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Why All the Fuss About Improving the Patient Experience?

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By Debra Wood, RN, contributor

June 10, 2014 -  Although some evidence exists demonstrating a connection between patient experience and patient safety and clinical effectiveness outcomes, the field remains relatively new with many opportunities for nurses.

Maggie Rafferty: Patient experience is an important outcome.
Maggie Rafferty, DHA, RN, considers patient experience an outcome to be looked at in addition to clinical metrics.

“Nurses are pivotal to the patient experience,” said Maggie Rafferty, DHA, RN, chief experience officer for Dignity Health’s St. Rose Dominican Hospitals in Las Vegas, Nev., who is responsible for processes, excellence in care delivery and making improvements.

“Nurses have wonderful opportunities to have an impact, but we sometimes do not appreciate the influence we can have,” added Mary Beth Modic, DNP, RN, CDE, a clinical nurse specialist in diabetes at the Cleveland Clinic and lead author of one of the articles in the inaugural issue of the Journal of Patient Experience.

What is meant by “the patient experience”? 

A 2013 study involving 672 organizations from The Beryl Institute in Bedford, Texas, reported that patient experience was a top priority among hospital leaders--yet only 27 percent of responding organizations had a formal definition for it.

Christina Dempsey: Patient satisfaction beings with a human connection.
Christina Dempsey, RN, MSN, MBA, suggested nurses learn to connect with their patients on a human level.

Christina Dempsey, RN, MSN, MBA, chief nursing officer at Press Ganey, defined the patient experience as the totality of the clinical, operational, cultural and behavioral care provided.

Dempsey reported evidence exists linking patient experience with clinical outcomes, including a systematic review published in BMJ Open in 2013, which found a positive association between patient experience and clinical effectiveness and patient safety. And a 2014 study in the Annals of Surgery found higher patient satisfaction scores were associated with higher surgical quality.

The new Journal of Patient Experience addresses the need for peer-reviewed evidence about what works to improve the patient experience as more organizations place additional effort on boosting their scores on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey the Centers for Medicare & Medicaid Services is using to assess patient perceptions in its Hospital Value-based Purchasing program.

“The government has done us a favor in the sense that they lit the fire around holding clinicians accountable, for not just clinical and quality metrics but also experience metrics,” said Adrienne Boissy, MD, MA, director of the Center for Excellence in Healthcare Communication, staff neurologist at Cleveland Clinic in Ohio and editor-in-chief of the Journal of Patient Experience. “For those of us in caregiving, it gives us added reason to do what we already do.”

While the government initiative has generated much emphasis in the topic, Rafferty said that patients are the true drivers of improvement.

“We are serving a patient population that is consistently more involved in their care, better educated and have expectations of exceptional service from other industries,” Rafferty said.

Boissy wants to drive more creativity in the field through ideas generated by the journal’s authors; he also wants to publish reflections from care professionals on the front line.

Modic and colleagues examined perceptions of caring behaviors and discovered nurses reported providing caring behaviors more often than patients reported receiving them, particularly when it came to patient education.

“Patients think we are having a conversation,” said Modic, who suggested framing educational moments by telling the patient the nurse is going to provide information important to their health before beginning the teaching.

Improving the bedside experience 

Making a connection with patients improves their perceptions, Dempsey said. Years ago, nurses learned how to truly get to know their patients while in school, giving back rubs and head-to-toe assessments. Today’s focus is much more task-oriented, often learned on a simulator, creating a need to instill the basics.

Focus on what is right for the patient, how to reduce their complications and make them more successful in managing their conditions, Dempsey advised.

“Explaining it that way, rather than trying to achieve a score or make a dollar reminds us how we got into this in the first place,” Dempsey said.

Rafferty also recommended nurses engage with their patients, learn about their fears and anxieties, and individualize the care. Sometimes, that may mean going beyond the basics, for instance, to arrange for a pet sitter for a patient more focused on his cats than his health.

While nurses are encouraged to do all they can to genuinely connect and assist patients in their areas of greatest need, experts understand that patient satisfaction is often a matter of perception.

Linda Plank: Evidence should drive patient experience efforts.
Linda Plank, PhD, RN, reported the evidence behind getting good results on patient experience surveys shows where staff can improve their practice accordingly.

Linda Plank, PhD, RN, associate dean for academic affairs at Baylor University’s Louise Herrington School of Nursing in Dallas, reported that various studies have shown what behaviors can help increase patient satisfaction scores. For instance, Plank explained that saying the word “excellent” will plant the thought in the patient’s mind and often will lead to a mark of excellent on a satisfaction survey. Other suggestions include nurses introducing themselves and their role every time they walk into the patient’s room and regular rounding.

“The research is very specific,” Plank said. “You have to do whatever is going to get the results you want, and that may mean scripting. The principles are basic.”

Some hospitals have tried scripting and instructing nurses to smile or make eye contact, but have met with resistance.

“For people who have been doing this for some period of time, it rubs people the wrong way to be told to smile more and to script their language,” Boissy said. “It doesn’t feel authentic to people who may be very talented at what they do.”

Boissy agreed a need may exist for basic service expectation training, but said conversations need to be authentic.

Rafferty provides nurses with information about patient perceptions. HCAHPS data lags real time, so she uses feedback from social media.

Considering the provider experience as well 

Nurses are most important to the patient experience, and there is a direct correlation between patient satisfaction and nurse satisfaction, Plank said. When there is an adequate complement of nurses, and people like their jobs and are happy to be there, it makes a difference.

As caregiving has become more difficult, with more regulations and pressure, Boissy said, it’s important to remind people that they are taking care of human beings. Additionally, the work of caregiving and the witness of suffering place a burden on those delivering care. Therefore, organizations must make efforts to empathize with frontline staff and consider their challenges and what would make their jobs more meaningful.

“In order for us to deliver a powerful patient or family experience, we have to attend to the provider experience,” Boissy said. “We must approach those caregivers with the same skills we are asking them to use.”

Related articles:

Health Systems Expanding Outpatient Care, Improving Patient Experiences 

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