The staff was uncomfortable with that initially, she acknowledges. “But now, it’s how they work, and they all take their behavior more seriously.”
An effort at Bellevue Hospital Center involves each nurse manager making rounds as if they were “concierges,” Johnston says. “They don’t just ask, ‘How’s your health?’ They ask, ‘How has your day gone so far, and is there something I can do to make your experience better?’”
Johnston says that NYCHHC as a system has seen overall scores rise, with varying rates of improvement at each facility. But Elmhurst Hospital Center, which Johnston says is one of the most culturally and ethnically diverse in the nation, saw a 13 percentage point increase over three years, from July 2007 to June 2010, followed by Coney Island Hospital, which rose 11 percentage points. She says the use of individuals as navigators or advocates who assist patients and families for whom English is not their primary language, is a likely reason for the improvement.
Nina Setia, administrative director of service excellence at Hackensack (NJ) University Medical Center, a 745-staffed-bed hospital, says her team saw from the last survey report “that responsiveness of staff, along with noise, are the two areas that are going to be hurting us the most in VBP.”
For noise, she says, cell phones and a liberal visitation policy that is patient-driven make these “two very tough areas to improve.”
So her team focuses on using skills lab settings to validate staff in their behaviors around the hourly rounding practice. In six months, more than 500 nurses have been validated.
Caregivers—usually nurses—focus on eight behaviors, such as making sure patients’ comfort needs and their pain are addressed and that they know when someone will return to the room. This has, so far, been effective.
They’ve boosted scores from 77% to 81% for “communication with nurses” between the first and second quarter of 2011, Setia says.
More improvement came in scores for “overall rating of hospital,” which went from 73% to 76% in one quarter, and in “willingness to recommend,” which increased from 79% to 83%.
Barbara Balik, a member of the senior faculty with the Institute for Healthcare Improvement and a former executive vice president for safety and quality with Allina Hospitals and Clinics in Minnesota, notes that “what we’ve seen nationally since HCAHPS has been in place is a general trend upward for everybody. And that does tell us we can move this when we put focus and attention on it.”
Aldire says the entire hospital staff has to understand that they all play a part in improving and sustaining HCAHPS, not just for financial reasons, but to improve patient care overall.
“For a hospital to be successful, they really have to hardwire, to make sure everyone who has contact with the patient is aligned. Because the patient can have a great, great
hospital experience, but boy, if going
out the door someone says something that’s wrong or rude, or doesn’t communicate well, it sticks in their mind, and then the response goes from ‘always’