Beyond HCAHPS Scores

Going Over a Patients Charts

Hospitals Aim to Improve the Patient Experience

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) has become a vital predictor of a hospital’s bottom line. That’s because the patient satisfaction survey required by the Centers for Medicare & Medicaid Services (CMS) is an important determining factor for agency reimbursements—and hospitals with lower scores are financially penalized.

Patient satisfaction rates make up 40 percent of the composite quality score that directly impacts the level of reimbursement that hospitals receive, says Todd DeVree, director of bundled payment solutions at HealthTrust. That score also determines whether hospitals are eligible for reconciliation payments. And just because patients in one area report high levels of satisfaction doesn’t mean that’s the case throughout the hospital. “The challenge for service lines is that HCAHPS is a hospital-wide measure,” DeVree says. “To earn high overall patient satisfaction scores, hospitals must make it a top concern by fostering a patient-centered culture.”

The National Quality Strategy, on which HCAHPS is based, focuses on six priorities that are opportunities to engage patients, caregivers and families:

  1. Making care safer by reducing harm caused in the delivery of care
  2. Ensuring that each person and family is engaged as partners in their care
  3. Promoting effective communication and coordination of care
  4. Promoting the most effective prevention and treatment practices for the leading causes of mortality, starting with cardiovascular disease
  5. Working with communities to promote wide use of best practices to enable healthy living
  6. Making quality care more affordable for individuals, families, employers and governments by developing and spreading new healthcare delivery models
STAFFING AND PATIENT SATISFACTION
How HealthTrust Workforce Solutions Can HelpThe patient experience is greatly impacted by the nurses and doctors who administer care. When patients perceive that their care providers are friendly, focused, helpful and attentive, they’re more likely to rank their experience as positive than if they feel their care providers are harried, unfriendly, rushed or distracted. And medical professionals, like most employees, are better able to deliver that positive experience when they are appropriately trained, supported and given the time and tools needed to perform their jobs well.”When healthcare professionals are empowered with the right skills, tools and environment to fulfill their mission, something incredible happens,” says Paula Phillips, vice president of clinical operations at HealthTrust Workforce Solutions (HWS). “Patient satisfaction soars, employee collaboration takes hold and healthcare organizations deliver high-quality, sustainable care.”

That can be a challenge given the many factors that can contribute to nurse dissatisfaction, including underutilization of contingent labor, resulting in overworked full-time nurses, and last-minute cancellation of shifts when nurse-to-patient ratios don’t require the extra manpower.

The staffing and recruiting services of HWS can address these and other clinical staffing shortages and retention issues as well as executive recruitment challenges. The organization also provides training programs to ensure staff is providing the care and service that will improve patient experiences. For instance, HWS partners with the clinical leaders of client organizations to implement training that supports tactics such as hourly rounding and bedside shift reporting, Phillips says.

“We take a holistic, long-term view of career wellness and focus on taking good care of our people, just as our hospital partners focus on taking good care of their patients,” Phillips says. “HealthTrust Workforce Solutions is committed to ensuring that client partners, when utilizing contract employees, receive staff who have the knowledge, skills and ability to provide an exceptional patient experience that is consistent with the standards expected of their facility.”

To learn more about HealthTrust Workforce Solutions and how it can help improve the patient experience at your facility, visit healthtrustpg.com/workforce.

Here are a few approaches to implementing these priorities that are helping hospitals provide better care and improve patient satisfaction.

Standardize care for similar patient groups. At CHI Franciscan’s St. Joseph Medical Center in Tacoma, Washington, a hospitalist evaluates prospective surgery patients to classify them into a group of patients with shared characteristics. Once patients are determined to be a fit for a specific group, or a preoperative surgical home, they are put on a pathway that will provide the best evidence-based care for their particular condition.

“Not all patients are the same,” DeVree says. “Based on their age, BMI, comorbidities, activity level and even their expectations, we need to design care paths that are unique to them.”

DeVree recommends using evidence and best practices to design patient-specific care paths and standardize care based on what has worked best for similar patient groups. This approach allows for providing the right care for the right patient at the right time—also known as personalized care.

Manage expectations. In addition to providing care pathways for similar patients, this type of grouping system can also help manage patients’ expectations. Gregory Brown, M.D., Ph.D., physician advisor for HealthTrust and an orthopedic surgeon at St. Joseph, is developing a model for predicting joint function after surgery. The predictive model combines patient demographics, comorbidities and self-reported outcomes to make those calculations. Expectations are measured by asking patients about their pain and activity levels—both current and expected a year after surgery.

“One of the factors often associated with dissatisfaction after total knee replacement surgery is unmet expectations,” Brown says. “By initiating a conversation about expectations preoperatively, we should be able to improve patient satisfaction.”

One important feature of the predictive model is the identification of factors that patients can modify to improve their outcomes, such as weight loss, smoking cessation, diabetes management and designating a care partner. Discussing these potential modifications upfront may encourage patients to take a more active role in setting appropriate expectations and engaging in their own care. “Real satisfaction is achieved by meeting patient expectations,” Dr. Brown says.

Educate patients. Not only should care providers understand patients’ likelihood for a successful surgery and recovery—they should also be able to educate patients about how to achieve those ends. At St. Luke’s Regional Medical Center in Boise, Idaho, spine center staff members hold a preoperative class to educate prospective patients about the operating experience and hospital stay. This class also prepares patients for their return home, including giving them exercises to improve mobility. But patients who undergo spine surgery at St. Luke’s aren’t only educated about the procedures before they occur. Postoperatively, like groups of patients reconvene to learn about the recovery process together. These meetings help them continue to be educated about their care and provide support to one another, boosting satisfaction with the overall experience.

Communicate proactively. Reconnecting with patients after a surgery or other procedure—rather than waiting for them to call with a problem or question—can also have a positive impact on their experience. “Check in on your patients regularly for a set period of time following their surgery,” DeVree says. “Even when things are going as expected, patients appreciate the communication. Hospitals can also use this engagement to gather more intelligence that can be applied to setting expectations for future patients.”

Creative Use of Commercial Products for Some Immediate Wins

The care experience is impacted by everything within a healthcare facility—staff, food service, air quality, cleanliness and even the pillow they sleep on. Hospitals that understand the comprehensive nature of the encounter for patients can also better appreciate how product choices can positively affect satisfaction scores.

HealthTrust has contracts for a number of supplier products that can do just that. Among the options:

Minimizing noise pollution. Rubber flooring can help reduce noise as well as decrease leg fatigue for staff members, says Vanessa Perutelli, portfolio manager, strategic sourcing at HealthTrust. The use of cubicle curtains without the metal tracks can also reduce noise pollution.

For instance, AmSurg, a Nashville-based ambulatory surgery center management company, uses On the Right Track by Standard Textile (HealthTrust Contract No. 500), which eliminates the noise of the metal hangers on a typical track, Perutelli says. In addition, the product can be taken down or hung up by one person, without a ladder. That both saves time and encourages staff to frequently change the curtains for laundering, reducing the potential for hospital-acquired infections.

Reducing patient falls. When patients who are prone to falls must leave their room or their floor, there is always a risk to themselves and sometimes to the staff member who is guiding them. Steelcase has designed a recliner (HealthTrust Contract No. 500171) to be used for patient transport as well as lounging, Perutelli says. Using such furniture for dual purposes can help ensure patient safety, contributing to overall patient satisfaction.

Providing an atmosphere of hospitality. An HCA TriStar facility recently designed a spine and joint surgery recovery unit with a dining area on the floor.

“It is important for patients coming out of surgery to get moving as quickly as possible, so instead of having meals delivered to rooms, the hospital designed the floor to have a common dining area to encourage patients to walk to their food,” Perutelli explains.

“This also gives the unit more of a hospitality feel, and this step has received positive reviews from patients and families.”

Thirteen hospitals in one HCA division are also taking advantage of a new arrangement with Staples Promotional Products (HealthTrust Contract No. 4064), which will allow them to distribute branded gift blankets to patients at admission as a means “to convey warmth and concern for their welfare.” It’s part of a broader strategy to increase satisfaction and thus improve HCAHPS scores, says Nikko Giovino, manager of strategic sourcing, commercial products, at HealthTrust. The hospitals previously tried to provide the blankets on their own, but had no space to store the quarterly shipments or staff to keep up with the supply. With the new partnership, Staples manages regional warehousing of the branded blankets and delivers the requested number to each hospital on a monthly basis. In addition, Staples polywraps each blanket and includes a note from the hospital to ensure that each patient understands it is a gift, courtesy of the facility.

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