient
satisfaction. Early results indicated that the organization was operating at the 18th percentile
when compared to other hospitals across the nation (Hellstrom, 2011, p. 3). Recognizing a need
to improve performance, Christus implemented an action plan and set clear long-term goals to
improve patient satisfaction and quality of care. A part of this plan included a correlation study
to identify the key drivers that affected their organization’s patient satisfaction scores. A patient
advocacy team was created in 2004 to help develop action plans to address issues identified in
FIVE STAR SERVICE EXPECTATIONS & PATIENT SATISFACTION
4
the correlation study and other patient satisfaction related concerns as they arose (Hellstrom,
2011, p. 3).
In 2007, Christus Santa Rosa made a substantial commitment to formalize their patient
satisfaction improvement initiatives and contracted the commercial vendor, Press Ganey, to
proctor their surveys and further develop programs to help improve patient satisfaction scores
and the overall patient experience (Hellstrom, 2011, p. 3). Some of the new processes
developed under this collaborative effort were a “mystery shopper” program, focus groups, and
customer service training for associates (Hellstrom, 2011, p. 4).
One of the most successful and critical elements developed to improve patient
satisfaction was the mandatory customer service training for all employees. Christus with the
assistance of Press Ganey provided professional customer service training for current staff
members and ensured all new employees received the same training during the organizations
mandatory orientation program. Providing the same customer service training to permanent
staff, contracted personnel, etc., set organizational expectations on how employees were to treat
patients and their families. Additionally, it helped ensured patients were all treated with respect
and dignity by all associates. Shortly after implementing all the aforementioned programs to
improve patient satisfaction, scores steadily rose from the mid teens to over the 75th percentile, a
significant achievement in a relatively short period.
The primary tenets of the customer service training were the five star service expectations
(Christus Santa Rosa, 2011). As previously noted, these are expected behaviors of all employees
regardless of their pay grade, work center, or individual responsibilities. The first expectation is
surrounding hallway and elevator etiquette. Under this concept, visitors are politely greeted and
asked if they need help. If they need directions, employees are to escort them to their
FIVE STAR SERVICE EXPECTATIONS & PATIENT SATISFACTION
5
destination. The second element concerns proper phone call etiquette. The third element
addresses how individuals are to enter or leave a patients room. Individual are always required
to knock, wait for a response, greet the patient by name, state your purpose, explain the process,
ask if they need any further assistance, and offer a thanks. The forth element regards interactions
with patients and families and the concept that all employee should understand that it is a
privilege to serve the patients and their families. Additionally, all employees are required answer
a patients call light regardless of their duties or responsibilities. The final element surrounds
treating others with respect, compassion, personal accountability, and fostering a positive
environment for healing (Christus Santa Rosa, 2011).
Impact of ACA and Patient Satisfaction Scores
In 2010, congress passed the Patient Protection and Affordable Care Act (ACA). A
component of this legislation is the Hospital Value-based Purchasing (HVBP) program that
provides financial incentives for quality care versus volume. Currently, the Centers for Medicare
and Medicaid Services (CMS) manages the program and establishes the benchmarks required for
hospitals, providers, and others to receive the financial incentives. The ultimate goal of the
program is to reward institutions for quality services that provide better value and patient
outcomes versus volume of services (CMS, 2013). The types of metrics used for the incentives
have changed since inception but a consistent and major component of the metric is patient
experience of care (patient satisfaction). In fiscal year 2014, the financial incentive metric
includes process of care (45%), patient outcomes (25%), and patient experience of care (30%)
(CMS, 2012).
To help fund this program, participating hospitals have a small percent of DiagnosisRelated Group (DRG) payments withheld. Since the start of the HVBP program, withholdings
FIVE STAR SERVICE EXPECTATIONS & PATIENT SATISFACTION
6
have increased from 1% 2013 to 1.5% 2015 (CMS, 2011). Institutions that receive a bonus or
penalty based on their ability to meet CMS’s HVBP metrics. Most institutions receive a fraction
of their withholding either on the positive or negative side. As of December 2012, 66% of
hospitals in Texas received a HVBP bonus and 34% received a penalty. The national average for
hospitals that receive a bonus is 52% and 48% received a penalty (KHN, 2012).
Conclusions
Due to Christus Santa Rosa’s initiatives and the concerted effort to improve patient
satisfaction scores, the organization increased results from the mid teens to the 75th percentile in
less than seven years. Christus Santa Rosa continues to hone their training programs and
develop their patient satisfaction improvement initiatives. Currently the organization is working
to be in the 90th percentile for customer service. An added benefit to improving the patient
experience is financial incentives from the ACA’s Value Based Purchasing program. In fiscal
year 2013, Christus realized a HVBP program bonus of 0.17% from CMS (KHN, 2012). This
bonus translates into substantial revenue that otherwise would not have been realized. By
improving quality and patient satisfaction, Christus Santa Rosa has also improved their financial
bottom line in a fiscally constrained budgetary environment.
FIVE STAR SERVICE EXPECTATIONS & PATIENT SATISFACTION
7
Works Cited
CMS. (2013). Centers for Medicaid and Medicare Services. Retrieved Aug 07, 2013,
from Hospital Value Based Purchasing: http://www.cms.gov/Medicare/Quality-InitiativesPatient-Assessment-Instruments/hospital-value-based-purchasing/index.html
CMS. (2012, 07 11). National Provider Call: HVBP FY 2014 Overview. Retrieved 08 07,
2013, from http://www.cms.gov/Medicare/Quality-Initiatives-Patient-AssessmentInstruments/hospital-value-based-purchasing/Downloads/NPCSlides071112.pdf
CMS. (2011, 07 27). Open Door Forum: HVBP Fiscal Year 2013. Retrieved 08 07, 2013,
from http://www.cms.gov/Medicare/Quality-Initiatives-Patient-AssessmentInstruments/hospital-value-based-purchasing/Downloads/HospVBP_ODF_072711.pdf
Hellstrom, P. (2011, 06 14). Hardwiring the Basics: 5 Star Service Every Time. Christus
Health: Christus Health.
KHN. (2012, 12 20). Kaiser Health News. Retrieved 08 07, 2013, from Interactive Chart:
Bonuses and Penalties for US Hospitals:
http://www.kaiserhealthnews.org/Stories/2012/December/21/value-based-purchasing-chart.aspx
Rosa, C. S. (2011). Five Star Service Expectations. Christus Santa Rosa Health System.