The patient experience just got more complicated for hospitals

According to the Beryl Institute, the patient experience – the sum of all interactions that influence patient perceptions across the continuum of care at a hospital – will be one of the top three priorities for healthcare leaders over the next three years.

Focusing on this, studies say, will help hospitals realize better patient satisfaction and HCAHPS survey scores, as well as increase reimbursement and marketing advantages.

As the industry grapples with the importance of a patient's total hospital experience, all of us are working to better understand what this means and how we can deliver on it. Amplion Clinical Communications, where I work, recently examined the expectations and experiences that patients and their loved ones/patient advocates have during hospital stays so we could better understand how that might affect the patient experience.

With our study, we were able to document and quantify what many of us thought might be true. Loved ones/advocates who accompany patients during their hospital care are also important to the perceived experience and quality of care a patient receives. But not only are loved ones an important influence, they are also harsher critics, setting a much higher bar for hospitals and nursing teams and giving nursing staffs far lower marks for responsiveness, communication and care coordination than patients did.

In other words, loved ones/advocates are tougher customers on hospitals than the patients that hospitals serve.

How we learned what we learned
We partnered with Catalyst Healthcare Research and surveyed 1,002 Americans about their experiences during recent hospital stays to better quantify their experiences, polling 502 patients and 500 loved ones/advocates who accompanied friends or family members during an overnight hospital stay. In addition to the quantitative review, we also conducted follow-up interviews with individuals from the initial study to probe deeper and record specific – both positive and negative – examples and experiences.

Because we believe communication is a critical component of care, we particularly wanted to better understand any communication issues between the patient, his/her loved one/advocate and the hospital staff, such as their responsiveness to patient calls and requests. In our view, while patients might not be able to judge a superior x-ray or an effective diagnosis, they can judge how compassionate and effective the various interactions they have with the nursing staff are, or how attentive the staff was to their needs. In many ways, that drives their perception of patient care at a hospital.

What we saw in the survey is that a majority of patients (60%) have loved ones/advocates actively supporting them during hospital stays. More importantly, in nearly every category surveyed in the study – from the range of feelings both groups felt about the care the patient received to how they would improve the hospital experience – the loved one/patient advocate consistently graded the nursing staff lower than the patient did in meeting the patient's needs.

In addition, fewer loved ones/advocates (46%) than patients (63%) said they were highly likely to recommend the hospital based on their perception. That's not good if you're trying to build positive word-of-mouth and repeat business!

We suspected that the loved one/patient advocate was a judge of patient care, but now we could validate that assumption. Plus, we were able to see just how powerful they might be in judging the quality of interactions and care their loved one received.

What does this mean for nurses and hospitals?
For sure, there were positive findings for nurses and hospitals in the study from both patients and their loved ones/advocates. For instance, the vast majority of patients (95%) and loved ones (91%) said how the nursing staff handled communication and care coordination had a significant impact on their overall hospital experience. But, there's no escaping the importance of the loved one/patient advocate in the care equation and the need for thorough, compelling communications between all three parties – the nurses/nursing team/hospital, the patient and the loved one/patient advocate.

To go a step further, during an independent review of our study, the Caregiver Action Network (CAN) speculated that the presence of a patient advocate is probably even more prevalent than our survey indicated. According to CAN, the loved one/advocate who is in the room with the patient is also the person likely managing medications for the patient or carrying out the care plan once they leave the hospital. That person may also help fill out the hospital satisfaction survey. His/her impression of the care and service the patient received will, therefore, be critical. And it doubly emphasizes the need to include the loved one/advocate in all communications efforts.

So, given this finding, how can hospitals help their clinical staff deliver superior patient (and caregiver) experiences?
Certainly, it's not easy to be a nurse today. The level of care and attention they are expected to deliver, while adhering to (and documenting) all governmental and hospital policies, is sometimes overwhelming. Should staffing levels on a floor be lower than desired, an increased load is placed on nurses. So, in many cases, it is challenging for nurses to deliver the level of attentiveness they want to give to patients and their loved ones.

But they must. And superior nurses and nursing teams will somehow find a way to deliver on the ages-old promise of care and compassion that first attracted them to nursing.

To us, the difference maker is the importance of the communication that occurs with the patient and caregiver, even while the nursing team is stretched. Based on our study, and my daily work in hospitals across the country, I would like to offer the following recommendations that nurses, nursing teams and hospitals should consider implementing. Each could help improve communication and, by extension, the patient experience.

1. Turn caregivers into allies by making them a part of the care team. The hospital should educate the staff about the importance of including loved ones/patient advocates in caring for patients, both in the hospital and at home. As partners, these individuals can be significant supporters to nurses' efforts to provide quality patient care.

2. Prepare the clinical staff to work with caregivers. Build an empathic clinical staff that can effectively deliver care to the patient while also providing attention to the loved one/advocate. More and more, the advocate is becoming a key judge of care quality that nurses will simply have to pay attention to.

3. Create a culture of shared accountability. A superior nursing team will help each other respond to patient needs, not ignore a patient's call because "he's not my patient." When the entire team "shows up" and finds a way to help each other out by giving attention to the patient's needs, everyone wins.

4. Understand how caregivers impact the hospital's image and reimbursement. Every impression on the patient AND loved one/advocate matters. From the moment the patient arrives at the hospital to his/her dismissal, every interaction plays a role in the patient's overall impression of the care they receive. Poor performance by one member of the hospital team can degrade the entire team's performance. Hospitals should recruit, train and retain staff that understands the service side of the care that EVERYONE should experience.

5. Provide consistent quality patient care. Hard wire consistency into patient care. Hospitals should ensure quality patient engagement is replicated throughout the care team, measuring for effectiveness and tracking for improvement.

6. Embrace smart technology that facilitates better patient care and patient caregiver attention. In today's environment, nurses and nursing executives have to be able to triage communications from patient rooms; ensure patient needs are being addressed quickly and appropriately; track delivery of care; and tap analytics that demonstrate how well the nursing staff, particularly, is executing on the organization's protocols. A nurse's job is tough, and hospitals need smart technology to help these teams deliver on the quality of care promised.

At the end of the day, our study revealed that patients and their loved ones actually want the same thing – their needs met in a timely and high-quality fashion. Hospitals simply need the proper people, processes and systems in place to ensure care is delivered consistently while communicating with – and demonstrating that to – both patients and their loved ones. We've condensed this study into an eBook titled "Your Toughest Customers" that is available to anyone who wants to download it here.


About the author
Brenda Aubin, RN, BSN, is a life-long practicing nurse and, today, the Clinical Integration Manager for Amplion Clinical Communications. She joined Amplion in 2013 after spending 34 years as a nurse and nurse executive at Androscoggin Valley Hospital. In her role as Amplion's Clinical Integration Manager she helps hospitals implement the Amplion Alert system and trains their staffs to ensure positive outcomes. Amplion combines advanced nurse call; messaging and reminders; alarm management; and reporting in a single system to help nursing teams track, manage and confirm care delivery for every patient – the first care assurance platform for hospitals.

The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.​

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