ADVANCE asks nurses how it is that they go about meeting the needs of today’s patient population in a value-based healthcare environment.
In 2011, the Centers for Medicare & Medicaid Services launched the Value-Based Purchasing Program, which rewards hospitals for receiving high patient satisfaction scores or for improving their satisfaction ratings compared to previous years. However, when it comes to nurses, the incentives for achieving patient satisfaction run much deeper than the financial bonuses that can be earned.
ADVANCE for Nurses recently interviewed three nurses about how they attempt to maintain strong satisfaction scores for themselves and their facilities, how today’s patients may differ from those in years past when it comes to evaluating their healthcare providers, and how to help their peers improve their performances by offering tips that could lead to better satisfaction scores. Participating in this forum are Michelle Moccia, DNP, ANP-BC, CCRN, president of the Gerontological Advanced Practice Nurses Association and program director at St. Mary Mercy Livonia (MI) Hospital; Summer Bryant, MSN, RN, CMSRN, director of the Academy of Medical-Surgical Nurses’ board of directors and nurse manager at the University of Kansas Hospital, Kansas City; and Antoinette Falker, DNP, RN, CBN, CMSRN, GCNS-BC, president of the Medical-Surgical Nursing Certification Board and clinical nurse specialist at Barnes-Jewish Hospital, Saint Louis, MO.
What are some of the ways that you attempt to communicate with patients in order to achieve a certain level of satisfaction from their perspective?
Michelle Moccia (MM): “Many healthcare facilities have adopted approaches to ensure patient-family centric care. I work in a senior emergency department (ED), and EDs are the ‘front porch’ of the community. It is important when communicating to [people] to alleviate their anxiety and establish trust immediately. An acronym we use [at our hospital is AIDET, to help decrease patients’ anxiety and establish a relationship:
- A = Acknowledge the individual: identifying the correct individual and establishing respect. Acknowledge everyone who accompanies the individual. Ask them what brings them to the ED and how we can help. This is a key safety feature and shows compassion.
- I = Introduce yourself: establish trust and decrease anxiety. Let people know they are in good hands. Manage up the staff and let patients know the names of the ED team who are caring for them.
- D = Duration: let patients know how long they will be in the ED or the time it takes for each exam.
- E = Explain the tests/procedures that will be done: ask patients if they have questions. Repeat what they have said to ensure you have the correct information. Show them how to use the call-bell system. Let them know when you will return.
- T = Thank patients for choosing your ED and for their confidence. This will establish loyalty.
Also, whiteboards in patient rooms are used to help with communication and include the names of ED staff, tests/procedures that are being ordered, and pain scores, if applicable. We utilize leadership rounding protocol through leaders on the unit who visit patients to ask open-ended questions about their care, ask if there is anything ED personnel can do to improve their care, and provide a business card [for contact info.]”
Summer Bryant (SB): “We provide patients and their family members with a patient-education folder that contains information about our unit and what to expect during their hospitalization. The packet of information also includes information about their diagnosis and procedures, and provides contact information for members of our unit-based leadership team and patient relations if they need assistance to resolve any issues.”
Antoinette Falker (AF): “I think the most important steps are to start by introducing yourself, explaining the purpose of your conversation, and then asking the patient and family if it’s is a good time to talk. This approach helps ensure that the patient and their family will understand that you want them to participate in the learning experience and that you value their input. Additionally, I make every attempt to sit down when I am talking to my patients and their families. I want them to get the feeling that I have the time to talk with them, and that I care about them and the situation we are discussing. After the teaching conversation takes place, it’s important to ask the patient and family if they have any outstanding questions or concerns. I feel this demonstrates a commitment to making sure all their issues have been addressed.”
What are some differences about today’s patients and their methods of communication from years past that nurses should be cognizant of when it comes to ensuring that satisfaction is achieved?
MM: “Patients expect you to be skilled to care for them. What they also want is someone who cares. Someone who inquiries about their goals of care — ‘what matters to them so that you can act on what matters.’ This may also include end-of-life planning. Patients are more than a chief complaint, they are people with a chief complaint. Recognizing them as an individual is key. People use their smartphones, so ensure they have signed up for their patient portal for receiving labs, X-ray results, etc. If you have a TV system that has patient-care videos of procedures/tests, utilize this avenue of communication. With older adults, we need to internalize that they may have visual and hearing impairments along with cognitive decline. These need to be taken into consideration to address their plan of care. For older adults who reside in a senior care facility, it is important to be aware of their capabilities for discharge planning.”
SB: “I don’t think the methods of communication have changed much over the years in the inpatient setting. Though technology has advanced, we still communicate with patients and family members in person, almost exclusively. When needed, we give family members updates by phone. What has changed is how diverse our patient populations have become. Nurses are exposed to numerous cultures and languages every day. The knowledge that nurses need to be culturally competent to ensure they are communicating effectively, and with empathy, is much greater than it used to be.”
AF: “Historically, nurses had brief conversations with patients and their families, and usually provided additional educational handouts, which included the healthcare topics of most importance. However, nurses now recognize that patients require more conversations and more education specific to their healthcare needs and educational awareness. As a result, nurses now try to tailor our conversations with each patient and family based on their educational needs. In addition, we have access to videos, CDs, and educational materials written at a fourth-grade level that use basic medical terminology and access to other healthcare practitioners, such as dieticians and physical therapists, to help provide education for our patients and their families. Additionally, nurses understand the need to start education as early as possible using teach-back methodology to better ensure people understand the concepts and skills being taught.”
What are some of the mistakes that nurses make when it comes to communicating with patients, and what kind of changes can they make to improve satisfaction?
MM: “The biggest mistakes are not finding out what matters to patients, not inquiring about their goals of care, not acknowledging their fears and/or anxieties, and not keeping them informed. Ask them about their advanced directive. If they have not completed one, give them information. Never assume an aphasic patient cannot understand. Aphasia is not a sign of intelligence. Never assume a patient living with dementia cannot understand. Utilize the correct pain scale for those who have dementia. An individual who has dementia is unable to articulate a pain scale of 0-10. Avoid the term “frequent flyer,” which seems negative, and maybe choose “familiar face.” Utilize hourly rounding, and before leaving the room always ask, “Is there anything else I can do for you?” Let patients know when you will return. Ensure their call bell is within their reach. Listen more and ask for more details if you do not feel you have enough information. The older population is the fastest-growing population, so ensure you know how to care for the older adult. Geriatric EDs are on the rise. Older adults need a system of care designed with their needs in mind. Currently, older adults routinely receive care that is unwanted and unneeded. They are the highest users of medications, and many are harmed by inappropriate medications. Be cognizant that medications must be tailored to age and lab values. ‘Start low and go slow.’ Sleepy patients may not engage in mobilization, conversing, or eating, and thus increase their risk for delirium and or disability. We keep them in bed when they need to be mobile. This will certainly lead to patient and family dissatisfaction. Their needs must be kept in mind, otherwise the patient and family will live in a reactive state to their illness instead of a proactive state. Avoid assuming that if the older adult has a caregiver that he/she knows how to best care for the individual.”
SB: “One mistake nurses make is not putting themselves in the patient or family member’s shoes. Nurses can forget they are taking care of an individual and have to remember that every patient who gets a knee replacement, for example, does not have the same comorbidities or social situation, so the communication they need has to be tailored to his/her individual needs. Another mistake some nurses make is to not check the latest policy or procedure before performing a task. Healthcare changes so fast that it is important that nurses find a way to keep their practice up-to-date.”
AF: “Historically, whatever the nurse said was taken as ‘the gospel’ by patients and families. However, patients and families are now better educated about healthcare and expect to actively participate in conversations and to express expectations for their healthcare. Nurses must come to the discussion fully prepared to discuss the healthcare topics of concern. Additionally, if the nurse does not have a complete answer to the questions asked by the patient and/or family, the nurse must acknowledge this fact, explain that he/she will obtain answers to the questions, and then follow-up with the patient and family in a reasonable period of time. In addition, nurses can consider becoming certified. Many patients ask about the credentials on our badges. When we explain we are board-certified, they know we care enough about their health and safety to achieve this level of practice. This definitely helps build trust.”