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Nursing Customer Service Initiative

A nurse-driven, investigative approach to improving patient satisfaction scores.

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Since the implementations of the Affordable Care Act, hospitals across the country have started seeing the impact of less than impressive customer satisfaction scores have on their financial bottom line.1

With a renewed focus on excellence in the areas rated, healthcare leaders are focusing on key areas of quality and satisfaction improvement, since even small changes can have an impact.2

Some believe that urban safety-net hospitals and hospitals handling more complex case more frequently possess an inherent disadvantage in the area of customer satisfaction.3

This is even more crucial for safety-net institutions as the reduction of payments comes not only from the value-based-purchasing approach set forth by the Affordable Care Act, but also by the reduction in half to the money set aside to reimburse safety-net hospitals for the disproportionate share of uninsured patients they see.4

The creativity of nurses at such an institution has devised an interactive, investigative training program for emergency department staff.

The Customer Service Initiative (or CSI) is a program devised by ED nurses at Grady Memorial Hospital, an urban, safety-net academic facility in Atlanta that sees in excess of 10,000 patients every month come through the doors of their department.

Investigation Stations

The CSI program at Grady Memorial was devised as a five-station, investigative approach to customer service, complete with caution tape and a body outline of "Mr. Customer Service" who after some time with less than favorable patient satisfaction scores needed to be "revived."

In each station, participants were given broad scenarios and directed to act them out, while course moderators where interjecting with challenges a healthcare provider may encounter. The free form, open discussion format of the course engaged even the more challenging staff members, and provided a fun interactive environment for staff member to share difficult customer service scenario, highlight challenges encounter throughout the department and share solutions or successful approaches to solve these challenges.

Don't Break The Chain. The first station in the investigation focused on proper use of the chain of command when handling customer complaints, employee disputes or interdepartmental challenges. Staff members shared how they solved difficult customer service situations and moderators reinforced proper chain of command and service recovery strategies.

Collecting Evidence. This second station highlighted the importance of non-verbal cues health care provider can collect from patients and their family members. Staff members experienced backboards with cervical spine immobilization to underline the discomfort and emotional stress patients experience when arriving to this busy level one trauma center. Various other scenarios were used to emphasize how patients and family members may not always voice their concerns, but rather give them away through body language and facial expressions. Moderators underscored the importance of staff members being vigilant to the needs of patient and family members and provided guidance with observing and anticipating patient needs.

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Teamwork. In this third station participants were given a less than perfect, somewhat challenging 3D puzzle to solve, with the added stress of being limited by time to complete the puzzle. Moderators gave feedback on the dynamics of each team, the importance of working together within the department and throughout the hospital. The often self-reliant ED staff were also reminded of available resources and inter-departmental collaborative programs.

Case of Communication. The forth station in the course was designed to highlight areas of improvement in communication with the patients and family members. Participants shared past experiences that allowed them to acknowledge the importance of appropriate and often communication with patients and family members, while the moderators presented tools and direction to improve patient communication and stressed the importance of the patient's perception through acted out scenarios.

DNA (Don't Negative Answer). The final station of the course addressed the importance of proper phone etiquette. In a department spreading over the size of a football field, different areas of the department may seem like foreign land to caller from outside and within the hospital. Moderators provided direction and tools in assisting callers to the approximate person or location.

Universal & Adaptable

Attendees were not limited to emergency nursing staff. Participants from all departments caring for ED patients were invited such as radiology, laboratory services, transportation services, environmental services and emergency medicine physicians and midlevel providers. Scenarios and feedback were customized to those in attendance, utilizing scenarios that resonated with participants. Rating of the course and feedback was collected at the end of each session.

The programs was initially offered in various sessions throughout the fourth quarter in 2012 and then again in the fourth quarter in 2013. Following the initial sessions a marked increase in customer satisfaction scores was noted and more so in the areas covered by the course. Following the success and overwhelmingly positive reviews of the course prompted department leaders to extend the course to all new employees and create regular session for emergency department staff and providers alike.

The universality and adaptability of the program enabled a productive interdisciplinary and interdepartmental collaboration. Together with nurses, physicians participated in customizing scenarios to serve the needs of a didactic environment, extending the lessons of good customer service to physicians in training.

To date more than 95% of ED nursing staff and over 50% of the more than 40 attending emergency medicine physicians have participated. Nursing staff responsible for the program has now established an ongoing training program that is specifically designed to highlight challenges physicians and midlevel providers.

This initiative allows an individualized approached to customer service challenges each department and institution faces, based upon a creative and engaging platform. The creativity and dedication of nurses to improve the performance of their department and perfect the care and service they provide to their patients has created a program recognized by departmental and organizational leaders alike, receiving accolades from physicians and executive level leadership.

References for this article can be accessed here.

Daniel Budusan is a staff nurse at Grady Memorial in Atlanta.

Articles Archives

This program sounds very interesting! As part of our new clinical ladder, us nurses must find ways to increase customer service and I think that program is a great way to do it. Is there a way I can bring this program to my hospital?

Stacey ,  RNJune 17, 2014

Even though this article appears to be written for nurses at a hospital, as I read through it I couldn’t help thinking that these exercises in this training program would apply to other employees in the hospital – and even other business not related to the medical industry. Then toward the end it was revealed that other departments and employees were invited to participate, even referred to as “Universal and Adaptable.” These ideas are worthy of consideration of all types of businesses.

Shep HykenJune 08, 2014


Sharonda LonginoMay 31, 2014


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