Enhancing patient experience through nurse bundling strategies
Ron C. Carpio, DNP, MHA, MEDSURG-BC, NE-BC - firstname.lastname@example.org
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Federal regulations have shifted healthcare systems to focus more on providing quality of care rather than quantity of care. Patient experiences that include nursing communication are important quality measures that have positive impact on satisfaction ratings. The project used nurse bundling strategies (Acknowledge, Introduce, Duration, Explanation, Thank You [AIDET], purposeful/hourly rounding, and bedside shift report) guided by servant leadership principles to improve patients’ experiences and overall hospital quality of care experiences. Pre and post education on the bundling approach and servant leadership theory and principles, registered nurses in the emergency department completed an electronic, 23-item Servant Leadership Questionnaire (SLQ) survey and were also observed for eight weeks using validated measurement tools from the Studer Group. The SLQ survey was demonstrated statistically significant increase (p = 0.0191) from pre-intervention to post-intervention. Bedside shift reporting observations were the lowest reported strategy at 50% compliance. The Hospital Consumer Assessment of Health Providers and Systems (HCAHPS) survey that measured patient satisfaction scores did not improve from previous quarter data. Though the registered nurses were aware of servant leadership principles, further exploration was warranted to strengthen structures and processes related to nurse bundling strategies as well as patients’ perceptions of courtesy and respect, an HCAHPS measure.
As a former employee and nurse leader at the clinical site setting, this learner was aware of the gap in practice. Many hospital industries, including this setting, have used an outcome data survey such as the Hospital Consumer Assessment of Health Providers and Systems (HCAHPS) to measure patients’ perceptions of hospital care. The organization receives a quarterly report from Press GaneyÒ Associates (2019), a major distributor of patient satisfaction surveys. In this data report, all in-patient care units and ambulatory care settings including the emergency department (ED), were listed with their quarterly scores against the national mean benchmark. Because this organization was a three-time American Nurses Credentialing Center’s (ANCC) Magnet-recognized hospital (Providence Health & Services, 2019), these patient care settings must outperform five out of eight preceding quarters in each of the key topics in the survey, which included “Treated with Courtesy and Respect” in the “Communication with Nurses” domain (Centers for Medicare & Medicaid Services, 2019). With the latest quarterly report in December 2019 in the “Treated with Courtesy and Respect” topic, the ED showed zero out of eight preceding quarters of the expected outcome (S. Mendelson, personal communication, March 25, 2020). The data also showed a Top Box Score of 62.5 percentile in the ED based on the national mean benchmark of 66.1 percentile for EDs with over 100,000 visits per year. A top box score was the percentage of responses that patients respond as “Very Good” or “Always” in the survey (Press Ganey Associates, 2019). According to ANCC’s guideline, a unit or department must outperform the mean benchmark (S. Mendelson, personal communication, May 26, 2019) based on patient satisfaction scores.
Furthermore, processes or procedures were not being implemented at the clinical setting related to a bundling approach of practicing AIDET, purposeful rounding, and bedside shift reporting. AIDET is an acronym for the 5-step practice to acknowledge (A) the patient, introduce (I) oneself to the patient, inform the patient how long the nurse will be with the patient (D or duration), explain (E) what the plan of care is to the patient, and thank (T) the patient for taking care of him or her. Hospital leadership shared that nursing staff have shown inconsistent or lack of practices of these strategies based on observation (S. Silva, personal communication, August 13, 2019). Additionally, no formal auditing tool to monitor compliance existed for these strategies. This process was part of a survey question from Press GaneyÒ Associates (2019) that determined how often patients are visited by the nursing staff.
Several pieces of evidence provided direct correlation between patient experience and outcome measures such as overall hospital ratings, profitability, quality, and patient compliance (Gharai, Tapak, Bahrami, & Askari, 2013; Goh & Vehvilainen-Julkunen, 2016; Richter & Muhlestein, 2017; Skaggs, Daniel, Hodge, & DeCamp, 2018; Vogus & McClelland, 2015). Research studies by Goh and Vehvilainen-Julkunen (2016) and Vogus and McClelland (2015) revealed that patients who were treated with respect, courtesy, and compassion and who were provided with adequate communication and information were more likely to be satisfied with patient and overall hospital experience. Additionally, a study by Gharai et al. (2013) and Richter and Muhlestein (2017) showed a direct relationship between patient experience and a hospital industry’s financial outcomes and profitability. Consequently, a hospital can lose a significant amount of federal reimbursement that could be detrimental in the organization’s financial stability if patient experiences are not improved. Moreover, Skaggs et al. (2018) found that nurse bundling strategies of practicing AIDET, hourly or purposeful rounding, and bedside shift report have resulted in positive patient experience and overall hospital quality of care experiences. Finally, improving nurse-patient communication can make a difference between influencing patient compliance in their treatment plan and promoting strong emotional experience (Ahmadi-Kashkoli, Zarei, Daneshkohan, & Khodakarim, 2017), hence, the likelihood of patients returning to the hospital, or switching to other health care facilities due to negative experience. Therefore, implementation of the project was crucial in enhancing patient and hospital quality outcomes.
|Type||DNP Capstone Project|
|Review Type||None: Degree-based Submission|
|Evidence Level||Quality Improvement|
|Research Approach||Translational Research/Evidence-based Practice|
Bedside Shift Report
|Advisor||Teixeira, Mary Elizabeth;
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