Improving Care Through a Change of Shift Bundle

Purpose:
Improving patient satisfaction and quality outcomes were strategic priorities at a teaching hospital which is part of a larger health system. Through the development of a bundle that included: A Safety Huddle, Bedside Report, and Patient Goal Setting, a hospital improved their patient satisfaction.

Relevance/Significance:
Improving patient satisfaction and patient outcomes through a huddle that includes: Safety huddle, Standardized Bedside Report, and Patient Goal Setting aligns with the goals of the ANA conference. Center for Medicare and Medicaid Services (CMS) includes HCAHPS as a domain in its Value Based Purchasing with a weight of 30% in FY2013. Since the development of Value Based Purchasing, domains have been added, however patient satisfaction remains a priority and in FY2016 will have a weight of 25%.

Strategy and Implementation:
In order to improve patient satisfaction and the quality of care, this hospital decided to redesign the care delivery system and develop a universal way to care for patients. Each unit at this hospital was implementing different interventions to improve their individual patient satisfaction scores, however this silo approach only furthered the disconnect between the care the nurses were attempting to provide and patient satisfaction. A Care Delivery Team, led by a Clinical Director and supported by the CNO, developed and implemented a bundle called the HEART Bundle which is an acronym that stands for Holistic, Evidence Based, Advocates, Research, Teamwork. The bundle includes: A change of shift safety huddle, standardized bedside report, and mutual goal setting/identification of the patient's main concern. The HEART Bundle was implemented via a PDSA cycle and included clinical nurse involvement and feedback. To date, the bundle has been implemented in every area of nursing.

Evaluation:
Clinical nurses at this hospital have embraced the HEART Bundle. Through the practice change related to the bundle, staff have embraced practices that demonstrate patient centered, quality care. In regards to patient satisfaction, the hospital's overall nursing HCAHPS score has increased from 72.9% to a most recent score of 79.8% which is beating the benchmark and in the 77th percentile ranking.

Implications for Practice:
The HEART Bundle creates a more efficient practice environment for nursing staff and increases patient satisfaction. The HEART Bundle can easily be replicated and adapted at other organizations that are struggling with patient satisfaction evaluating strategies to improve nursing practice.