9Readiness Rounds Presents

THE ApproachesThat must bePERFECTLY EXECUTED

To Improve & Sustain Patient Satisfaction & Experience

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Patient Satisfaction & Experience

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The health care industry hasstruggled with patient satisfactionfor many years. The introduction ofValue Based Purchasing and theattachment of a financial rewardor penalty with HCAHPS scoresturned what had been for manyyears an interesting look athistorical data into an importantpart of daily operations.

Improving and sustaining patient satisfaction and experience is as much about systems as it is

about smiles.

You need both strong systems and welcoming smiles.

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The NEED for ChangeSome Fundamentals

There is no “silver” bullet. There are key elementsthat need to become a part of your hospital's DNA toexcel in patient satisfaction.

Action must be taken while the patient (inpatient &outpatient) is within the continuum of care. This isabout identifying issues and correcting in “real time”.

It’s not just a nursing responsibility. Theaccountability must be effectively deployedthroughout all hospital management.

It’s beyond just rounding and talking to patients. Itis excellence in all aspects of visible operations.

"Real Time" electronic capability is non-negotiable. The volume and speed of executiondemanded will overwhelm any manual system.

Don’t stop at "Yes". There is often significantdisconnect with customer satisfactionresults obtained internally and post-discharge.

It is all about customer service recovery. Focus onrapid service recovery and the results will follow.

It’s not just the HCAHPS calculation. With rapidlyincreasing transparency, these results will continueto play a bigger part in patient selection of hospital.

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What hasn't worked...

Post-discharge satisfaction surveys often hurt theprocess more than help. Use of HCAHPS as thescoreboard, after all, is where the financial calculationwill be made and the public satisfactionnumber established.

The analysis and planning of improvement from post-discharge patient surveys complicates the process. Staffis frustrated as the time between patient input, hospitalactions, and positive results is spread far apart and thedata is essentially unbelievable. This type of responsehas typically resulted in endless meetings with very littlemeasurable progress.

Prompting and influencing the patient in an attempt toobtain a good score is unreasonable and ineffective.

Looking at data 6-8 weeks old and expecting to develop effective

strategies... ...is like playing tennis but

only watching the scoreboardand expecting to win...!?

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Getting StartedThe Key Elements9

"Real Time"

The speed required to beeffective and the diversity ofresponse points demand "realtime" capability.

"Real Time" Follow-Up: If theperson identifying the issuecannot correct it (ideally they will),then the electronic platformsupporting the processmust immediately dispatch therequest for correction.

"Real Time" Results: No morewaiting for results. If you arenot seeing today’s resultstoday, then it’s not "real time", it'sa historical review.

think about it...If banks processedinformation at the samespeed as health care,an ATM transactionwould take a day.

But fir

st!

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1 Customer ServiceAttitude

Greeting, Welcome, Appreciation

Professional Telephone Presence

Confidentiality and Privacy

Respect

Environment

Eye contact, smile, use the patient's last name, and introduce yourself. Provide direction and assistance, don't just point.Wear readable ID badges at shoulder level.Acknowledge others by using "please" and "thank you".

Minimal use of voicemail. Answer in 3 rings. Introduce yourself.Get approval to put on hold.Ensure transfer extension is correct.End call with "thank you" and offer of future assistance.

Knock on patient door, pause, wait for response, indicate who you are.Emphasize importance of privacy... preferences for curtains and doors.Act in accordance with HIPAA. Respect co-workers privacy.Avoid discussing personal information.

Recognize, respect, and respond to the diversity of customers and staff.Protect the dignity of customers.Demonstrate genuine interest by using "yes" and phrases such as "I'mhappy to help you", and "I have the time".

Personal ownership of the environment. Pick up trash, workplace is neatand tidy, minimal wall signage, etc.Reduce noise in patient care, work, and public areas.Report any safety issues.

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2 Don't Stop at "Yes"When conducting patient care rounds or patient interactions, ournature is to be looking for a "yes". "Yes" means it’s "all good and Ican move on."

There are often major disconnects with patient feedback received while at hospitalwith what is from subsequent surveys.

o The low return rate of surveys.o Only people who are upset or delighted complete surveys.o While in care continuum, there is an inherent fear of reprisal for many patients if acomplaint is made.

Don’t Stop At "Yes"o Remember "yes" can often just be avoidance.o Don’t challenge the validity of the answer.o Have a script if the answer is "yes".

Example of not stopping at "yes" in a patient interview:o "Is the nursing care meeting your needs today?" – “Yes”.o Follow up script: “Excellent. What is the best part of the care from yourperspective?”o Be watchful of hesitation or generalizations - don’t badger but gentlycoax response as appropriate.

"YES"

The Restaurant ExampleHow often are you asked when eating out "how is everything"?

4-5 times?How often do you answer "everything is fine"?

99% of the time?How often is your actual experience less than fine?

75% of the time?

What might happen if you replied "everything is fine" and the nextquestion was, "Excellent, what has been the best part of the meal?"

Some reasons for this disconnect are:

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3 EnvironmentCleanliness

Food Maintenance

NoiseFirst

Impressions

Most patients cannot judgequality of medical care.All patients will judge the environment.

Must be "top class" all the time.Rooms checked and cleaned daily.Consistent high-gloss floors.Hotel finish.

Cosmetic maintenance mustbe excellent.Ceiling tiles with no stains.Chips/marks found on walls/doors fixed.

No hallway clutter.Wall signage: professional, printed, minimal.Furniture in good repair and appearance.Rooms not overcrowded.No staff on break in public spaces.

No overhead paging; overall noise low.Staff using low voices.No audible nursing station-to-hallwaydiscussions.Consider a visual decibel reader.

Room service.Variety of snacks and meal choices.Just dropping off meal tray unacceptable.

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4Communication Boards

! If you do not complete themALL of the time, take themdown. They are hurting you.

Launching this type of board is a major organizationalinitiative, requiring a lot of resource time. Well-executed,it has an enormous impact on inpatient satisfaction.

The most overlooked issue with communicationboards that is if they are not kept completed and up-to-date ALL of the time they will drag down your satisfactionresults. The negative impact of incomplete boards cannotbe overstated, not just for the patient, but also the family,significant others, and visitors in the room.

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5Hourly Rounding 5 PsThe

1. Rounds every hour2. The 5 Ps:

How it Works: PPainPositionPottyPeripheryPump

3. The Script:

"I'm here to do rounds. How is your pain? Do you need to use the restroom? Doyou need help to reposition (or get up, or get back to bed)?" Once the patient'sneeds are met, the nurse should make sure the call light, telephone, TV remote,bed light, bedside table, and tissues are within the patient's reach. The nurseshould also see if the IV bags or lines need to be changed and ensure any pumpsare set correctly. Before the nurse leaves the room, ask "Is there anything else I cando for you? I have the time"

Why it Works:1. Reduces patient concern and anxiety.2. Ensures increased patient comfort.3. Increases patient perception of care (HCAHPS).

The Benefits:1. Greater patient satisfaction.2. Ensures regular patient contact.

This is a vitally important inpatient nursing practice. The challenge is executing thecultural shift to making this second nature. This is not about documentation, oradvanced care practice, or anything other than back-to-basics and consistent nursingpractice. And the best part? It improves outcomes!

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6Executive Leadership

Senior Leadership (CEO, CNO, CFO, CMO, etc.)

Ensuring that front-line staff have the tools, training andresources to consistently deliver exceptional care.

Why it Works:1. Reinforces hospital staff and physician leaders' commitment topatient satisfaction and safety.2. Ensures regular communication between executives,department managers, and staff.3. When staff sees management commitment, it provides thefoundation to drive sustainable improvement.

How it Works:1. Executive meets with department manager, as well as staff.2. Executive gathers feedback on wide range of operational issues.3. Scheduled to ensure all departments are visited.4. 30-60 minutes per department.5. Automated follow-up on items that need attention.

The Benefits:1. Staff sees the executives "walking the walk", not just "talking the talk."2. Department-based accountability for results.

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7Inpatient Rounding

Why it Works:

How it Works:

The Benefits:

Every Patient

Every Day

It's not just anursing responsibility

...assign the entire management

team.

1. Launches service recovery during stay.2. Reduces patient concerns and anxieties.3. Ensure nursing routines are completed regularly.4. Increases patient perception of care (HCAHPS).

1. Assigned to entire hospital management team on rotation basis.2. 5 - 10 minutes per patient interview.3. Every patient, every day.4. Tablet/iPad/iPhone deployment.5. Fully customizable template.6. "Real time" notification for items requiring follow-up.7. "Real time" delivery available of Dashboards and Reports.

1. Improved patient experience.2. Perception of care increases.3. Department-based accountability for results.

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8Outpatient RoundingEvery Patient

Every Day

Why it Works:

How it Works:

The Benefits:

1. Launches service recovery while patient still in facility.2. Reduces patient concerns and anxieties.3. Ensures nursing routines are completed regularly.4. Increases patient perception of care (HCAHPS).

1. Feedback gathered and reviewed before patient leaves.2. Immediate correction in most cases.3. Every patient, every day.4. Tablet/iPad/iPhone deployment.5. Fully customizable template.6. "Real time" notification for items requiring follow-up.7. "Real time" delivery available for Dashboards and Reports.

1. Service recovery improves patient experience.2. Increased perception of care.3. Department-based accountability for results.

At Checkout :Feedback collected

ANDacted on

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9Discharge Follow-UpCalling

Using Teach-Back to Reduce Readmissions

Why it Works:1. Confirms understanding of discharge instructions and medications, etc.2. Confirms follow-up appointments.3. Reduces patient concerns and anxieties.4. Increases patient's perception of care (HCAHPS)

How it Works:1. Tablet/workstation deployment.2. Fully customizable template.3. Centralized resource completes patient call by the second day afterdischarge.4. 5 - 10 minute per patient interview.5. "Real time" notifications for items requiring follow-up.6. "Real time" delivery available for Dashboards and Reports.

The Benefits:1. Increased perception of care.2. Reduction in medication errors post-discharge.3. Positive impact on readmission rates.4. Department-based accountability for results.5. Improved patient compliance with discharge instructions =improved outcomes.

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The 9Customer Service Attitude

Don't Stop at "Yes"

Environment

Communication Boards

Hourly Rounding "5 Ps"

Executive Leadership Rounds

Inpatient Rounding

Outpatient Rounding

Discharge CallingTM

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Readiness Rounds1 (800) 705 - 3401

readinessrounds.com