2. Meeting Patient Expectations Presentation by: Rhonda Jones & Rachael Seiter

3. INTRODUCTION Patient satisfaction has a direct correlation with meeting patient expectations. Patients are no longer just receiving care but are informed consumers that have a wide variety of choices when selecting a healthcare organization. Healthcare organizations are required to publically report quality measures. These measures also have an impact on financial reimbursement to organizations. Nursing, as the largest group with both direct and indirect patient contact is the most influential group on patient satisfaction and meeting patient expectations.

4. LEARNER OBJECTIVES By the end of this presentation the learner will be able to: 1.Understand the financial impact that Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey scores have on a healthcare organization. 2.Ways to implement change in an organization that will impact patient experiences. 3.List nursing sensitive issues related to patient experiences.

5. ASSESSMENT OF THE HEALTHCARE ENVIRONMENT How do healthcare organizations determine patient expectations and patient satisfaction? Research 3rd party formal surveys such as Press Ganey, Arbor, and Gallup Organizational comment cards and patient questionnaires Rounding observations Patient relation data such as reported grievances, complaints, and positive letters HCAHPS survey information

6. ASSESSMENT OF THE HEALTHCARE ENVIRONMENT Why is it important for healthcare organizations, especially nursing, acknowledge the importance of meeting patient expectations and improving patient satisfactions scores? There is a direct impact on the quality of care provided to patients. Ability to improve in patient outcomes. Provides a platform for research on nursing sensitive issues. Implementation of changes to policy and procedures. Obtain the highest amount of financial reimbursement for the organization.

7. ROOT CAUSE ANALYSIS: FISHBONE DIAGRAM Bacon & Mark (2009)

8. ROOT CAUSE ANALYSIS Problem: What factors impact patient satisfaction? Hospital Environment Nursing Unit Environment Unit Capacity Work Engagement Work Conditions Patient Characteristics Bacon & Mark (2009)

9. IMPLICATION AND CONSEQUENCES HCAHPS has standardized data collection and provides a comparison of organizations. Information on organizations is now publically reported. Patients have never been more informed of healthcare choices. HCAHPS results are linked to reimbursement received by organizations. Almost all of the HCAHPS survey questions can be directly impacted by the nursing.

10. IMPLICATION AND CONSEQUENCES Lower reimbursement can result in a staff reduction or possible closure of an organization. Decreased patient satisfaction will result in consumers not coming to an organization. Exclusion of nursing staff in quality improvement measures is a missed opportunity in healthcare. The focus cannot be on one area of an organization to meet patient expectations and improve patient satisfaction. Nursing led quality improvement projects and research need to be addressed.

11. RECOMMENDATIONS Be aware of organizational HCAHPS scores and other survey information utilized by your organization. Go to the CMS website to identify how your organization compares to other organizations in your area. Make sure this information is understood by senior leadership and shared with front line staff. Be knowledgeable of the HCAHPS survey as well as other formal and informal survey – what questions are being asked and how they impact patient care.

12. RECOMMENDATIONS An organizational approach needs to be utilized in quality process improvement projects. The type and quality of nursing care directly impacts patient satisfaction. Research needs to be reviewed and performed to assess the improvement projects. Nurses need to be knowledgeable on the nursing sensitive indicators that impact patient satisfaction. Become empowered to investigate quality improvement projects at your organization.

13. RECOMMENDATIONS What is nursing’s role in meeting patient expectation for an organization? Nursing can lead in the following quality improvement projects: Fall Programs Investigate Acuity and Nurse to Patient Ratios Medication Management Processes Discharge Planning Processes Recruit Nursing Leadership and Senior Leadership Support

14. CONCLUSION Patients, as consumers, have the capability and right to select organizations that are prepared to meet their needs. Organization must continue to improve delivery of care to stay viable in the healthcare market place. Nurses are in a unique position to implement change that improves patient care and the organizational delivery of care.

15. REFERENCES Bacon, C. T., & Mark, B. (2009). Organizational effects on patient satisfaction in hospital medical-surgical units. J Nurs Adm, 39(5), 220–227. doi: 10.1097/NNA.0b013e3181a23d3f. HCAHPS (2014). Hospital Consumer Assessment of Healthcare Providers and Systems. Centers for Medicare & Medicaid Services. Baltimore, MD retrieved on September 15, 2014. Kennedy, B., Craig, J. B., Wetsel, M., Reimels, E., & Wright, J. (2013). Three nursing interventions' impact on HCAHPS scores. J Nurs Care Qual, 28(4), 327–334. doi: 10.1097/NCQ.0b013e31828b494c. Wagner, D., & Bear, M. (2009). Patient satisfaction with nursing care: A concept analysis within a nursing framework. J Adv Nurs, 65(3), 692–701. doi: 10.1111/j.1365-2648.2008.04866.x.