Best Practices: Crozer-Chester Medical Center VHA RAN Team Aspires to Improve Patient Satisfaction with Nursing Communications
In 2009, a team from Crozer-Chester Medical Center began work on a VHA Rapid Adoption Network (RAN) project focused on improving Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores related to three nursing communications questions:
1. How often did the nurses treat you with courtesy and respect?
2. How often did the nurse listen carefully to you?
3. How often did the nurse explain things in a way that you could understand?
CKHS scores in this domain had taken a dip, averaging 70 percent versus the system’s goal of 78 percent for fiscal year 2009-10. Crozer VHA RAN team leader Karen Canning, RN, MSN, clinical nursing director, 2 North, and Betty Drozd, director of Quality at Crozer, began addressing the challenge at the VHA Clinical Design Day held in October 2009 where they discussed best practices and learned skills for observing and identifying opportunities for improvement.
After returning to Crozer, Canning and Drozd began observing the way that nurses communicate, listen and observe over a one-month period. The two noted that the nurses frequently seemed busy to the point of being rushed while in patient rooms. Although patients appreciated the skill and efficiency of their nurses, many expressed the perception that the nurses seemed so busy that they “didn’t want to bother them” because they “didn’t seem to have time.”
Canning and Drozd started working on solutions, and went to the Nurse Quality Council and the Nurse Practice Council for assistance. After dividing the council members into three teams, they assigned each team one of the three HCAHPS questions and asked them to develop ideas that would be quick and inexpensive to implement, as well as help to improve scores.
Based on these ideas, Crozer’s VHA RAN team launched a 90-day pilot program in March 2010 on two units – 2 North and the Stepdown Unit – to implement the following changes.
1. The team designed new nurse communication white boards, with feedback from the Nurse Management Council, to be hung at the end of each patient bed. Previously, the white boards had space for the date, nurse’s name, patient care assistant’s name, and the physician’s name. The new boards were designed to also include the room phone number and the number to call for TV and phone service. In addition, the team added space for a “patient goal for the day” and “Family Notes.”
2. To enhance courtesy and respect for the patient, nurses now ask, “What would you like to be called?” and note it in quotation marks on the patient’s white board.
3. The team organized in-services to help nurses improve listening skills and understand the teach-back method in which patients repeat back to the nurse what they heard. Also emphasized was the importance of taking five minutes in the morning to sit down and talk with the patient instead of immediately rushing to the next room.
4. On 2 North, Canning initiated walking rounds with Crozer Patient Representative Terry Lynch, a fellow VHA RAN team member. During the pilot, the two visited five to ten patients daily on this 35-bed unit, asking patients all of the HCAHPS questions and using their feedback to coach nurses on any areas for improvement.
“Walking rounds is one of the most important changes we’re implementing because it enables us to address any issues immediately,” says Canning. “Something as simple as having a broken call button fixed right away means a lot to a patient.” During rounds, the team encourages patients to fill out their patient satisfaction surveys, and they have already noted an increase in the number being completed. “We expect to see other positive gains from walking rounds,” Canning adds.
5. On the Stepdown Unit, the nurses write their Spectralink phone numbers on the patient white boards. “If an urgent need arises, the patient can call his or her nurse directly instead of putting on the call light,” notes Canning. “This additional link to the nurse is reassuring to the patient and increases satisfaction.” Initially, the nurses were concerned about the number of patient calls they might receive, but this has not been a problem.
During the pilot period, HCAHPS scores in the nursing communications domain reached 75 percent on 2 North, an 8 percent improvement, and 77 percent on the Stepdown Unit, up 5 percent.
“We’ve had nothing but positive feedback on the new white boards,” says Canning. “Nurses find them a helpful tool for communicating with their patients each day. Families write on them all the time, and physicians have commented about their usefulness.”
As a result, the new white boards have been expanded to two more Crozer units – 2 South and 2 East. Canning plans to present this successful initiative to the Executive Nurse Council and propose implementation throughout Crozer and, ultimately, collaboration on a system wide approach.
Crozer VHS Rapid Adoption Network Team – Nursing Communications
Karen Canning, RN, MSN, leader
Connie Sonder, RN, BSN, MBA