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The Fear Factor and Patient Satisfaction

by Rick Blizzard, D.B.A.
Healthcare Editor

Few events in life are more potentially stressful than a hospital stay. Admission to a hospital generally indicates a major health event in a person's life -- surgery to correct a problem, or a medical condition requiring intensive treatment. Most patients fear either the treatment itself or the medical outcome. Even seemingly positive events such as childbirth can be laden with fear. In this highly emotional environment, one key to success is the ability of the staff to effectively calm patient fears.

That ability on the part of nurses is a core measure in Gallup's patient satisfaction and loyalty database. Not surprisingly, this measure has a high correlation (.61) with inpatient satisfaction, meaning that patients who give high scores on this item tend to be much more likely than other patients to be satisfied overall with their inpatient experiences.

Average ratings of nurses' ability to calm patients' fears are high compared to other measures that involve communication, but they lag behind overall inpatient satisfaction, and should therefore remain a high priority for improvement. Between 2000 and 2001, this item declined among the hospitals in Gallup's database more significantly than overall inpatient satisfaction. Additionally, the "nurses calming patients' fears" item scores lower than the item asking about nurses' ability to "make the patient feel safe and secure." This would indicate nurses are doing a better job of dealing with patients' physical concerns than their emotional concerns.

The Risk of Complacency

Often, examining mean satisfaction scores for a survey item such as this one, for which the average score is higher than that for most other items, can mask opportunities for improvement and lead to complacency. Managers may view the positive relative performance on the item as a success and therefore shift attention to other issues. But ignoring an area of strength risks its erosion. Instead, workgroups should be encouraged to continually build upon the strong points identified in the survey.

Another way of looking at patient satisfaction scores is to examine "top box" performance -- the percentage of respondents who give a score of 4 ("very satisfied") on a scale of 1 to 4. This distinction is critical to successful improvement: Gallup research indicates that more than 80% of very satisfied patients (those giving a score of 4) say they would definitely return to a hospital, while less than 50% of patients who are merely "satisfied" (those giving a score of 3) report they would definitely return. Hospital performance at these two levels is clearly different; therefore examining them separately provides a true measure of performance and helps avoid complacency.

Examination of top box responses shows that only 48% of inpatients are very satisfied with the ability of nurses to calm their fears. This indicates significant potential for performance improvement on this item. By comparison, 59% of patients are very satisfied with the inpatient experience overall.

How Can Hospitals Improve?

Nurses tend to score highly on measures of empathy, care, and compassion. The barrier to improvement on the "easing fears" item may often be not so much a lack of talent, as a lack of experience in dealing with complex emotional issues. Here is some specific advice about what hospitals can do to help nurses improve at calming their patients' fears.

  • Encourage nurses to be sensitive to the level of fear their patients experience when they're admitted to the hospital. Empathy and communication are key. If a nurse can't get a good read on the degree of fear a patient is experiencing, the solution is simple -- they should ask the patient and/or a family member.
  • Set nurses up for success through training and support. In many instances, it is easy to deal with safety concerns by providing detailed protocols, policies, and procedures. Fear is a more abstract concept and more difficult to deal with. How do you relate to a patient's chronic, incurable medical condition, a cancer patient's fear of death, or the fear of impotence or incontinence in a prostate patient? Not all nurses have been trained to deal with these issues. Social workers and pastoral care workers can assist by providing training for nursing staff, and can also be called to step in when nurses identify difficult patient fears.

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