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Trust in us

Facilities work to boost patient satisfaction scores using relationship-building skills

Monday August 5, 2013
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The trust patients always have placed in their nurses to help them get through the toughest moments in their lives has moved to the front-and-center of hospital culture with recent changes in reimbursement equations to incorporate patient satisfaction. That vital nurse-patient relationship can directly affect a facilityís financial health.

The Centers for Medicare & Medicaid Services has been providing patient satisfaction scores to the public via its Hospital Compare page on the Medicare.gov website since 2008. As part of the Affordable Care Act, the agency began factoring those scores into reimbursement this fiscal year as part of its Hospital Value-Based Purchasing programís Patient Experience of Care Domain (see sidebar). Private insurance companies have followed suit.

The American Nurses Credentialing Center also weighs patient satisfaction heavily when considering facilities for inclusion in its Magnet Recognition Program. In the process of earning Magnet excellence designation, nurses must demonstrate patient satisfaction outcome data from every inpatient and ambulatory setting, choosing four of the following measures: pain, education, courtesy and respect from nurses, careful listening by nurses and response time. Within each measure, outcome data is based on individual questions captured, analyzed and reported by an outside vendor who conducts the patient satisfaction survey and compares the results nationally.

The trend has made the front pages of professional journals. Researchers from Georgia Regents Universityís Department of Family Medicine in Augusta published a study in the July-August issue of Osteopathic Family Physician that stated: "... hospital-level and clinician and group-level Consumer Assessment of Healthcare Providers and Systems surveys would begin to dramatically affect physician reimbursements, potentially change the way we practice medicine to meet guidelines to be consistent with the Patient-Centered Medical Home model, as well as making other important changes based on patient feedback provided in the surveys mentioned previously."

M. Bridget Duffy, MD, became a trailblazer when the Cleveland Clinic named her "chief experience officer" in 2008. The number of senior managers with similar titles and roles has grown, and Duffy now leads roundtables and training for San Francisco-based Vocera Communications Inc., which focuses on quality improvement, patient safety and patient satisfaction.

Inclusion of family

Healthcare facilities throughout the country are instituting more inclusive types of rounding in patient care. At the Charlotte R. Bloomberg Childrenís Center in Baltimore, making the rounds means something different today than it did just a few years ago. Itís no longer just a physician or a nurse going room to room checking each patientís status. The pediatric hospital, part of Johns Hopkins Medicine, offers family-centered rounds, which involve the entire care team, including physicians, nurses and others, meeting with the patients and their family members to discuss concerns and answer questions, said Judith Rohde, RN, ScD, NEA-BC, director of pediatric nursing for the childrenís center.

In the fiscal quarter spanning April to June 2012, the facilityís nursing section placed in the 56th percentile in Press Ganeyís Inpatient Pediatric database. After implementing the family-centered rounds, that score rose to the 94th percentile for the quarter from April to June 2013, according to Rohde. "The nurses section of the Inpatient Pediatric survey usually is one of the highest scoring, and our nurses have really been doing exceptionally well on the survey as of late," she said.

Bloomberg Childrenís Center also offers training to nurses on how to communicate with empathy to build relationships, and has created customer service positions that specialize in handling patient concerns immediately. Advisory groups made up of former patients and family members help establish regular agendas to address concerns and solve any recurring problems, she said.

Transforming culture

At Massachusetts General Hospital in Boston, patient satisfaction tactics have transformed the workplace culture, and building relationships with patients has been the key, said Jeanette Ives Erickson, RN, DNP, FAAN, senior vice president of patient services. There are several dimensions to the relationship-based care model, including the concept of knowing yourself, knowing the patient and knowing the care team. By knowing patients and building those relationships, a culture is created in which patients feel like they are a part of their care, Erickson said.

"When you have that foundation in place, it allows us to implement best practices," said Rick Evans, senior director of service excellence at Massachusetts General. For instance, he said, the facility gives each patient a welcome packet that includes a notebook in which both the patient and the patient-care team can write questions and answers. Being more responsive to the patient is the driver of this kind of practice, he said.

Customer service

The U.S. is in a consumer-driven healthcare economy now, according to Kristin Baird, RN, BSN, MHA, president and CEO of the Baird Group, a nursing consulting firm based in Wisconsin, and a specialist in patient satisfaction. "Healthcare has been slow to get to the party in recognizing that customers are decision-makers," Baird said. In fact, the new reimbursement model has been the motivational tool that prompted much of the industry to take notice. Nurses play a critical role in the tactics and strategies the industry is using to improve and gauge patient satisfaction, she said.

The patient experience is not just about putting tiramisu on the cafeteria menu or offering the right lighting, though those factors do play a part in how patients perceive their care, Baird said. "You may be the most competent nurse with tons of credentials, but if you donít communicate well, if you donít make eye contact, [patients and families] may see past the competency and be mistrustful of you," she said.

Nursing is part science and part art, Baird said. "The art of nursing is about interpersonal skills," she said.

A workplace culture that values excellence, quality of care and compassion for all is essential, Baird said. "Itís about culture and about service, safety and quality," she said.

"But, in an attempt to really hone in on the perfect patient experience, nurses can easily be caught in the middle of a long list of new directives that on the surface could work but may become a burden if not implemented properly — and that may take away from the central nurse-patient bond that should be the focus," Baird said.

Lasting memories

New York City-based journalist Robert C. Samuels, who experienced such inadequate healthcare when he was hospitalized on a ventilator with full paralysis from severe Guillain-Barre syndrome that he decided to publish a book about it in 2011, supports this new model of care. "Blue Water, White Water" describes his months spent in the ICU three decades ago, focusing on the way nurses influenced his days and his nights.

"Their attitudes count for an awful lot," he said. "If a nurse wonít bring you a glass of water or a bed pan, youíre not going to have a good experience, even if the doctors are good."

In fact, nursing care correlates directly to a patientís mental outlook, Samuels said. "I had one nurse who brought me a lobster dinner one night," he said. "It made me feel great. It was just extraordinary." And that moment has stayed with him all these years.

What people remember is an important component of patient satisfaction, Rohde said. "It endures long after people leave," she said. "A lot of patient satisfaction centers around their memories of their stay here, what they remember about their experience." •

Shawn Fink is a freelance writer.


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Value-based purchasing

The Patient Experience of Care Domain in Hospital Value-Based Purchasing is based on the Hospital Consumer Assessment of Healthcare Providers and Systems Survey. Along with about a dozen measures related to clinical processes and prevention of healthcare-associated infections, the survey helps determine a hospitalís Value-Based Purchasing score. Based on their scores, hospitals received as high as a 1% bonus payment from Medicare for fiscal year 2013 or paid as much as a 1% penalty. By fiscal year 2017, that range will increase to 2%. The HCAHPS survey encompasses eight aspects of hospital quality:

* Communication with nurses: Shown as percentage of patients who reported their nurses explained things clearly, listened carefully and treated them with respect.

* Communication with physicians: Shown as percentage of patients who reported their physicians always communicated well.

* Responsiveness of hospital staff: Meaning the patient was helped quickly when he or she needed help in getting to the bathroom or using a bedpan, for example.

* Pain management: Shown as percentage of patients who reported their pain was always well-controlled, meaning hospital staff did everything possible to help.

* Cleanliness and quietness: Shown as percentage of patients who reported the hospital environment was always clean and quiet.

* Communication about medicines: Shown as percentage of patients who reported staff always explained prescriptions, including side effects.

* Discharge information: Shown as percentage of patients who reported they were given information about what to do during their recovery at home.

* Overall rating of hospital: Shown as percentage of patients whose overall rating of the hospital was Ď9í or Ď10í on a scale from 0 (low) to 10 (high).

Source: Centers for Medicare & Medicaid Services