"I never thought I would be involved in medically focused research,” says Dina Zemke, Harrah Hotel College assistant professor. “There is, however, a cross-discipline appeal to the questions we are asking.”
Such questions are the subject of Zemke’s ongoing exploration of what hospitals should be doing to boost patient satisfaction. “Hospitals want to know what defines a good patient experience. Where did things go right? Where did things go wrong?” Zemke says. “This is where the fundamentals of good customer service come into play.”
Striving for happy clients is nothing new to administrators at both hotels and hospitals. As with the hospitality business, the health care industry has long been aware that patient satisfaction, or its opposite, has a big effect on peer recommendations, repeat business, and, ultimately, revenue. But since the 2012 introduction of the federally mandated Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) in 2012 — a reporting initiative that allows patients to rate their hospital experiences — patient opinion holds even greater sway.
“Medicaid and Medicare reimbursements are tied directly to HCAHPS scores determined from patient-experience surveys,” Zemke says. “Health care providers with low patient-satisfaction scores get less reimbursement. That’s why the health care industry has turned to the hospitality field to find insight.”
For Zemke, who earned a doctorate in hospitality administration from UNLV in 2003, the hospital study was a departure from her typical research. That work had primarily focused on hotel design — specifically, the effects of ambient noise, scents, and hotel cleanliness on guests. But she was convinced to change course after Harrah Hotel College Dean Stowe Shoemaker — a notable researcher in the area of hospitality in health care — urged her to join him on the study, which had been commissioned by a local hospital.
Zemke, Shoemaker, and a small research team (including UNLV psychology professor Noelle Lefforge and Indiana University’s Olena Mazurenko and Nir Menachemi) began the project by surveying patients, employees, custodial staff, administrators, and physicians at the hospital. They then delved into an analysis of relationships among hospital personnel, identifying the most important factors that contributed to positive patient experiences.
Their findings, which appeared in the September/October 2015 issue of Journal of Healthcare Management, suggested that hospitals tend to do well when addressing basic patient needs such as toilet accommodations and meals. Complex issues are more problematic. The researchers found that issues such as scheduling (e.g., too much charting, not enough communication); dysfunctional equipment; a lack of sufficient staffing; and problems during discharge often left patients less than completely contented. In addition, satisfaction scores plummeted when patients and their families witnessed discord among staff. “The more surgeons, nurses, and hospitalists disagree with one another, the more unhappy patients get,” Zemke says.
According to Zemke, good communication is a salve that remedies: “Like any guest in any hotel, patients want to be listened to, and they feel better when they receive accurate, timely information.” Such rapport can be transformative, says Zemke, resulting in decreased patient recovery times, lower infection rates, and improved therapeutic outcomes — positive effects that, for hospitals, result in better HCAHPS scores and increased reimbursements.
After they concluded the study, Zemke and the research team revisited their data, this time with a different research objective in mind. “The notion that the patient is the only customer with specific needs is an oversimplification,” Zemke says.
Instead, they focused on defining a variety of “customer” groups that exist within the hospital setting — including not only patients but physicians, insurance providers, and patients’ family members. These results will be published in an upcoming Journal of Healthcare Management article.
Both studies ultimately challenge the norms of the relationship between patient and health care provider while broadening the definition of customer. “As long as so many choices are available in health care, providers are going to have to take a hard look at all of their customer relationships,” Zemke says.
The work has warmed Zemke to the idea of crossing disciplines for other projects. She recently worked with a UNLV student in the School of Dental Medicine’s orthodontics program to delve into how attention to consumer preference and more effective marketing strategies might improve the bottom line for orthodontic practitioners.