1. Richardia Gibbs-Hook Julie Walker

2.  Patient satisfaction surveys are one tool by which quality and safety are measured. ◦ Hospital Consumer Assessment of Healthcare Provider and Systems (HCAHPS) survey

3.  The learner will understand how meeting patient/family expectations can improve patient satisfaction  The learner will understand the general expectations of each patient/family  The learner will understand how patient satisfaction impacts facility reimbursement  The learner will be able to provide examples of tools to be used to improve patient satisfaction in his/her practice

4.  According to Stoddart (2012), the establishment of a therapeutic nurse-patient relationship plays a “fundamental” role in quality of care and patient satisfaction.

5.  Lack of focus on patient satisfaction resulted in organizations’ compromising quality and safety in order to manage costs (Health Affairs 2012).  The HCAHPS survey is one tool by which the patient’s perception of his/her hospital experience is measured.

6.  All patients and families have similar basic expectations (Lateef 2011):

8.  According to Lateef (2011), understanding the patient’s expectations can improve satisfaction. Improved satisfaction now benefits hospitals in the way of additional reimbursement.

9.  Kennedy et. al (2013) describe the implementation of “value-based purchasing (VBP), a plan that bases Medicare reimbursement rates on quality of care.” ◦ Both clinical and patient satisfaction targets are included. ◦ The patient satisfaction targets include: “communication with nurses and physicians, responsiveness of staff, pain management, communication about medications, cleanliness and quietness of hospital environment, adequacy of discharge information, and an overall rating of the hospital” (Kennedy et. al 2013).

10.  Increased pressure on medical and nursing staff to request unnecessary and expensive diagnostic tests in an attempt to prevent “negative” reviews.  Nursing salaries may be tied to HCAHPS scores.  The response rate range is approximately 2 to 10 percent (Emergency 2009). This is a small proportion of patients that, in turn, have a major impact on the hospital’s policies, staff, and reimbursements.

11.  Communication ◦ Ask open-ended questions to determine patient expectations (Belizario, 2011)  White boards ◦ Updated with staff names, goals, upcoming tests, physical therapy times (Belizario, 2011)  Hourly rounding ◦ Check in with patient at least once per hour to determine if needs/expectations are being met  Daily rounding by nurse managers ◦ Nurse manager to introduce self to each new admission, round daily to ascertain needs. Round on discharge day. (Stoddart, 2012)

12.  Patient/family education ◦ Patient/family may have unrealistic expectations. Educate individuals on what the healthcare delivery system is able to provide at this visit (Belizario, 2011)  Discharge teaching ◦ Be sure to include “what to do if…” and include appropriate referrals. (Belizario, 2011) ◦ Encourage questions.  Discharge phone calls ◦ Follow up to ensure that the patients’ needs were met to the best of our ability (Stoddart, 2012)

13.  Healthcare organization reimbursements will continue to be dependent on meeting patient expectations  Nurses should establish a relationship with the patient so that all understand the expectations and how these can be met.  Keep the lines of communication open with patients and their families. Continue to update involved parties about what is next in the plan of care.

14.  Belizario, Sylvia (August 2011). Boosting patient satisfaction scores – and nurses’ morale. Doi: 10.1097/01.NURSE.0000399591.81228.3e  Emergency Physicians Monthly (2009). Could satisfaction surveys be harming patient care? Retrieved from http://www.epmonthly.com /whitecoat/2009/12/could-satisfaction-surveys-be-harming- patient-care/  Health Affairs (2012). Health policy brief: pay-for-performance. Retrieved from http://www.healthaffairs.org/healthpolicybriefs /brief.php?brief_id=78  Kennedy et. al (2013). Three nursing interventions’ impact on HCAHPS scores. Doi: 10.1097/NCQ.0b013e31828b494c  Lateef, Fatimah (2011). Patient expectations and the paradigm shift of care in emergency medicine. Journal of Emergencies, Trauma, and Shock 4.2 (2011):163.  Stoddart, K. (2012). Social meanings and understandings in patient-nurse interaction in the community practice setting: a grounded theory study.