Improving the Patient Experience: Responsiveness and Nursing Communication

Purpose:
Issue: Need to increase HCAHPS patient satisfaction survey scores. Goal: Attain sustained increases in Responsiveness and Nurse Communication HCAHPS scores to levels that exceed the comparative national mean.

Significance:
The literature shows positive associations between patient satisfaction and clinical outcomes. Additionally, public reporting of HCAHPS scores and their inclusion in the calculation of value-based incentive payments make these scores a key element of maintaining a hospital's financial health.

Strategy and Implementation:
Site: 28 bed progressive care unit in 600+ bed urban academic medical center. Time frame: 1/2013 through present. Patient/RN perceptions of current state were assessed through surveys and interviews. Using TCAB methodology (snorkeling, prioritizing, PDSA, rapid-cycle testing and evaluating, adopting), intervention was identified, refined, and implemented. RN and NA responsibilities and workflow processes were adjusted to optimize patients' perceptions of call bell, bathroom help, and overall response time. Specific changes included NA responsible for answering all call bells, focused rounding, and ADLs. RNs assumed responsibility for all vital signs, accucheks, Is/Os, and initiating turning. Same TCAB methodology was also used to develop scripting, or communication cues, to be used to guide RNs in essential communication processes with patients to optimize patients' perceptions of nurses communicating respectfully, listening attentively and explaining care thoroughly.

Evaluation:
Responsiveness(Overall,Call Bell,Bathroom Help respectively) Pre/Post: % Always:53/67, 57/83, 60/60; % Always Trendline: 56/60, 63/67, 58/59. Communication with RNs(Overall,Respect,Listen respectively) Pre/Post: % Always: 75/81, 88/100, 75/75; % Always Trendline: 77/82, 87/97, 81/88.

Implications for Practice:
TCAB methodology and techniques are effective tools for the rapid identification of patient/RN perception gaps and the implementation and evaluation of HCAHPS improvement interventions at the nursing unit level.