Easing Patient Fears Can Raise HCAHPS Scores

Not everyone feels the same way about the blue "H" sign indicating a hospital's proximity. For Colleen Sweeney, RN, the sign is a reminder to whip out her phone to go on hospitalcompare.com and see how the hospital stacks up next to Memorial Hospital and Health System in South Bend IN, where she works as director of innovation, ambassador and customer services.

"I love everything about hospitals – the smell, the bad art on the walls, everything. I've been in hospitals since I was 18," Sweeney says. "But not everyone feels that way."

In one form or another, everyone has some fear or anxiety surrounding hospitals and healthcare, she says. Sweeney recently completed a patient empathy project in which she interviewed patients on what they fear about hospitals and healthcare systems. Ninety six percent of patients suffer from "Clinicophobia", a term Sweeney coined meaning the fear of healthcare.

"If you don't address patient fear, it will work its way in," Sweeney says. "If we give you instructions and you are too busy thinking about how scared you are or who's going to take care of you – before you know it, you're back in the hospital."

Sweeney asked the audience at the Society for Healthcare Strategy and Market Development (SHSMD) Annual conference in Phoenix to guess the order of the top four patient fears. Some people shouted infections, others shouted death.

The most common patient fears are:

1. Infection
2. Incompetence
3. Death
4. Cost
5. Mix-Ups
6. Needles
7. Rude doctors and nurses
8. Germs
9. Prognosis
10. Communication issues
11. Loneliness

Surprised? Addressing patient fear is a huge component, if not the core component of the patient experience. Sweeney says she asked her staff, if you had known that the patient was fearful, would you have treated them differently? All heads nodded.

As a part of the patient empathy project, Sweeney received dozens of postcards with anonymous patient fears on them. Postcard messages included statements about fears of loneliness, how hospitals smell like death, and worries that the doctors and nurses do not really care.

Under Sweeney's leadership, Memorial began implementing practices to address patient fears. Starting in April, nurses in the childbirth unit were required to ask every patient if she had fear or anxiety about her hospitalization. Nurses were then able to check off the appropriate boxes on the electronic health record and follow up on the patient's specific fears by pointing the patient to the appropriate resource:

Worried about cost? We have someone who can help you with that. Worried about the procedure? Here is some extra information.

Adding a "fears" check box in the EMR was a quick solution, Sweeney says. Asking the patient about their fears has also contributed to Memorial's Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores.

Prior to the nurses asking, patients' 'likelihood to recommend' score was 81.5. After 90 days of asking 'what is your greatest fear or concern around your hospitalization?' the score increased to 83.5 and is currently 85.5.

"The huge result of having nurses ask the question is that it has changed their view of caring for the patient and [made them] realize that they were neglecting the very thing that concerned the patient the most," Sweeney says. "And to ask the question is the only way to arrive at truly 'patient-centered care.'"

Memorial Health has refined its approach to patient-centered care based on feedback from Sweeney's patient empathy project. For example:

• Memorial volunteers have been recruited to bake cookies near the elevators during the day so the smell fills the building. Staff is then allowed to offer patients cookies.

• A dog has been known to greet patients upon arrival. It helps many patients relax. Even patients who do not care for dogs may benefit; the dog offers a distraction from distress about the visit, Sweeney says.

• Staff no longer assumes that a patient wants a private room. Instead, patients are asked if they would like a private or shared room. Having a roommate can help with patient fear #11: loneliness.

• The practice of saying "good luck" to patients upon admittance is banned at Memorial.

Not all clinical staff is happy about Sweeney's system of addressing patient fear. Eye-rolling nurses and complaints are not uncommon, she says. Most staff complaints center on the time factor –asking about and addressing fear adds a step to a busy nurse's day.

She argues, however, that addressing fear will actually save nurse's time. And if the staff is unwilling, they will not last at Memorial, Sweeney says. "If they don't really care about the patients then they will not last."