Marie Elivert, RN, remembers reading with dismay the feedback from a patient who reported an unsatisfactory stay at the hospital. After all, meeting or even exceeding patients' expectations is a vital part of the patient-centered care Queens Hospital Center strives for.
Elivert thought this could be a teachable moment and invited the patient to come in and speak to the staff directly. The woman even agreed to come in at 7:30 a.m. so she could address representatives from both the day and night shifts. She had a lot to say.
The phlebotomist had come into the room to take her blood and did not explain what he was doing. When the patient told a nurse that she wasn't feeling well, the nurse gave her a vague explanation that the patient did not understand. Later, the patient overheard two nurse aides standing just outside her hospital room door loudly discussing plans for what they were going to do that evening after work.
"It was humbling," Elivert, who is Senior Associate Executive Director for Patient Care Services, said of the patient's testimony. "But it helped the staff to see themselves the way the patient sees them, and that motivates them to improve."
In November 2011, the 40-bed medical-surgical unit had a low patient satisfaction ranking for nurse-patient communication – at a level which would negatively influence the hospital's overall rating. Under the Centers for Medicare and Medicaid Services (CMS) value-based purchasing program, hospitals with a national ranking below the 50th percentile suffer a financial penalty. But more importantly for Elivert, the team at Queens Hospital recognized that they had to do a lot more to demonstrate the respect and compassion they all share toward patients.
Using Breakthrough, HHC's process improvement methodology, the med-surg team identified causes of their low patient satisfaction scores and created a plan for change that could be quickly implemented and sustained. Elivert said that health industry data including that provided by Press Ganey, the national consulting firm that administers the Hospital consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores at HHC, indicate that a key driver in patient satisfaction scores is nurse communications.
"You may see the doctor or other healthcare professionals once or twice a day. You see the nurse throughout the day. You have more interaction with the nurse, so that has a higher impact on the patient's perception of care," Elivert said.
Today, within a short time of being admitted to this unit at Queens Hospital Center, patients can expect a visit from their nurse and doctor. Together, they will introduce themselves, explain why the patient has been admitted, discuss the plan of care, go over the medication regimen and make sure to answer any questions the patient has.
Later, as the nurse shift changes, the same patient can expect yet another team to visit. This time, it's the nurse coming on duty and the nurse going off duty. They will go on rounds together, visiting each of about six patients assigned to them. And following the same script, they too will introduce themselves, review why the patient is in the hospital, go over the plan of care, and answer any questions the patient may have.
By introducing these and other changes that focus on improving nurse-patient communications, the medical surgical unit has dramatically improved its patient satisfaction rank in this category to the 82nd percentile amongst New York state peers. Among HHC hospitals, the Queens Hospital med-surg unit has a 99th percentile ranking.
"It's about nurses and doctors working together to improve communication with the patient to provide high-quality care," said Julius Wool, Executive Director of Queens Hospital. "That's the foundation of high-quality, patient-centered care. This med-surg unit has provided a model that we can roll out in other areas of the hospital to help improve the patient experience and patient outcomes."
The staff reviews the patient satisfaction surveys monthly and continues to make adjustments to improve patient care and satisfaction. Although the process has been rolled out to five more med-surg units, Elivert said the work is never done.
"We need to enhance the way we work, the way we coordinate and the way we communicate with our patients so they can work with us and trust us. A patient who learns from us is going to be able to take care of themselves, stay out of the hospital and enjoy a much better health outcome."