Patient Satisfaction: The Patient Experience and it’s importance in healthcare today.

Patient Satisfaction There is a new face to healthcare, and a pay for value environment will affect healthcare reimbursement for years to come…. (Caspers & Pickard, 2013) Patient and family-centered care is a commitment by the organization to ensure attainment of quality outcomes and a memorable patient experience… (Mahoney, 2013) Patient satisfaction is one of the patient outcomes that will encumber or enhance payments to healthcare organizations… (MacLeod, 2012) Patient satisfaction can be positively related to their ability to comply with the healthcare plan , improve patient outcomes, and reduce readmissions. (Wolosin, Ayala, & Fulton 2012)

Background 10 standards are measured per hospital In 2002, the Center for Medicare and Medicaid Services (CMS) along with the Agency for Healthcare Research and Quality (AHRQ) contemplated the use of a survey to evaluate the patient experience during hospitalization. The “Hospital Consumer Assessment of Healthcare Providers and Systems” (HCAHPS) was endorsed in 2005 and the first nationally published scores were seen in 2008. 10 standards are measured per hospital Summaries include nursing communication, doctor communication, staff responsiveness, pain management, communication regarding medication, and discharge information “Nursing communication” survey information correlates closely to the global “overall hospital rating” and the “would recommend” results. (MacLeod, 2012)

Challenges for Healthcare Organizations… The Institute of Medicine (IOM) has challenged the healthcare system to: Show performance improvements in providing quality care Meet the expectations of patients and their families who receive healthcare Reduce costs to provide affordable care to the patients (Caspers & Pickard, 2013) The U.S. Department of Health and Human Services have implemented the reporting of scores. “Beginning in 2012, hospitals providing services to Medicare beneficiaries will receive increased or reduced payments based on the quality and satisfaction measures”. (MacLeod, 2012, p.42)

Scope and Significance of Problem “Current data indicate that about one in three patients would not rate their hospital stays high enough to qualify for the satisfaction-based incentive payments” (MacLeod, 2012, p. 42) Institutions that do not achieve top ratings will receive less money from Medicare and will be less desired by patients on a competitive market. (Snide & Nailon, 2013) Since staff nurses are so closely associated with overall patient satisfaction, factors that affect their working environment such as leadership relationships, physician relationships, support services, staffing issues, and communication should also be addressed. (MacLeod, 212)

Role of Nurse Leader… “It Takes a VILLAGE” …. “Patient satisfaction cannot be mandated by senior management, nor is it solely a nursing responsibility. Unless a hospital-wide commitment is made to a comprehensive program, results will be decidedly disappointing” (MacLeod, 2012, p. 42)

Role of Nurse Leadership… Transformational leadership High expectations clearly communicated Regular nurse leader rounds Ongoing team and individual coaching Staff nurse empowerment A system of rewards and celebrations for success Encourage staff input and shared leadership (MacLeod, 2012)

Alternative Suggestions Transformational and participative leadership. (Tomey, 2209; MacLeod, 2012) Increase caring behavior and allow more time spent with patient. (Amendolair, 2012) Bedside Handoff to allow patient participation in their plan of care and communication can increase satisfaction. (Hagman, Oman, Kleiner, Johnson, & Nordhagen, 2013) Rounding with a purpose improves patient satisfaction and their perception of caring staff. (Rondinelli, Ecker, Crawford, Seelinger, & Omery, 2012) Communication and interaction by nurses increase patient satisfaction in inpatient settings. (Wolosin, Ayala, & Fulton, 2012)

One Solution…. Use transformational leadership combined with the concept of shared governance to engage the staff on the unit.

Improving the Patient Experience Because nursing is the art of caring… Improving the Patient Experience

Rationale Leadership styles such as relationship based behavior are the combinations of behavior and tasks used to influence other to accomplish goals. (Huber, 2010) Transformational leaders can motivate followers to perform to their full potential by allowing them to change their perception and to engage the team to focus on the purpose such as patient satisfaction. (Huber, 2010). Use of shared governance to communicate patient satisfaction scores and get staff buy in for all interventions. Shared governance demonstrated positive links to better nurse satisfaction which led to improved patient satisfaction. (Stumpf, 2001) Input of team through brainstorming, tests of change, patient care involvement, to provide innovative ideas. A “user-driven innovation” and “disruptive innovation” are ways that nursing staff can improve satisfaction in their work and to their patients. (Snide & Nailon, 2013, p. 46)

Implementation Engage the Unit Nurse Practice Council and provide scorecards for review Work along side the “patient experience” sub-committee of the UNPC to establish goals and interventions for our patients. Create an “daily satisfaction rounding tool” to be used for approximately 4 weeks (until next UNPC meeting). Patient rounding daily by leadership, Charge Nurse, and patient experience team members (when they are working). Allow rounders to sit with patient and provide the caring attitude.

Implementation Create a rounding sheet that can be shared and passed to the Charge Nurse each shift to provide a continuum of care needs. Daily Huddles each shift by leadership, CN , or PE team member that address customer satisfaction issues or celebration. Implement and monitor the “NO Pass Zone” of all staff on the floor (all call bells, alarms, and patient needs are addressed by all who walk past their room) Hold staff accountable for their actions while also supporting their needs. Staff appropriately to ensure a CN is available for staff and patient support.

Evaluation Leadership Evaluation Patient Experience Team Daily rounds on patients and monitoring “daily satisfaction rounding tool” Weekly updates to the Customer Experience Bulletin board to update the unit on progress Frequent communication both verbal and written with the “sub-committee” to support, provide feedback, and guidance. Daily Rounds Evaluate weekly the “daily satisfaction rounding tool” Bring feedback to the leadership to deal with specific patient or staff complaints or issues. Spread the successes to the rest of the team. Provide summary of implementation at next UNPC meeting. Evaluation

Conclusion Patient satisfaction is a necessary initiative to ensure financial sustainability for healthcare organizations. The front line nurse is an essential stakeholder in efforts to improve patient satisfaction scores. Nursing leaders must not underestimate the front line nurse and the patient perception. Managers must support the nurse and all front line staff and ensure resources are available to meet the clinical and nonclinical needs of the staff. All organizational levels must play proactive roles in creating the kind of supportive nursing environment that can make it possible. (MacLeod, 2012)

References Abualrub, R., & Alghamdi, M. (2012). The Impact of leadership styles on nurses' satisfaction and intention to stay among Saudi nurses. Journal of Nursing Management, 20, 668-678. Amendolair, D. (2012). Caring Behaviors and Job Satisfaction. The Journal of Nursing Administration, 42(1), 34-39. Caspers, B., & Pickard, B. (2013). Value-Based Resource Managmement. Nursing Administration Quarterly, 37(2), 95- 104. Hagman, J., Oman, K., Kleiner, C., Johnson, E., & Nordhagen, J. (2013). Lessons learned from the Implementation of a Bedside Handoff Model. Journal of Nursing Administration, 43(6), 315- 317. Huber, D. L. (2010). Leadership and Nursing Care Management . Maryland Heights: Saunders.

References MacLeod, L. (2012). Three Keys to Patient Satisfaction: Nursing, Nursing, and Nursing. Nurse Leader, 10(5), 40- 43. doi:doi:10.1016/j.mnl.2012.03.012 Mahoney, D. (2013). The Many Facets of Excellence. Partners: a Press Ganey Publication(29), 4-24. Rondinelli, J., Ecker, M., Crawford, C., Seelinger, C., & Omery, A. (2012). Hourly Rounding Implementation: A multisite description of structures, processes, and outcomes. The Journal of Nursing Administration, 42(6), 326-332. Snide, J., & Nailon, R. (2013). Nursing Staff Innovations Result in Improved Patient Satisfaction. American Journal of Nursing, 113(10), 42-50.

References Stumpf, L. R. (2001). A Comparison of Governance Types and Patient Satisfaction Outcomes. Journal of Nursing Administration, 31(4), 196-202. Tomey, A. (2009). Nursing leadership and management effects work environments. Journal of Nursing Management, 17, 15-25. Wolosin, R., Ayala, L., & Fulton, B. (2012). Nursing Care, Inpatient Satisfaction, and Value-Based Purchasing. The Journal of Nursing Administration, 42(6), 321-325. Wong, C., & Cummings, G. (2007). The relationship between nursing leadership and patient outcomes: a systematic review. Journal of Nursing Management, 15, 508-521.