Taking STEPS to IMPROVE the PATIENT EXPERIENCE

Purpose:
Overall patient perception regarding nursing care and communication on a 25 bed medical-surgical telemetry floor demonstrated <5th percentile. Acceptable goal targeted 35th percentile rank and 75th percentile rank as excellent goal by December 2011 in five dimensions.

Significance:
Patient perspectives are publicly reported allowing comparison with other hospitals, affecting consumer hospital selection, reduced payment for Inpatient Prospective Payment System if hospitals fail to report quality measures and are used to calculate value based incentive payments.

Strategy and Implementation:
Unit based shared governance council reviewed data and approved the quality project. Nurse manager champion, quality/safety council representative and multiple level staff from both shifts formed a quality team engaging and educating unit staff on 7 step quality process, tests of change, timeline and results. Six tests of change were implemented including: 1) admission/discharge folder – daily explanation and utilization 2)white boards – daily explanation and utilization with nurses and Clinical Technician (CT)s name and phone number 3) medication education leaflets explaining side effects and daily plan of care 4) patient rounding with a purpose every two hour by CT and nurse rounding alternate hours, charge nurse shift rounds and nurse manager admission/discharge/service recovery rounds 5) Nurses take 1st set of vital signs enabling prompt CT rounds for call lights, AM/PM care, toileting and 6) CT walking rounds for handoff report.

Evaluation:
Monthly measure review includes: 1) Patient perspective survey scores 2) HCAHPS scores 3)charge nurse audit rounding 4) patient complaints. Results to date show two dimensions exceeding excellence target, two dimensions achieving acceptable score and one dimension below target after four months.

Implications for Practice:
Focusing changes on high priority dimensions markedly impacts patients' perception of communication/care received. Fulfilling the needs the patient states as important are key to affect perceptions. Projects driven by staff in shared governance environment encourages participation to achieve goals.