CUSTOMER SATISFACTION IN LABORATORY:

TIME FOR REALITY CHECK

FELIPE S TEMPLO, JR., MD, DPSP ANATOMIC AND CLINICAL PATHOLOGY PHILIPPINE HEART CENTER

CUSTOMER SATISFACTION

I. Objectives

II. Costumer Definition

III. Current Concepts on Consumer Satisfaction

IV. Costumer Satisfaction in Clinical Pathology

• A. Physician as Customer

• B. Nursing as Customer

• C. Test Turn around

• V. Costumer Satisfaction in Anatomic Pathology

I. OBJECTIVES

1. To describe perceived factors affecting customer satisfaction in clinical and anatomic pathology services of the clinical laboratory.

2. To describe practical recommendations in the improvement of customer satisfaction in the service of a clinical laboratory.

II. WHO ARE THE COSTUMERS?

PHYSICIAN CUSTOMER

NURSING

PATIENTS

III. Current Concepts in Customer Satisfaction

Monitoring customer satisfaction is an important and useful quality improvement tool for clinical laboratories, health care organizations and business in general.

A.C. Nielsen: ratings of television and movie media.

J. D. Powers: for new automobile quality.

III. Customer Satisfaction in Clinical Pathology

6 ELEMENTS OF QUALITY

1. Patient’s safety2. Effectiveness3. Patient centredness4. Timeliness5. Efficiency6. Equity

III. Current Concepts in Customer Satisfaction

1.College of American Pathologists (CAP)

The CAP checklist asks whether ‘referring physicians and patients satisfaction with the laboratory service have been measured within the past 2 years’.

2. Joint Commission on Accreditation of Healthcare Organization

The data be collected on the needs, expectations and satisfaction of individual and organizations served.

IV. CUSTOMER SATISFACTION IN CLINICAL PATHOLOGY SERVICE (2007)

A. PHYSICIAN AS CUSTOMER

Q-Probes Study of 375 laboratories of 10,469 surveys.

RESULTS:EXCELLENT

1. Quality/ reliability of test results

2 Staff courtesy

3. Accessibility of laboratory staff

4. Accessibility of pathologist

5. Critical value notification

IV. CUSTOMER SATISFACTION IN CLINICAL PATHOLOGY SERVICE

BELOW AVERAGE/POOR RATINGS

1. Esoteric test turnaround time

2. Outpatient STAT turnaround time

3. Clinical report format

4. Critical value notification

5. In patient STAT turnaround time

OBSERVATIONS

1. Over-all, physicians are satisfied with the services of the clinical laboratory

2. Monitoring performance and having a customer focus , as indirectly measured by participation in customer satisfaction programs, contribute to this level of satisfaction.

RECOMMENDATIONS

1. Monitor critical value notifications as part of performance improvement

2. Evaluate ways to improve turn-around time for esoteric tests.

3. Maintain control of courier services.

4. Adopt a customer service based (‘ high touch’) philosophy.

5. Treat each physician customer as if you were competing with other laboratories for their business.

IV. CONSUMER SATISFACTION IN CLINICAL PATHOLOGY

B. NURSING AS CUSTOMER

RANKING OF CATEGORY

1. Accuracy of results

2. Phlebotomy courtesy toward patients

3. Ability to answer telephone questions

4. Abnormal results notification

5. Laboratory POC support

IV. CUSTOMER SATISFACTION IN CLINICAL PATHOLOGY

6. Phlebotomy courtesy toward nursing

7. Accessibility of laboratory

8. Phlebotomy responsiveness

9. Promptly answered phones

10. Laboratory management

11. Telephone courtesy

12. STAT test TAT

13. Routine test TAT

OBSERVATIONS

1. Laboratories provided the greatest level of satisfaction in the areas of test results, phlebotomy courtesy and notification of abnormal results. Nursing personnel were least satisfied with TAT, laboratory management responsiveness and accessibility and phlebotomy responsiveness.

2. ICU and ED which demand a high level of service from laboratories are the least satisfied with the current level of service

OBSERVATIONS

3. Phlebotomy courtesy received generally high mark, but there was much less satisfaction with phlebotomy responsiveness, suggesting a targeted opportunity for improvement.

4. There was no correlation between satisfactory performance and the rate of complaints per tests performed.

RECOMMENDATIONS:

1.Laboratory management should not rely on the formal complaint process to provide an accurate indication of nursing satisfaction with laboratory services.

2. Laboratories should conduct monthly meeting with nursing representatives with re-assessment of the content and resultant actions of these meetings.

RECOMMENDATIONS

3. Provide customer service training to the laboratory employees to also include raising the level of nursing satisfaction.

4. Work with the nursing staff to establish realistic turnaround time standards and a serious examination of pre-analytic, analytic and post-analytic aspects of TAT, can results in a plan of action to improve service and customer satisfaction.

IV. CUSTOMER SATISFACTION IN CLINICAL PATHOLOGY

C. TURN AROUND TIME (2003)

Problems:

1.Laboratory test emergency department TAT has remained at a greater than 1 hour since at least 1965.

2. Laboratories have difficulty meeting internally set goals for TAT

TURNAROUND TIME

• TAT DEFINITIONS:

1. Order to Draw TAT

2. Draw to Receipt TAT

3. Receipt to Report TAT- laboratory definition

4. Draw to Report TAT

5. Order to Report TAT- clinician definition

TAT goal: percentage of specimen they expected to report within a number of minutes they would allow.

OBSERVATIONS

1. Laboratories have improved their ability to meet internal goals

2. ED physician perceived that laboratory TAT extends ED length of stay always, usually or often.

3. Most common reasons for test delays were linked to collecting and transporting specimen , queuing the tests on an emergency basis and communicating results to the physician

OBSERVATIONS

4. ED physicians believe laboratory TAT delays treatment always, usually or often.

5. There is perceived need that STAT testing is better served in a dedicated laboratory.

RECOMMENDATIONS

1. Focus the quality improvement initiatives on factors that can be controlled.

2. Develop a schematic of all steps in the laboratory total testing process and then to overlay all possible changes that can be implemented in an orderly fashion at each of these steps.

3. Changes must be considered in staffing and personnel scheduling, equipment purchase and use, and work flow pattern and processes within the hospital as well as within the clinical laboratory of these steps.

RECOMMENDATIONS

4. Old habits, practices and protocols must be investigated and reasonable changes must be instituted in the name of improved TAT.

5. Staff members need to substitute the time they are spending internally dealing with their frustrations with working together to find and satisfactorily implement solution

V. CUSTOMER SATISFACTION IN ANATOMIC PATHOLOGY

• A College of American Pathologists Q-probes study of 3065 physician surveys from 94 laboratories (2006)

• RESULTS: Ranking of the Service Category with Excellent/ Good Ratings:

1.Quality of professional interaction

2.Diagnostic accuracy

3.Pathologist responsiveness to problems

4.Pathologist accessibility to frozen section

5.Tumor board presentation

V. CUSTOMER SATISFACTION IN ANATOMIC PATHOLOGY

6. Courtesy of secretarial and technical staff

7. Communication of relevant information

8. Teaching conferences and courses

9. Notification of significant abnormal results

10. Timeliness of reporting

V. CUSTOMER SATISFACTION IN ANATOMIC PATHOLOGY

SERVICE CATEGORY WITH BELOW AVERAGE/ POOR RATINGS

1. Timeliness of reporting

2. Notification of Significant Abnormal results

3. Communication of relevant information

OBSERVATIONS

1. The highest ratings obtained in this survey were critical aspects of pathology practice that are essential to delivering quality patient care.

2. The greatest opportunities for improvement were all shown to relate to communication.

RECOMMENDATIONS

1. Communicate a complete and perhaps expanded information set at the outset and within a truncated timeframe that anticipates return patient visit schedules.

2. Timeliness of reporting should be a divisional goal and specific turnaround time and for specimen types are monitored and shared with staff weekly.

RECOMMENDATIONS

3. Pathology practices may design approaches that cater to subsets of clinicians whose timely and specific content demands are made known by this type of survey tool.

4. Establish policy that clinicians are notified of significant or unexpected results.

SUMMARY

• 1. Customer satisfaction surveys in laboratory are an attempt to enable the voice of the customer to articulate the need for quality improvement in patient care related services.

• 2. Setting goal of achieving customer satisfaction requires knowing what services you provide or for which you have accountability and recognize your current state, that is what level of service you currently deliver compared to benchmark goals.

SUMMARY

• 3. To fulfill the goal of customer satisfaction requires complete and long term commitment to the process of continuous improvement.

A. PLAN APPROPRIATE CHANGES

B. MAKE THESE APPROPRIATE CHANGES

C. GATHER INFORMATION ON THE EFFECT OF THE CHANGES

D. ACT ON THE INFORMATION ABOUT THE CHANGES

E. REPEAT THE SAME 4 STEPS PROCESS OVER AND OVER AGAIN