Previous Gallup analysis has shown that in order to achieve higher patient satisfaction scores, hospital emergency departments (EDs) must focus first on their processes and then on their people.
An examination of Gallup's healthcare patient satisfaction database shows that "best-practice" EDs (those scoring in the 80th percentile of the database) most differentiate themselves from "average" EDs (those scoring in the 50th percentile of the database) on six question items, five of which relate to process and one of which relates to people (see "Best Practices Help Staff Survive in the ER" in Related Items).
These findings raise an interesting question: What role, if any, does the size of the hospital (as defined by the number of beds) play in determining the hospital's success on these six key items? To determine the answer, Gallup divided the hospitals in its database into three size categories (100 to 199 beds, 200 to 399 beds, and 400+ beds), and compared the mean scores for each of the six items that most differentiate best-practice from average EDs.
Results show that EDs in the smallest hospitals (100 to 199 beds) have a clear advantage on each of the six items, scoring above the overall mean score on each. In contrast, the larger hospitals score below the mean score on every item.
It is reasonable to assume that hospital size is linked to ED volume, and that high volume could put a strain on ED services. Therefore, it is not surprising that smaller EDs differentiate themselves most strongly on wait time and speed of service -- process items that are highly influenced by fluctuations in patient volume and staff resources.
However, that doesn't mean more beds necessarily equate to lower ED satisfaction. These data suggest that beyond a certain size the effect disappears. Although hospitals with 100 to 199 beds show the highest mean scores, there is virtually no difference between hospitals with 200 to 399 beds and hospitals with 400+ beds.
How Important Is ED Size?
Given these results, one might conclude that smaller EDs simply have an inherent advantage in achieving high levels of satisfaction, and hence becoming best-practice facilities. Does this mean that EDs in hospitals with more than 200 beds should not be held to the same standards as EDs in hospitals with fewer than 200 beds?
The answer is no. The variance in average patient satisfaction scores between best-practice and average EDs is far greater than the variance between smaller hospitals and larger hospitals. Smaller EDs may have an advantage in achieving high levels of patient satisfaction, but smaller size does not play a paramount role in determining "best-practice" status. Conversely, larger size does not automatically confer "average" status on a hospital. Regardless of size, EDs are most likely to achieve success with efficient operating systems and highly engaged, hardworking employees.