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Service Delivery Innovation Profile

Active Solicitation of Patient Feedback and Engagement of Employees in Customer Service Significantly Increases Patient Satisfaction

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Poudre Valley Health System actively solicits and gathers actionable information from patients and families through various mechanisms, and then uses this information to develop patient-centered initiatives to improve customer service. A separate set of initiatives engages employees in customer service, including standards related to behaviors, training, and awards recognizing outstanding service. These programs have led to an 11-percentage point increase in patient satisfaction and to the system's hospitals being placed in the top 10 percent nationally on the Hospital Consumer Assessment of Healthcare Providers Survey (more commonly known as HCAHPS) on measures relating to overall hospital quality and willingness to recommend the organization.

Evidence Rating (What is this?)

Moderate: The evidence consists of pre- and post-implementation comparisons of patient satisfaction scores, along with post-implementation HCAHPS scores for two Poudre Valley Health System hospitals.
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Developing Organizations

Poudre Valley Health System
Fort Collins, COend do

Date First Implemented


Problem Addressed

Patient-centered care and service leads to improved patient outcomes and has been touted as a focus at most hospitals. Yet, many hospitals do not have programs that formally incorporate the patient or employee perspective on needed care delivery improvements, operational decisions, or strategic planning.
  • Relationship between customer focus and better outcomes: A wide body of research suggests that the patient care experience affects satisfaction and outcomes.1 For example, one study found that, compared with usual care, patient-centered care management for oncology patients resulted in a 39-percent reduction in hospital admissions, a 36-percent reduction in hospital days, a 30-percent decline in emergency department (ED) visits, and to fewer inpatient diagnoses suggestive of uncoordinated care, such as nausea (44 percent fewer cases), anemia (33 percent), and dehydration (17 percent); the same study found that patient-centered care management for these patients resulted in higher satisfaction among 92 percent of patients.2
  • Failure to engage patients and families: Giving patients and family members a meaningful role in health care delivery and incorporating patient and family perspectives is critical to improving care processes. Unfortunately, many institutions seek feedback from patients and families in a limited way, with no formal, sustained patient engagement programs.3 Similarly, many organizations do not have formal programs to engage and focus employees on excellent customer service.

What They Did

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Description of the Innovative Activity

Poudre Valley Health System actively solicits and gathers actionable information from patients and families through various mechanisms and then uses this information to develop patient-centered initiatives to improve customer service. A separate set of initiatives engages employees in customer service, including standards related to behaviors, training, and awards recognizing outstanding service. Key elements of these programs are described below:
  • Voice of the Customer framework to guide effort: Poudre Valley embraces the Voice of the Customer framework for developing active processes and initiatives to capture customer-related information and feedback.4 This framework, one of the Baldrige National Quality Program's Criteria for Performance Excellence, specifies that organizations should develop specific methods to actively solicit and gather actionable information from present and past customers, address customer complaints, measure customer satisfaction and engagement, and analyze and use customer data. The health system has defined high quality and prompt and friendly service as key requirements for all patient-focused initiatives.
  • Organizational structures to elicit and respond to customer feedback: The health system has several formal organizational groups that receive and address customer feedback, including the following:
    • Customer Service Steering Committee: This multidisciplinary committee, chaired by a chief nursing officer, includes representatives from all areas of the health system, including (but not limited to) volunteers, physicians, nurses, and senior managers. The committee meets monthly to review customer feedback data and design and oversee customer service initiatives. Unless initiatives have a major budgetary impact, the committee can launch them immediately without approaching senior health system leadership for approval. The decisionmaking autonomy of this group stems from a document called a "Team Purpose" that is completed and reviewed every year. The Team Purpose specifies what the team should accomplish in the meetings, how they support the strategy of the organization, parameters for the types of initiatives they can create, their measures of success and deliverables, who leads the team, who serves on the team, and to whom the team reports.
    • Patient and family advisory council: A 14-member patient and family advisory council meets monthly, with meetings moderated by a health system nurse. Interested community members must apply for a position on the council and go through an interview process that evaluates their commitment and the potential value of their contribution. The council manages various initiatives to enhance patient-centered care and patient engagement in care; examples include rewriting the health system's patient handbook to better meet the needs of patients/families and translating patient education materials to consumer-friendly language. Individual council members may also participate on specific health system committees (e.g., the Customer Service Steering Committee).
    • Patient/family focus groups: Poudre Valley holds focus groups with patients and family members on an ad hoc basis to obtain feedback on specific issues or initiatives. For example, as the health system prepared to build a new medical center, it held different focus groups related to furniture selection, spiritual care, wayfinding, department naming, and food selection/cafeteria services.
  • Other formal mechanisms to collect patient feedback: The organization has developed other formal mechanisms to collect patient feedback, including the following:
    • Patient satisfaction survey: The health system mails a satisfaction survey to a random sample of recently discharged patients every other week. Although survey questions are standardized, different surveys can be used to reflect the types of services an individual patient received. For example, a trauma patient entering through the ED will receive a survey that reflects ED services, intensive care unit services, unit floor services, and physical therapy. In 2009, Poudre Valley Hospital received 10,400 completed surveys yielding 370,000 distinct data points, and Medical Center of the Rockies received 4,300 surveys with 153,700 distinct data points. To stimulate improvement, survey results are shared with hospital employees through the health system's intranet, department meetings, and employee forums.
    • Volunteer liaisons: A subset of trained health system volunteers serve as patient liaisons by rounding on units daily to ask patients for feedback. Volunteers document all feedback on forms submitted to the risk management department for inclusion in the comment management database (see below). If a patient expresses a need or concern that requires immediate attention, the volunteer contacts the charge nurse or department supervisor.
    • GetWellNetwork™: The GetWellNetwork™ is an interactive system that patients can access on the television in their room using a wireless keyboard. At admission, patient information entered into the registration system flows into the GetWellNetwork™. When the patient turns on the television, he/she views a personalized welcome message and a menu of options for learning about patient safety initiatives, providing feedback, and making requests (e.g., room temperature change, food requests, care needs, a visit from a hospital administrator). A volunteer liaison teaches patients how to use the network.
  • Aggregation of feedback for analysis: All feedback (including patient satisfaction survey data, volunteer liaison reports, and GetWellNetwork™ feedback) is either automatically or manually entered into a comment management database run by the risk management department. The database sorts comments into recurrent themes and allows department staff to analyze trends. The Customer Service Steering Committee uses this information to inform the development of initiatives designed to improve customer service (see next bullet).
  • Creation of customer service initiatives: All of the customer feedback highlighted above lead to the creation of various initiatives to improve customer service. In fact, since 2002, Poudre Valley has implemented a wide variety of such initiatives, including (but not limited to) a service recovery program called "Splash of Sunshine" that allows employees to provide $5 cafeteria coupons to patients and families experiencing suboptimal customer service (e.g., an unavoidable delay in care); a new patient/family parking program; a concierge service to assist patients and families with transportation, lodging, and other requested services; signage improvements; new cafe options; and a thank you note program for patients, physicians, and volunteers.
  • Concurrent initiatives to engage staff in customer service: The health system has several formal and informal programs that help staff retain their focus on customer service. These include (but are not limited to) the following:
    • Standards for employee behavior: The health system developed standards related to staff behavior that focus on the provision of patient care, attitude, safety, professional appearance, communication, and respect for health system colleagues. Regular performance evaluations and reviews include discussion of an employee's adherence to these standards.
    • "Every Person Every Time": All health system employees participate in this 75-minute system-wide training, which highlights the importance of employee interactions with patients and families. New employees participate as part of their orientation program.
    • Thank you notes: Supervisors routinely write thank you notes to employees who go "above and beyond" providing excellent customer service.
    • Penguin Award: The Penguin Award recognizes departments that achieve excellence in patient satisfaction. The award, which consists of a trophy with three penguins (the system's mascot for customer satisfaction), goes to the unit that demonstrates the most improvement on scores from the previous month's patient satisfaction survey and to units where 90 percent or more of respondents give the unit the highest possible rating.

Context of the Innovation

Poudre Valley Health System, a private not-for-profit health care system serving residents of Colorado, Nebraska, and Wyoming, includes two acute care hospitals (a 241-bed Poudre Valley Hospital and a 112-bed Medical Center of the Rockies) and a network of additional facilities. In 2009, Poudre Valley Hospital had more than 18,000 discharges, while Medical Center of the Rockies, which opened in 2007, handled more than 6,800 discharges. Poudre Valley Health System received a 2008 Malcolm Baldrige National Quality Award.

In the mid-1990s, based on requests from patients and families, the health system adopted family-centered care activities in the newborn intensive care and neurological intensive care units, thereby integrating families into the decisionmaking process and seeking their feedback in an attempt to better meet their needs. The value of this feedback encouraged the organization to develop more formal and widespread methods for engaging patients in care.

Did It Work?

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The programs have led to an 11-percentage point increase in patient satisfaction and to the system's hospitals being placed in the top 10 percent nationally on Hospital Consumer Assessment of Healthcare Providers Survey (HCAHPS) measures relating to overall hospital quality and willingness to recommend the organization.
  • Higher patient satisfaction: Survey responses include five boxes rated 1 through 5, with 5 reflecting the best possible rating; the health system measures patient satisfaction performance as the percent of respondents giving a "5" rating across all questions. This percentage increased from 72 percent in 2002 to 83 percent in 2009.
  • Top-decile performance: In 2009, both Poudre Valley Hospital and Medical Center of the Rockies ranked in the top 10 percent of HCAHPS-surveyed hospitals nationally with regard to satisfaction with overall hospital quality and willingness to recommend friends and family to the organization.

Evidence Rating (What is this?)

Moderate: The evidence consists of pre- and post-implementation comparisons of patient satisfaction scores, along with post-implementation HCAHPS scores for two Poudre Valley Health System hospitals.

How They Did It

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Planning and Development Process

While planning and development steps vary according to the particular initiatives implemented, the general process for setting up this program included the following:
  • Starting with general patient focus groups: Poudre Valley held formal, unit-specific focus groups to obtain patient feedback. The groups included a random selection of discharged patients asked to provide in-depth feedback about their experience and suggestions for improvements. Groups were held monthly for several years; however, eventually they did not yield much new information, and the organization began looking for new strategies to obtain more detailed and useful patient feedback.
  • Progressing to focus groups for specific initiatives: The organization transitioned the general focus group format into community focus groups targeted at specific topics.
  • Instituting patient and family advisory council: Poudre Valley solicited interest for participation in an ongoing patient and family advisory council via mailings to recently discharged patients and advertisements in different health system market areas.
  • Developing system-wide committee: System leaders created the Customer Service Steering Committee to review consumer feedback and develop specific initiatives based on that feedback.
  • Creating comment management database: The Customer Service Steering Committee worked with the risk management department and information technology personnel to design the comment management database so that feedback from all sources could be aggregated and trended, thereby informing decisions regarding new initiatives.

Resources Used and Skills Needed

  • Staffing: The program requires no new staff; initiatives are typically integrated into the everyday responsibilities of existing staff.
  • Costs: Data on program costs are unavailable but consist of largely minor expenses associated with implementing specific improvement initiatives.
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Funding Sources

Poudre Valley Health System
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Tools and Other Resources

More information about the Baldrige National Quality Program can be found at

The Baldrige National Quality Program Criteria for Performance Excellence is available at

Adoption Considerations

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Getting Started with This Innovation

  • Include customer service leaders on system board: Chief nursing officers, who have responsibility for customer-focused initiatives, sit on the Poudre Valley Health System Board Quality Committee, thus ensuring that customer service remains top-of-mind for board members and is included as a critical component of all system-wide initiatives and strategic plans.
  • Give centralized customer service committee autonomy to implement initiatives: Designate a central committee to focus on customer service, and then give that committee sufficient autonomy so that members can move forward with certain initiatives (e.g., those without major budgetary implications) without requiring senior leadership approval. Including some senior managers on the committee will generally be sufficient to allow the committee to have this autonomy. For example, at Poudre Valley Health System, the Customer Service Steering Committee includes several senior managers and is led by a senior manager. This composition allows for some decisionmaking autonomy and ensures the team's decisions support the strategic plan of the organization.
  • Make customer service a major strategic initiative: Many organizations embed customer service in a variety of quality and safety mission statements, principles, and initiatives. However, making top-notch customer service a distinct goal will ensure that the organization develops initiatives specifically geared toward achieving that goal.
  • Develop small initiatives rather than seeking "silver bullet": No single initiative will prompt a significant improvement in customer satisfaction; instead, many small initiatives developed over time can eventually have a huge collective impact at relatively minimal cost.

Sustaining This Innovation

  • Focus on staff engagement as well: Because improvements in customer-focused outcomes cannot occur without staff engagement, develop initiatives geared toward staff satisfaction (e.g., employee forums, thank you note programs, educational sessions) concurrently with customer-focused initiatives.
  • Link initiatives to data: Develop initiatives based on actual feedback received from consumers, thus ensuring that initiatives directly respond to patient and family needs.
  • Continually share data, celebrate and recognize success: Sharing results data, celebrating successes, and recognizing employees with a strong service orientation can keep staff engaged in customer service initiatives.

More Information

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Contact the Innovator

Priscilla J. Nuwash, MBA, CLM
President, Center for Performance Excellence
Poudre Valley Health System
2315 East Harmony Road
Suite 200
Fort Collins, CO 80528

Innovator Disclosures

Ms. Nuwash has not indicated whether she has financial interests or business/professional affiliations relevant to the work described in this profile.

References/Related Articles

U.S. Department of Commerce National Institute of Standards and Technology. Baldrige National Quality Program. 2008 Award Recipients. Poudre Valley Health System. Available at:


1 Institute for Patient- and Family-Centered Care. Available at:
2 Sweeney L, Halpert A, Waranoff J. Patient-centered management of complex patients can reduce costs without shortening life. Am J Manag Care. 2007;13(2):84-92. [PubMed]
3 Johnson B, Abraham M, Conway J, et al. Partnering with Patients and Families to Design a Patient- and Family-Centered Health Care System. Institute for Family-Centered Care. June 2006. Available at: (If you don't have the software to open this PDF, download free Adobe Acrobat ReaderĀ® software External Web Site Policy.)
4 Baldrige National Quality Program. 2011-2012 Criteria for Performance Excellence. National Institute of Standards and Technology, Gaithersburg, MD. Available at:
Comment on this Innovation

Disclaimer: The inclusion of an innovation in the Innovations Exchange does not constitute or imply an endorsement by the U.S. Department of Health and Human Services, the Agency for Healthcare Research and Quality, or Westat of the innovation or of the submitter or developer of the innovation. Read more.

Original publication: December 08, 2010.
Original publication indicates the date the profile was first posted to the Innovations Exchange.

Last updated: June 04, 2014.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.

Date verified by innovator: November 09, 2011.
Date verified by innovator indicates the most recent date the innovator provided feedback during the annual review process. The innovator is invited to review, update, and verify the profile annually.

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