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2013 CNL® Summit
January 17-19, 2013
Abstract Submission Form
Abstract title: Interventions to Improve Patient Perceptions of Nurse Communication
Author Name & Credentials: Danell Stengem, MSN, RN-BC, CNL
Institution: Texas Health Harris Methodist Hospital Fort Worth
City/State: Fort Worth, Texas
Primary Contact Email: Danellstengem@texashealth.org
Instructions: Please complete each of the following sections, when applicable. Each section
should contain between 50 and 250 words, using Times New Roman, 12 point font.
Background Information:
Communication plays an important role in the well-being of both patients and health care
professionals. Communication with nurses from the patient’s perspective works to assign value
to the patient’s perception of the care delivered. The patient feels validated when they are given
information concerning their care and thus they feel the nurse is knowledgeable and competent.
Communication skills are acquired and refined through practice. Evidence has suggested that
impaired communication can affect patient outcomes and many studies indicate that the
information that patients receive often fails to meet their needs.
The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey
questions; ‘Nurses treat with courtesy and respect ’, ‘Nurses explain in a way you understand’
and ‘Nurses listen carefully to you’ were identified by Texas Health Resources as the top 3
HCAHPS priority index items for improvement. HCAHPS is the first national, standardized,
publicly reported survey of patients' perspectives of hospital care. The Patient Protection and
Affordable Care Act of 2010 (P.L. 111-148) includes HCAHPS among the measures to be used
to calculate value-based incentive payments in the Hospital Value-Based Purchasing (VBP)
program, beginning with discharges in October 2012. Impact of the proposed VBP model will
affect Medicare payments for acute-care hospitals, within the United States, beginning with
October 1, 2012 discharges. Depending on the outcomes of the proposed performance
categories, a portion of the hospital’s Medicare reimbursement dollars is at risk (beginning with
1% in FY 2013 and growing to 2% by 2017).
Aim:
The aim of this project was to educate, promote, reinforce and hardwire the evidence-based
practices & interventions of a welcome folder, bedside report, hourly rounding, white boards,
leadership rounding and service recovery in an effort to improve the HCAHPS patient
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satisfaction scores related to nurse communication. Welcome folders, bedside reporting, hourly
rounding and whiteboards were implemented by this microsystem in September, 2011 but the
processes for these interventions were not clearly defined for the staff. The goal of this project
was to improve nurse communication scores by 5% during the project period of Februrary 1 March 17, 2012 based upon HCAHPS scores from Press Ganey.
Methods/Programs/Practices:
This project was conducted on a twenty-nine bed, acute surgical microsystem. Staff members
were asked to attend a 45 minute in-service presentation that educated them on implementation
of and rationales for techniques to improve nurse communication. Nurse communication inservices were offered at various times beginning on Februrary 6, 2012. All staff members within
the microsystem were asked to attend: RN's, LVN's, Patient Care Technician's, and Unit
Secretaries. Staff members received information on communication styles, value based
purchasing, and HCAHPS. Instructions were given for successful implementation of welcome
folders, bedside report, hourly rounding, and white boards. Staff members were also educated
briefly on the importance of healthcare literacy and immediate service recovery related to patient
complaints/concerns. An educational bulletin board was placed in the staff lounge to reinforce
key points of the nurse communication in-service education. Weekly nurse communication
HCAHPS scores were also posted on this bulletin board as well.
Nursing leadership rounding was perfomed by the Clinical Nurse Leader, nurse manager, or unit
supervisor daily during the project timeline. Daily leadership rounding was performed for every
patient within the microsystem. A scripting tool was developed to facilitate the rounding process
fo the leadership team. Patient complaints and concerns were addressed during leadership
rounding. Recognition was given to staff members when a patient mentioned them by name as
giving them exceptional care during leadership rounds.
Outcome Data:
HCAHPS nurse communication average percentile rank scores were compared pre- and postimplementation of this project. HCAHPS nurse communication average percentile rank scores
were 70% prior to project implementation (n=101) (September 1, 2011 to December 30, 2011).
HCAHPS nurse communication average percentile rank scores improved 20% after the project
implementation to the 90th percentile (n=100) (November 1, 2011 to February 29, 2012). Top
box trends or “always” ratings for all nurse communication questions increased immediately
after full project implementation beginning the week of Feb 12th. These scores were based on
received dates. Incidentally, HCAHPS physician communication average percentile rank scores
also increased from 79% to 92% during this same time period.
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Conclusion:
Initial findings suggest that the in-service communication training program for all staff members
within the microsystem and consistent leadership rounding were effective to improve patient
perceptions of nurse communication on the HCAHPS patient satisfaction survey. The
recognition that was given when patients identified exceptional caregivers during leadership
rounding was another key component to the success of this project. Staff members who received
recognition for their exceptional care then felt validated in their efforts to implement the
interventions of the project. Transparency of HCAHPS scores provided the staff with a visual
reminder of how patients perceived the staff members efforts in communicating with them.
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