How to Avoid "Teaching to the Test" for HCAHPS Score Improvement

A recent report by Press Ganey identified communication with nurses as a "rising tide" patient experience measure — one that influences a host of other HCAHPS measures, including responsiveness of hospital staff, communication about medication and overall patient experience scores. Hospitals could potentially affect 15 percent of their Value-Based Purchasing incentive payments by focusing their improvement efforts on the nurse communication metric, according to Press Ganey's research findings.

 

Instead of focusing on HCAHPS scores as an end in itself, healthcare leaders should devote resources to improving the components of patient experience, according to Christy Dempsey, Chief Nursing Officer of Press Ganey. "A focus on nursing and nurse communication is key to improving patient experience — the clinical, cultural, behavioral and operational aspects of care we provide. The natural consequence of this focus is improvement in [the HCAHPS] score. It's not a focus on the score, but on the quality that drives the score," she says.

 

Nurse communication best practices
As an important element of patient experience and healthcare quality, nurse communication should be a focal point of patient experience improvement efforts. Hospitals can improve nurse communication by implementing best practices such as hourly rounding, bedside shift reporting and using scripts, according to Ms. Dempsey.

 

Bedside shift reports make nurses' shift changes transparent to patients by conducting the handoff at the bedside instead of at the nursing station, as is traditionally done. The outgoing nurse informs the incoming nurse about the patient's condition, goals for the patient and discharge plans. Providing this information at the bedside keeps patients informed and gives them a greater sense of autonomy in their care, which improves their experience, according to Ms. Dempsey.

 

Using scripts is another nurse communication strategy that can impact patient experience. Scripts can be keywords and phrases, or entire paragraphs that ensure nurses communicate key information to patients. For example, a script for informing a patient of a certain diagnosis may include an explanation of what the diagnosis means and treatment options. While scripts can help nurses remember important information to tell patients, they are effective only if nurses tailor them to their personal style so their explanation doesn't sound stilted and impersonal, according to Ms. Dempsey. "Allowing the person delivering the message to help create the way [he or she is] going to talk about a topic is important so it doesn't come across as scripted," she says. She suggests role playing to help nurses feel comfortable communicating standard information in their own way.

 

Integrating bedside shift reports, scripts and other strategies into everyday practice drives long-term improvement in nurses' communication with patients, which translates into a better patient experience.

 

Listening to patients
Equally important as talking to patients, listening and responding to patients engages them in their care, leading to a better experience. "Listening helps patients feel like communication is going both ways; they feel more autonomy and control over their care," Ms. Dempsey says. "Upon entering a hospital, they have lost almost all control. The more you can give back through communication, the better."

 

Ensuring two-way communication with patients helps nurses establish a relationship with the patient. Since nurses are the providers who tend to spend the most time with patients, this personal connection offers continuity for patients.

 

Ongoing training
Hospital leaders should provide ongoing communication and patient experience training for nurses to continually reinforce the value of patient-centered care, according to Ms. Dempsey. Providing training on an ongoing basis ensures patient experience efforts are not a one-time project, but a part of the culture of the organization.

 

Establishing standard protocols for nurse communication with patients and providing ongoing training will help to ensure improved communication in the organization, contributing to a patient-centered culture that ultimately results in higher HCAHPS scores.

 

More Articles on Patient Experience:
Hospitals Aim to Curb Burnout, Boost Patient Experience With Art
How and Why Emotional Intelligence is Affecting Hospitals' Bottom Lines
Federal, State Programs Focus on Outpatient Patient Experience

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