It's no surprise that hospitals with high morale would have happier patients. But a new study reveals exactly how some hospitals create a positive place that patients appreciate.

  • Step One: Reward employees with cash and boost morale.
  • Step Two: Give the patient the home phone number for the hospital's CEO.

That's exactly the type of culture and service that delights patients and makes for the most successful community hospitals in the United States, as rated by caregivers and patients, according to John Griffith, professor in the University of Michigan School of Public Health.

In his new report, detailed in the Journal of Healthcare Management, Griffith examined the attributes of 34 community hospitals in nine states that have earned the Health Care Sector Malcolm Baldrige National Quality Award, a nationally recognized quality benchmark for various industries.

Griffith's findings suggest that the single-biggest factor in patient satisfaction is hospital employee morale, which starts with outside-the-box thinking at the very top management levels.

These community hospitals had the happiest patients and caregivers, but only because these hospitals departed radically from traditional hospital management, Griffith said.

For instance, at the Florida hospital where patients receive a welcome letter with the CEO's signature and home phone number, they're also paid a visit by their unit's nurse manager, who also leaves cell and office phone numbers.

This personal service doesn't come cheaply, yet the hospitals kept costs low enough to thrive financially on standard Medicare and insurance payments, despite paying employees "extremely well," Griffith said.

"They reward a good job, both with celebration and financially with cash," he said. "One of the interesting things about these places is they don't have any nursing shortages. They have enough nurses, well-trained nurses and well-motivated nurses."

Griffith's report finds that the 34 hospitals emphasized a broadly communicated mission, a supportive learning culture, universal measurement and benchmarking, and systematic process improvement. Traditionally, hospitals emphasize static domains of authority and don't formally measure performance, goal setting or continuous improvement, the study concludes.

The shift in management thinking has astonishing results in worker and patient satisfaction, Griffith said.

"The key issue for the patient is the answer to two questions, 'Will you return and will you refer?'" he said. "A loyal patient will do both. These places got that in 90 percent of patients. The usual answer is a little better than half."