“How are you doing?,” “Paper or plastic?,” “How was everything?”

We’ve come to expect questions such as these in specific situations, and when we hear them, they tend to stimulate an automatic, if not somewhat mechanical, response within us. In these situations, many of us are unknowingly following our own unwritten scripts.

As creatures of habit, we human beings have incorporated these unwritten scripts into almost every aspect of our lives. Scripts help us create a predictable experience and guide us in unfamiliar or uncomfortable situations.

In the same way, scripting can be very useful in healthcare as a tactic to create predictably positive patient experiences. Because, even though humans are creatures of habit, providing a consistent level of great service is often the biggest obstacle in creating a culture of service excellence.

Build Consistency
“Initially, I was opposed to the concept of scripting,” says Carol Hill, BSN, manager of a medical/surgical unit at Scripps Memorial Hospital in Encinitas, California.

“When it was first proposed throughout the hospital as the right thing to do for better service, I was skeptical. It seemed forced and unnatural.”

However, as Hill reflected on her unit’s patient satisfaction scores, she could see the need for greater consistency in the staffs’ approach to patients.

“It hit me like a lightning bolt. Scripting is the key to consistency!” Hill says.

Given the size and cultural diversity of her staff, scripting made the most sense in building greater consistency in staff interactions with patients.

No one will argue that clinical pathways have helped to create systems and processes for predictable clinical outcomes. Scripting, like a pathway, is a tool to help create a more consistent experience for patients. And, once engrained as a habit for staff, scripting can actually make their jobs easier.

Link to Goals
No matter the size of the organization or where customer service encounters take place, scripting is most successful when it’s used to link all the elements in a culture of service excellence. And, really, what about the concept of scripting is bad for your patients?

For example, clinical managers might use scripting during rounding. Staff can explain to patients and their family members, “We’ve been working on reducing noise on patient floors. Have you had any experiences with noise that you’d like to tell us about?” This script accomplishes a double mission. Not only are you using the language that the patient will see on a future satisfaction survey, but you are creating an opportunity for on-the-spot service recovery for an issue that you already know is an area of concentration.

Use Key Words that Reflect Survey Questions
“We use key words at key times to convey concern, privacy, or emotional support,” says Darv Andersen of the University of Utah Medical Group (UUMG). “Phrases such as ‘I’m closing the curtain for your privacy’ or ‘I have the time’ have worked to convey to patients that we care.”

One of scripting’s advantages is its abilities to strengthen teamwork among caregivers. Telling a patient, “Dr. Jones wanted me to review your medications one more time before you leave,” also reinforces to the patient that all members of the care team are working together to provide seamless care.

And, as Hill discovered at Scripps Encinitas, scripting is the powerful glue to providing a consistent experience for every patient.

“Scripting the initial contact with our patients compels staff members to make eye contact and greet the patient as a person first, and that’s so important.” Hill reminds us.

In addition to the initial patient contact, Hill’s unit scripted other encounters that showed the greatest likelihood to make a difference in patient satisfaction survey scores.

“We took the language right from the patient satisfaction surveys and scripted situations accordingly,” Hill explains. “I, along with the rest of my staff, was amazed to see the immediate and undeniable improvement in satisfaction scores after we had started scripting. And we’ve been able to sustain that improvement through continued scripting.”

Use a Grassroots Approach to Build Ownership
While Hill admits to being skeptical of scripting’s potential when it was first introduced at her organization, she and her staff were among the scripting pioneers at Scripps Encinitas.

“I have some incredibly engaged nurses on my patient satisfaction committee,” says Hill. “They took over the scripting project and made it their own. That was a real key to success.”

According to Andersen, some employees at UUMG were reluctant to follow “exact” scripting.

“After adopting scripting, they’ll tweak the scripts so that they’re still using the key words, but the script doesn’t feel as impersonal to them.”

To introduce the concept of scripting, Hill’s committee created a scripting presentation that they required every staff member to view. When Hill encountered some initial resistance from staff members, she simply encouraged them to try scripting once.

“It’s just the right thing to do,” she says. “There’s nothing wrong with patients all getting the same message.”

Hill’s patient satisfaction committee has continued its commitment to scripting by using different posters and visual aids on the unit. They also talk about it at every meeting and tie it back to patient satisfaction surveys.

“To engage the interest of the staff, it has to be their process,” Hill says. “They need to understand why it’s effective, and our survey scores were a great illustration of how scripting promotes a more predictably positive patient experience.”

After having success on their unit, Hill’s staff was asked to help mentor other units on their approach to scripting. Now patients are seeing the same consistency, not only among members of one unit, but throughout the whole organization.

Andersen has seen the same result at UUMG.

“Our satisfaction scores on many units and clinics have improved significantly, and our mean scores on surveys are generally trending upward over time. It takes consistency for many months, and even years, to change culture.”

Leadership Ensures Success
“The key to making scripting successful,” says Hill, “is to have a leader who believes in it with staff who are empowered to make the scripts their own.”

Once all the pieces fell into place for Hill’s unit, scripting became another one of those habits that we humans are accustomed to.