Nurse-patient Communication Affects Hospital Consumer Metrics

By Debra Wood, RN, contributor

May 14, 2013 - Improving nurse–patient communication could result in gains in other Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) metrics, including responsiveness of hospital staff, pain management, communication about medication and overall patient experience scores, which together affect 15 percent of hospitals’ value-based purchasing (VBP) incentive payments, according to a new study released by Press Ganey Associates.

“It is research that confirms and highlights what nurses have known for a long time,” said Christina Dempsey, MSN, MBA, CNOR, CENP, senior vice president and chief nursing officer of Press Ganey, headquartered in South Bend, Ind. “Nurse communication drives a lot when it comes to the overall patient experience.”

The Centers for Medicare and Medicaid Services (CMS) will determine 30 percent of hospitals’ VBP incentive payments by how patients evaluate their stay on eight HCAHPS dimensions that make up the patient experience of care domain within the VBP framework.

Researchers at Press Ganey, a patient experience improvement firm, analyzed publicly available data from 3,062 U.S. acute-care hospitals, conducted a hierarchical variable clustering analysis and issued the paper “The Rising Tide Measure: Communication with Nurses” with the results.

Chris Boothe: nurse-communication is crucial to patient experience and outcome.
Chris Boothe, RN, considers nurse–patient communication crucial to an optimal patient experience and outcome.

“It’s accurate from my standpoint, but not new information,” said Chris Boothe, RN, director of nursing for critical care services at Memorial Regional Hospital in Hollywood, Fla. “We recognized the communication with nurses’ domain as one of the more crucial domains.”

However, the study validated what Memorial has been working on, he said.

Dempsey agreed that communication with nurses is not a new priority, saying Press Ganey had seen indications of the value of nurse–patient communication in its surveys, and conducted the study.

“It’s always good to have research to confirm anecdotes,” Dempsey said. “The research elevates the discussion in healthcare about how much the nurse communication component drives.”

Press Ganey offered several recommendations for improving nurse–patient communication, including:

  • Rounding purposefully every hour;
  • Bedside shift reporting;
  • Using scripts;
  • Making post-discharge phone calls;
  • Hiring nursing candidates who exhibit strong interpersonal skills; and
  • Providing service-skills training with periodic reinforcement.

Montefiore Medical Center in the Bronx, N.Y., has incorporated all of the suggestions. Jane O’Rourke, RN, DNP, director of evidence-based practice at Montefiore, said that patient handoffs at the bedside also serve as a peer review of the patient’s care.

“Nothing is missed in terms of communication,” O’Rourke said.

Rounding lets patients know when the nurse will return and has been shown to improve safety as well as communication.

Boothe indicated that Memorial also has incorporated all of these suggestions, including an “AIDET script” that calls for staff to:

  • Acknowledge the patient;
  • Introduce oneself and put the patient at ease;
  • Share the duration for the next step in the care process;
  • Explain what the care plan is; and
  • Thank the patient for allowing Memorial staff to care for him/her.

Memorial hires nurses with an engaged, “can-do” attitude, trains for skill and reminds staff regularly that they are there for a bigger purpose: deeper caring, Boothe added.

“That’s the keep element when looking for a new employee,” Boothe said. “The difficult piece of it is having people who are engaged, positive and interactive in an often challenging environment, like healthcare.”

Dempsey said that examples of good practices include Magnet hospitals and others that encourage the involvement of nurses in decision making and process improvement.

“That helps to foster buy-in that leads to personal accountability,” Dempsey said.

With nurses as busy as they are, Dempsey said, it becomes difficult to incorporate everything and make the optimal patient experience, but communicating the reason for such efforts will help nurses and others in the organization understand all of the issues around value-based purchasing.

“It’s not ‘one more thing,’ but optimizing the patient experience has to be part of the fabric of patient care,” Dempsey said. “The most important thing is establishing that connectedness with the patient.”

Hospitals fostering those connections are reaping the benefits. And as reimbursement shifts from fee-for-service to value-based, those already focused on nurse communication will have a head start.

“A rising tide will raise all ships and communication with nurses has always been and continues to be crucial in providing the optimal patient experience,” Boothe concluded. “That ultimately results in positive patient outcomes.”



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