By: Mary Griffin Strom, MSN, RN, Consultant, Creative Health Care Management
In the inspirational new book, See Me As A Person, authors Mary Koloroutis and Michael Trout define the practices that make up a truly authentic connection to patients and families. These practices are the essence of a therapeutic relationship. Koloroutis and Trout define a therapeutic relationship as one in which “the clinician offers care, touch, compassion, presence, and any other act or attitude that would foster healing, and expects nothing in return.” (Koloroutis & Trout, 2012.)
The “expects nothing in return” segment of that definition is what differentiates the therapeutic relationships we form with patients and their families from all other relationships. However, the elements that comprise the therapeutic relationship—presence through attunement, wondering, following, and holding—apply to all authentic relationships, personal or professional.
The therapeutic relationship practices that create authentic relationships with patients and families are something that we can think about, talk about, study, and DO. It takes intentionality, practice, reflection, and effort to move those practices from a way of thinking, to a way of doing, to a way of being.
The same holds true for servant leadership or caring leadership. We can talk about how important it is to be in service to those we lead or how important it is to be caring, but we seldom define those actions in a way that moves us to a new way of being a leader. Let’s explore what it looks like when we apply the therapeutic relationship practices to leadership.
Attunement
Presence through attunement is the container that holds the three essential practices. If we are not present and giving our undivided attention to the other, then wondering, following, and holding are not likely to be experienced by the receiver. First, we must be attuned.
As leaders, when we “round” on staff, are we attuned to them, focused on them, present for them, and with them? In other words, how do we show up? Are we working to meet our agenda or theirs? Are we with them to listen or to tell? If we are servant leaders, we might need to entertain how to set our agenda aside and be open to whatever their agenda is for that moment.
Wondering
Wondering begins then as soon as we are attuned. Wondering involves openness, curiosity, using wide eyes, and open ears. And perhaps most importantly, it means suspending conclusions. It means knowing that knowledge comes not from what we already know, but from what we might learn about our staff, the climate of the unit, and the staff response, as well as about the patients/families in our care that day on our unit.
Following
Following means we consciously decide to be guided in our discussions and our interactions with patients, families, and colleagues by whatever happens in the moment. It truly helps to know our staff as individuals, so that when they mention someone or something that has resonance to us, we pick up on that part of the dialogue and show respect and understanding of whatever conversation transpires. They are leading, and therefore, naturally you are the follower. This requires giving special attention to body language, tone of voice, choice of words.
Holding
Holding is the conscious decision to lift up, affirm, and dignify what you are hearing and learning from those who know the work the best: your team. Even if you encounter a strong emotional response in the moment, holding helps you as a leader to be a steady and nonjudgmental presence. Holding might mean that you convey that you have heard what was said, that you might need to get back to someone, and that you respect them enough to honor their concern. Holding also means that you keep your promise and return to them with an answer to their raised concern.
Just as these practices must be defined, practiced, and reflected on in order to be true elements of the therapeutic relationship with patients and families, the same holds true for these practices in our role as caring servant leaders. They do not come easily; they often come through trial and error and learning from our mistakes. Formal leaders would benefit from group/peer discussions centered on exploring these practices, putting them into practice, and then reflecting on how they worked and how it might become a way of leading. Staff will learn from you as they witness your steady intentional presence, your openness to their dialogue, your willingness to follow their train of thought and discussion threads, and your holding of their contribution as something valuable to you and to the organization.
I invite you to suggest at your next formal leadership meeting that you set aside some time to use See Me as a Person as part of your learning agenda for each of your meetings. As a leadership team, you will learn the language and definitions of its therapeutic practices and be able to role model the behaviors and practices such that caring servant leadership is demonstrated in actions more than words.
Learn about Leadership and Management Training Available Online Through HealthStream.
Throughout her career, both as a nurse at the point of care and as an administrator, Mary has seldom used the word “patient” without the word “family” following right behind it. Currently, Mary is a consultant at Creative Health Care Management, where she partners with health care organizations on team building, patient safety and quality, leadership development at all levels, physician engagement, and patient experience. Mary can be contacted at mgriffinstrom@chcm.com
By Gwen Faust, RN, MS, Consultant (HCAHPS & Other Surveys), HealthStream
I live about 19 miles from Newtown Ct. One of my healthcare providers is a surviving sibling of one of the adults killed at Sandy Hook elementary school this past December. I saw him yesterday for a checkup and wasn’t sure how I was going to address his loss. I didn’t want to bring up something that I could only imagine was still extremely raw but I did want him to know I cared about him. When I saw him, I just touched his arm and said “Hello my friend.”
As I was leaving the office I saw him in the hallway… I wished him a good spring and told him to get out fishing (which I know is a lifelong passion of his). He began to talk about a trip he had just taken and how much it helped. We ended our conversation with a sincere hug. He went on to say that the best comfort available to him in these times is found in the caring touch from others. Words weren’t necessary… but the touch on a shoulder, arm, hand, or hug are now essential to getting through the day.
I have been thinking about the importance of touch since our conversation.
Touch is Valuable in Healthcare
In a society made keenly aware of abuse issues, sexual harassment and now impacted by technology to the nth degree… I fear that human touch in healthcare and elsewhere is limited at best and more than likely limited to task or procedure-related touch.
Touch was first recognized by Aristotle as one of our senses… right along with taste, smell, sight, and hearing. Infant survival depends on it. The positive and real impact of Touch Healing has long been studied and documented. Massage therapy is appreciated by many of you reading this, and hospitals are now starting to include integrated medicine in their programs for patients with cardiac issues, cancer, and chronic pain. Some hospitals have taught all levels of staff gentle hand massage as a rest-inducing or pain-relieving technique for the patients with whom they come in contact. Touch can be reassuring. When we are talking about being a team and “We’ll work on your cancer, heart failure as team”… how much more reassuring would it be to have that message accompanied with a hand being held or a hand on the shoulder? Communication, pain relief, healing (physical and emotional), stress management, improved circulation, and survival all are positively affected by human touch.
Touch is an Important Part of Effective, Caring Communication
So when we are with our patients and their family member, and we are speaking with them, we should use non-verbal communication techniques of looking at them, listening to them, and sealing the deal… with a human touch. I learned very early on in my nursing training that we can’t save everyone and that helping them through whatever their health care experience brings is the gift I could give as a nurse. One year I drew the cover for our Nursing School yearbook… I’ll spare you the art experience….but it was a drawing of two hands which were intended to portray the hands of a nurse—caring hands and hands that help heal.
While we may not return to PM care, complete with patient backrubs, we do need to revive touch as part of the care we give and the way we communicate.
Learn more about HealthStream's Survey Research and Consulting Services.
Few studies have been conducted on length of stay (LOS) and patient satisfaction, and studies of this type have mixed results. In the past, LOS has been associated with both higher and lower patient satisfaction. No studies have compared LOS and HCAHPS scores. The current study compared LOS with HCAHPS scores from inpatients of 602 hospitals. LOS was associated with HCAHPS scores. HCAHPS scores tended to decline as LOS increased across most HCAHPS categories, although discharge planning increased as LOS increased.
Examining the Relationship Between Length of Stay (LOS) and HCAHPS Scores
This HealthStream study, conducted by Research Analysts Jim Eggers, Chad Wrye, and Paul No, under the leadership of Randy Carden, Ed.D., Senior Research Consultant, examined the relationship between inpatient length of stay (LOS) and patient ratings of the hospital as measured by HCAHPS scores. LOS is defined as the number of days that a patient spends in the hospital as an inpatient and in this study is calculated as the difference between date-of-admission and date-of-discharge. While it is clear that patients should be in the hospital long enough to receive appropriate treatment, there is a push throughout the healthcare industry to reduce length of stay as much as possible through increased efficiency. Some open questions related to LOS are whether it is an appropriate measure of hospital performance, and how it is related to hospital quality and efficiency.
The source of the data for the current study was the 2012 HealthStream HCAHPS Database which contains 432,998 inpatient respondents from 662 hospitals. Of these 432,998 inpatients, 39,468 did not have LOS data and were eliminated. The remaining 393,530 patients, representing 602 hospitals, had an average LOS of 3.69 days with 2 days being the most common LOS. About two-thirds (65.8%) had a LOS of 3 days or less. Raw LOS values were then grouped into seven buckets: 1 day, 2 days, 3 days, 4 days, 5 days, 6 days and 7 or more days. Top box scores by the grouped length of stay were then calculated for each question and for each category in the HCAHPS survey. A mix of formal statistical testing accompanied by tables and graphs were utilized to analyze the data.
Findings of this analysis include:
- There was a relationship between LOS and HCAHPS Scores
- Lengthening of the patient stay affected some HCAHPS categories more than others
- There was a LOS threshold where scores changed significantly
- One HCAHPS category was outside the general LOS-dependent scoring trend
Complete the form below to download the discovery paper.
(This white paper is posted in conjunction with healthcare performance management expert and partner Baptist Leadership Group.)
In addition to establishing goals for clarity to achieve long-term outcomes and success, it is essential for an organization to establish clear behavioral expectations, often referred to as “Standards of Performance.” Standards of Performance are the day-to-day behaviors an organization expects everyone to live. Standards are not only important for staff, but also for leaders. These established behaviors allow each employee to live the values of the organization every day.
Standards of Performance are commo
n, observable behaviors that help achieve the organizational goals. At times they can be confused with the values of the organization. While values are important, they do not provide the clear and specific behavioral expectations. Standards are what ensure we live our values. Standards must first be clearly defined for everyone. This establishes consistent alignment of all leaders and employees. It also sets organizational expectations and interests to create loyal, cooperative, and willing employees who go above and beyond assigned duties. Without clearly defined behaviors, it will be difficult to make certain that everyone understands the expectations. This reduces the positive benefits for the organization.
They may consist of global behaviors everyone exhibits as well as jobspecific behaviors necessary to produce outcomes in a given role.
Standards in Action
For the Standards to permeate an organization’s culture and drive overall performance, it is imperative that these behavioral expectations are:
An accountable organization helps staff and leaders follow the standards of performance by assuring they are lived daily by everyone during every interaction. Standards are a tool to create consistent behaviors across the entire organization. These behavioral expectations support healthcare performance management and are the ways you can meet and exceed patients’ expectations.
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By Cyndi Tierney , Research Consultant (CG-CAHPS and Other Surveys), HealthStream
Setting Sights on Leadership in the Patient Experience
I
recently met with a hospital’s Patient Experience team. The team leader and hospital executive were committed to improving their results, passionate about the team of champions they assembled… and frustrated about their lack of progress. We talked about a few specific areas of opportunity, and then I asked where the initiative stood with department leaders. It was a long pause before they confided that it was a weak spot. Some department heads were on fire for the cause, while others weren’t supportive. Not dismissive either, they both quickly added. Just not pushing the agenda with the staff, and could I do something about that?
Dead in the Water
Hospitals and systems take varied paths in driving patient experience improvement efforts in their organizations. Some use a traditional top-down approach, some are de-centralized from corporate office and administered by leadership, while others run with a grassroots effort, using staff for the effort to take hold. No matter which route you’ve chartered, there’s a point (okay, sometimes multiple points) where you’re standing still. The water is dead calm and not a breath of wind in sight. Welcome to change.
A Riptide out to Sea
On my next visit, I met with the directors. As we started to talk, a few were brave enough to voice doubts about requiring staff to use catch phrases with patients. One or two even used the dreaded S word, “My staff members don’t like being scripted.” Now really, who does? Unless you’re in cement on Hollywood Boulevard, scripting feels like a small box in which to stuff your personality.
But enough commentary; let me get back to the point. This is classic resistance. There’s nothing wrong with it, this group is not dysfunctional, but they are not bought in. And if they don’t see the value of using key messages with patients, they sure can’t, or won’t support it. It wasn’t the staff who needed to look at scripting from another vantage point. It was the leadership. They hated the idea of forcing act one, scene one on their staff. No wonder it wasn’t catching on.
Swimming with the Current
I have a checklist I use whenever I travel. There’s nothing on the list that is so esoteric. It’s all basic stuff—toothbrush, shoes, phone charger, etc. I use it because when I don’t, I end up at Wal-Mart, hunting for a battery pack for my laptop. I’m not stupid, it’s just there are better things to do with my brain then remember all my travel items. That’s what the checklist is for.
Key words are a verbal checklist. Whether it’s teaching a medication, rounding in the rooms, or admitting a new patient to the floor, thereare a few critical points you want to cover. My colleague, Bo Hansen, calls them Word Tracks—essential words or concepts that help patients feel important and cared for and help them understand and remember what we are teaching.
That was easy for the group of directors. They got it. They liked it. They could get behind a verbal checklist.
A View from the Shore
You’d think this story would end here. Mid-level leaders had a change of perspective and change of heart. So, all is good, right? Well, no, it wasn’t all good. This wasn’t just a perspective problem; it was also a role problem. What exactly, are these leaders supposed to do? That wasn’t clear at all.
In this initiative, the Patient Experience (PE) team members were frontline staff from throughout the hospital. They were the change agents--the champions who introduced key words to their work areas and talked it up with their co-workers. In the units, on the floors, and around the hospital, they were role-modeling with colleagues.
And where should the leaders have been? On the sidelines, supporting the effort. This wasn’t a group of lazy leaders; it was a group of clueless leaders. They didn’t realize that was their job.
Too often, we are dazzled by a breath-defying best practice. Behind each of those, there’s a set of core leadership skills that ground the team. While the staff is center stage, the leader is encouraging behaviors into habits and publicly connecting those new habits to the changing results. This leader is the authority figure who sets the stage for this new way of life, as an expectation. He or she ultimately manages the group’s performance, rearranging priorities, removing or navigating barriers, and addressing stragglers or non-conformers.
Ships Ahoy
Healthcare professionals are far from lazy—in fact, our field is known for being dedicated and innovative. We are accustomed to learning new techniques, implementing new procedures, and operating new equipment. We learn it, and then we turn around and do it.
Without any guidance for seeing their role as a sponsor and understanding how they function to complement their champion, it’s no wonder these leaders are treading water. The lifeline we need to throw is a leadership checklist, a few key words, and this ship will be soon set sail again. Here’s to the champions who lead this effort, and their unsung leaders, who chart the course and steer the ship. Aye , Aye, Captain!
Learn more about HealthStream Patient Insights/HCAHPS.
By Traci Hanlon MN, RN, Consultant at Creative Health Care Management
Health care organizations are now focused on achieving great clinical and financial outcomes in a value-based culture where service excellence and the patient experience play a significant role in how organizations are being reimbursed. Gone are the days of a fee-for-service culture.
This shift is transforming how health care organizations deliver care, prioritize organizational initiatives, and how we think about the patient experience. Savvy organizations understand there is a positive correlation between financial, clinical, and patient experience outcomes. Leveraging opportunities to become better in all areas using resources already available just makes good sense.
Preceptor Programs are Growing in Importance
It is well documented that preceptor programs have a positive financial return on investment for organizations. A study done by Beecroft et al (2001) estimates that the cost to orient a new graduate nurse is between $39,000 and $65,000 and that 30 percent of them will leave their place of employment within the first year. Fifty seven percent of new graduate nurses will leave within two years.
It is significant to note that poor training and lack of support systems are the main reasons nurses leave within that timeframe. (Patrick, 2000). Preceptor programs bridge the gap from transition to practice and have a positive financial impact on the retention rate of new graduate nurses.
Preceptor Programs and HCAHPS
What is not well studied or documented is the impact preceptors have on improving an organization’s HCAHPS scores.
Did you know that a significant number of preceptors who have been formally educated in precepting, and practice in organizations that have a formal precepting program, reported feeling more prepared to teach, and mentor nurses on practices that have been shown to improve the patient experience?
This qualitative information comes from focus groups I did with nurse educators and preceptors when exploring the influence preceptors have on transition to practice outcomes of new graduate nurses. It makes sense if you think about it. Formal preceptor programs demand the best of the best. Those selected to be preceptors are the individuals who are already engaged and active in culture changing initiatives and have had formal training in adult learning, communication, and the practice of creating healthy work environments.
Improve Care and Improve HCAHPS Scores
Let’s face it; none of us went into health care to improve scores. We wanted to make a difference in the lives of others. It just so happens that when you build healthy environments that nurture self, each other and the patient, scores across the board improve.
Preceptors are the point-of-care staff who role model therapeutic relationships and then as part of their formal teaching role, teach the specifics of how to build and sustain trust with their patients. This is the heart of the patient experience, and if done well, will not only improve an organization’s clinical outcomes, but will also improve HCAHPS scores.
Investing in preceptors and a formal preceptor program is a critical link to improving financial, clinical, and patient experience outcomes. More importantly, it’s the right thing to do for patients.
Traci Hanlon MN, RN is a consultant with Creative Healthcare Management and specializes in preceptor, nursing orientation, and transition to practice program development.
SOURCES
Altier ME, Krsek CA. Effects of a 1-year residency program on job satisfaction and retention of new graduate nurses. J Nurses Staff Dev. 2006; 22(2): 70-77.
Beecroft P, Kunzman L, Krozed c. RN internship: outcomes of a one-year pilot program. J Nurs Adm. 2001; 31 (12): 575-582.
Lindy CN, Reiter P. The financial impact of staff development. J Contin Educ Nurs. 2006; 37 (3): 121-127.
Myrick F, Luhanga F, Billay, D, Foley V, Yonge O. (2012). Putting the Evidence into Preceptor Preparation. Nursing Research and Practice.
Patrick, S. (2000). Managers shoulder burden of retaining staff. Retrieved April 20, 2013, from http://www.bizjournals.com/dallas/stories/2000/08/14/story7.html?page=all
Wolf, J., Palmer, S. (2012). Voices of Practice: Exploring the patient experience in action. Highlights from on the road with the Beryl Institute.
By Steve Sasser, Chief Executive Officer, Assess Systems
At a time when hospitals are required to do more with less, the importance of having the right individuals in the right job becomes both a quality of care and bottom-line financial concern. The daily interactions between caregivers, patients, and their families create impressions that last long after the patient is discharged. Top performing employees demonstrate higher levels of patient care/service, increased satisfaction, and better engagement, all of which can ultimately impact your patient loyalty metrics.
While selecting for a specific skill set and experience (learned capabilities) is very important in the healthcare industry, identifying candidates who also have the natural tendencies (innate capabilities) to display the right behaviors and competencies to deliver a positive patient experience can contribute to higher HCAHPS scores. Our research with healthcare organizations has found that personality characteristics such as empathy, multi-tasking, frustration tolerance and collaboration, etc., while hard to see on a resume will become readily apparent on the job.
Yet, how do recruiters and hiring managers discern which applicants are the “right fit” from the applications they are inundated with on a daily basis? On paper everyone can look good, but who will ultimately perform well? Aberdeen’s Assessments 2013: Finding the Perfect Match report concludes that best-in-class companies incorporate the use of assessments as part of a well-defined section process to improve both the speed and quality of their hiring decisions. Additionally, these best-in-class companies utilize assessments throughout the talent lifecycle from recruitment through on-boarding, development, promotion, and succession planning.
Behavioral assessments, when properly chosen for the purpose intended and when implemented within a well-constructed selection process that include good training, offer many positive advantages:
- Improves and standardizes the decision making process by providing objective data for comparison between candidates
- Measures things that are difficult to train and hard to see in the interview such as:
- Positive service attitude
- Work pace
- Frustration tolerance; resilience
- Empathy
- Screens out candidates who are a poor job fit and help to identify candidates with high probability of success
- Enhances interviews with probes/suggestions based on the candidate’s specific results
- Provides hiring managers with additional insight into candidates, thus enabling them to more successfully on-board new hires
In a research study of entry-level employees in high patient contact roles, we found a strong relationship between behavioral assessment results and supervisor ratings of performance (see graph).
We are excited about our partnership with HealthStream and the opportunity to help their customers make better hiring, placement, and promotion decisions for their workforce by using behavior-based, non-clinical assessments designed for the healthcare industry: Select for Healthcare™ and Assess for Healthcare™.
When coupled with Healthstream’s research, learning, and competency solutions, we have an important, unifying purpose – to help our customers improve healthcare.
Learn more about HealthStream's workforce solutions from Assess Systems.
By Todd Sorenson, Consultant (HCAHPS & Other Surveys), HealthStream
Statistics provided by the Centers for Disease Control reveal that there were 136.1 million emergency department visits in the U. S. in 2009, with over 17 million of these visits resulting in inpatient hospitalizations. Nationally, roughly 50% of all inpatient admissions come through the ED.
Research performed during the HCAHPS testing period several years ago found that patients admitted through the Emergency Department rated care across all dimensions of care more negatively than those patients admitted through other avenues. HealthStream has documented this occurrence as well, summarized by the results of a study done in 2012.
|
HCAHPS Dimensions of Care Mean Scores By Type of Admission |
|
Measure |
Admitted through ED |
Not Admitted through ED |
Difference |
|
Communication with Nurses |
3.68 |
3.73 |
-.05 |
|
Communication with Doctors |
3.67 |
3.75 |
-.08 |
|
Responsiveness of Hospital Staff |
3.43 |
3.54 |
-.11 |
|
Cleanliness of the Hospital Environment |
3.56 |
3.62 |
-.06 |
|
Quietness of the Hospital Environment |
3.40 |
3.52 |
-.12 |
|
Pain Management |
3.57 |
3.65 |
-.08 |
|
Communication about Medicines |
3.24 |
3.37 |
-.13 |
|
Discharge Instructions |
1.83 |
1.86 |
-.03 |
|
Overall Rating of Hospital |
8.68 |
8.86 |
-.18 |
|
Willingness to Recommend the Hospital |
3.63 |
3.67 |
-.04 |
This analysis revealed that inpatients who were admitted through the ED rated all HCAHPS Dimensions of Care lower than those who were not, most decidedly so for the Overall Rating of the Hospital, Communication about Medicines, Quietness of the Hospital Environment and Responsiveness of Hospital Staff. Previous research conducted by HealthStream has also shown that hospitals scoring high on ED overall patient satisfaction tend to have high HCAHPS scores, while those with low ED overall patient satisfaction tend to have low HCAHPS scores. These data imply that experiences in the ED have an impact, either positively or negatively, on inpatient HCAHPS scores. 
While hourly rounding on patients, post-discharge phone calls and numerous other strategies have been shown to improve HCAHPS scores, many hospitals can also benefit from improving patient satisfaction in the ED to drive improvement on HCAHPS as well. Many of the same types of factors that drive the HCAHPS Overall Hospital Rating are also among the top drivers of the Overall Rating in the ED. Querying the HealthStream Emergency Department Database reveals the following items are the most highly correlated to the Overall ED Rating:
- How often did you feel that the care and services received during the visit were well coordinated?
- How often did the patient care staff do a good job of keeping you informed of delays in care or treatment?
- How often did you feel the doctor really cared about you as a person?
- How often did the nurses, doctors and other staff do a good job of working as a team?
- How often did the patient care staff do a good job of responding quickly to requests?
- During this hospital visit, how often did the hospital staff do everything they could with your pain?
- How satisfied were you with the amount of time the doctors spent with you?
- How satisfied were you with the total amount of time spent in the emergency department from arrival to discharge?
- How often did the patient care staff show the proper sense of urgency in treating your medical problem?
- How satisfied were you with how clearly and completely you were told what to do and what to expect after returning home?
From this list, the key drivers of the Overall ED rating include perceptions about the coordination of care, including teamwork and responsiveness of staff, the amount time spent waiting and keeping patients informed of delays, and the care provided by the ED doctors, in terms of time spent with patients and caring about patients as persons. How is your emergency department performing on these important factors?
With reimbursement dollars on the line, those involved in hospital quality and improving HCAHPS scores should not overlook the importance of the patient’s ED experience on how they respond to the HCAHPS survey.
Learn About HealthStream Patient Insights/HCAHPS Surveys.
Read Consultant Bo Hansen's blog about HCAHPS and the Emergency Department, with prescriptive advice for hospitals.
By Gwen Faust, Consultant, HealthStream; Sarah Kresnye, MBA, Director, Client Services, CHAMPS Patient Experience; and Carol Santalucia, MBA, Vice President, CHAMPS Patient Experience
A field that has been developing over the past 20+ years, patient navigation has recently gained national attention as the American College of Surgeons’ Commission on Cancer has mandated patient navigation services for accreditation beginning in 2015.
What is Patient Navigation?
Patient navigation is a process in which an individual guides a patient through and around barriers to care and virtually integrates a fragmented and complex healthcare system. The barriers address by a patient navigator may fall into a number of categories, including[i]:
- Financial
- Cultural
- Communication
- Transportation
- Bias based on culture/race/age
- Fear
By working to eliminate these barriers, patient navigators ensure that our patients receive access to timely care thereby increasing their length and quality of life.
The History of Patient Navigation
Pioneered at Harlem Hospital Center in 1990 by Dr. Harold P. Freeman, patient navigation focused on the critical window of opportunity to save lives from cancer by eliminating barriers to timely care between the point of suspicious finding and the point of resolution by diagnosis and treatment. The program compared 5-year survival rates of breast cancer patients who were navigated to those who were not. The study demonstrated a 5-year survival rate of 70% for patients who worked with a Patient Navigator to that of 39% for those who did not.[ii][iii]
Since its inception as a community-based intervention program, Patient Navigation has expanded and transformed into a nationally recognized model that extends well beyond cancer care to include the timely movement of an individual across the entire healthcare continuum.
The Business Case for Patient Navigation
Patient navigation is not only the right thing to do; it’s the smart things to do. In addition to the many benefits it can provide to patients, families, and communities, robust programs can also provide many benefits to the organization.
For example, by reducing no-shows, cancellations, and redirecting ED patients to more appropriate resources, hospitals that took part in a pilot program in Cleveland, OH, saw a return on their investment of anywhere from 2.5 to 6 months. After this time, the patient navigator’s work contributed solely to the bottom line of the organization.
Learn More about Patient Navigation
We invite you to learn more about Patient Navigation and its impact on your organization and patients. Carol Santalucia, MBA, Vice President of CHAMPS Patient Experience will be presenting on the topic of Patient Navigation during our July Webinar. Carol will also speak about the benefits of patient navigation at one of the many exciting breakout sessions at HealthStream Summit 2013 in Nashville, TN, October 15-17.
In the meantime, for more information on developing and implementing patient navigation programs please visit www.champspatientexperience.com. And get your questions on patient navigation answered by leaving a comment on CHAMPS Patient Experience’s blog: www.pxperspective.com.
[i] 2Freeman HP. Voices of a Broken System: Real People, Real Problems. President's Cancer Panel: Report of the Chairman 2000-2001. Reuben SH, ed. Bethesda, Md: National Institutes of Health, National Cancer Institute; 2001.
[ii] Oluwole SF, Ali AO, Adu A, et al. Impact of a cancer screening program on breast cancer stage at diagnosis in a medically underserved urban community. J Am Coll Surg. 2003;196:180-188.
By Bo Hansen, RN, MBA, Consultant
Like it or not, first impressions are lasting; and, if they are negative they can be difficult to overcome. We don’t get a second chance at first impressions! They are deeply embedded in our memories and often turn into a lasting prejudice with hefty price tags attached. The cost of being indifferent, unkind, careless, non-communicative, or unprofessional may cost someone the opportunity of a great job or thwart a new friendship. In the case of patients’ first impressions of a hospital, a negative one may cost the hospital hundreds of thousands of dollars in CMS reimbursement, and it may take the hospital years to regain the trust of its community.
First impressions Count
First impressions to patients admitted through the emergency department (ED) are powerful. Visits to the ED are always unplanned and disruptive of lives, and they may be life altering. Whether patients suffer minor injuries, unexplained illnesses, or severe trauma, they arrive at the ED, often alone, in a state of fear and worry about what is going to happen to them. They are not in control of their life; they feel helpless and vulnerable. How they are received by the first person of contact is critical to their impression. Is the person friendly, making the person feel like he is in good hands? Trusting that we will be safe when we are vulnerable is critical. Patients trust that the doctors and nurses will treat their physical illness and injuries. Equally strong is their trust that the same physicians, nurses, and ED staff will comfort them, calm their fears, and reassure their loved ones. Violating that trust can be a serious mistake in terms of damage to the hospital’s reputation, patient loyalty and HCAHPS scores.
High scores in ED equates to high H-CAHPS scores
We know 50 to 60% of all inpatients are admitted to the hospital through the emergency department. Since the inpatient HCAHPS survey asks questions of discharged patients that are prefaced by the words “During your hospital stay,” it means that more than half of all inpatients include their ED experience in their feedback in the post discharge survey.
In an effort to better understand the relationship between the ED experience and the inpatient experience, HealthStream completed a study of 551 hospitals that surveyed both their inpatients and their ED patients. One important finding of the study showed that patients admitted through the ED scored significantly lower on all HCAHPS measures than those who were not!
The study also revealed that hospitals that score high on ED Overall Satisfaction also tend to have high HCAHPS scores. This relationship is stronger in higher-performing hospitals than in lower-performing facilities. We can conclude that hospitals with high patient satisfaction scores in the ED are likely to see that satisfaction carry over to inpatients who are admitted through the ED. Consequently, hospitals that want to maximize their chances of high HCAHPS scores and associated reimbursement should take a close look at how their EDs are performing.
First Impressions That Pay (We Are Talking $Millions!)
The degree of care, kindness, timely information, and attentiveness that the patient and family receive from ED staff determines the first impression of the hospital. Beyond the best practices most commonly discussed, such as rounding, smiling, clear explanations of pending tests and results, etc., what else could the ED staff contribute to meet the patients’ expectations of hospital experience?
From my days as an ED staff nurse and manager, I have a few examples of how the ED staff can enhance patients’ ED experience. There are many more than the ones I have listed, but these address some of the areas of opportunity that I see in EDs today:
- Hire the right people with the right attitude to greet your patients and families.
- Replace silos with bridges. Know the value of reaching out to other departments. Let them know you are friendly. (ED staff sometimes has a reputation of being grumpy with their colleagues in other departments). Ask what you can do to help speed up the transfer of patients from the ED to their unit. Would it help if the ED nurse starts the care plan, the doctor’s orders right away? Getting the patient transferred to a unit is not THEIR (the unit’s)problem, it is OUR (everyone’s) goal to make it happen!
- Adopt an attitude that tells patients you understand their sense of urgency. Once admitted, your patient wants to get out of the ED and into a bed to start treatment, recovery, rest, and healing. He doesn’t understand why it can’t happen right now! Be empathetic and keep your patients updated at least every half hour on how long it will be before they can get to their bed.
- If your patient is spending extended time in the ED, treat them like guests. Keep up with the comfort measures. Offer extra pillows, blankets, ice, juice, or snacks.
- Start the care plan if your patient is held more than two hours in the ED after being admitted. It is the right thing to do for your patient.
- Being one team with a shared goal is one of the fundamental requirements for creating a positive patient experience. Include ancillary and support staff in department meetings. Make sure your phlebotomists, IV team, radiology technologists, housekeepers, and registration staff have the attitude and training that provides the first class service experience that you intend for your patients.
- Act in a way that makes the patients glad they chose your hospital for their care.
- Every time we are in front of our patients, we are “on” or as Disney describes it, we are “on stage. ” How well we perform determines the lasting impression with leave with our patients.
- Pretend you are a patient in your ED. How would you rate your ED experience?
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