Nurse Communication, Teamwork to Boost Care Experience Scores

Healthcare organizations must identify evidence-based strategies to support nurse communications and patient perceptions of caregiver teamwork to improve on patient care experience scores, concluded a new Press Ganey report obtained in an email.

Patient experience consulting firm Press Ganey conducted an analysis of HCAHPS scores from between 2013 and 2017 to better understand how patient perceptions of care have changed over the past half-decade. The analysis also looked into the factors that drive a better top-box score, defined as a nine or 10 on a 10-point scale of overall hospital quality.

“Taken together, the findings indicate that hospitals and health systems are continuing to raise the bar on the experience of care they deliver despite the many challenges facing the health care industry,” the organization wrote in the executive summary of its report. “They also offer insight into the specific types of improvement that are most likely to drive performance in patients’ global ratings of their care.”

As objective hospital quality improved, so has patient experience, Press Ganey concluded. In 2013, the percentage of patients giving their hospitals a top-box score was 70.3 percent. By 2017, that number rose to 73.3 percent, an improvement rate of 0.6 percentage points annually.

“The parallel improvement in safety, quality and patient experience is not a coincidence,” the organization argued. “A growing body of literature demonstrates the interdependency of these care considerations.”

Past Press Ganey research indicated that a positive patient experience correlated with lower instances of hospital-acquired conditions.

The growing imperative to improve both patient experience and healthcare quality has prompted organizations to regularly look for the specific drivers that will improve overall patient perceptions of care. Through an analysis of HCAHPS scores, the Press Ganey researchers determined the top survey questions that influence a better top-box score:

• Staff asking patients if they have help when patients are discharged into their homes
• How well nurses explained healthcare concepts to patients and families
• How well nurses appeared to listen to patients and families
• Hospital room cleanliness

The Press Ganey team boiled these findings down into three main healthcare improvement imperatives, including nurse respect and courtesy, nurse friendliness, and teamwork amongst the clinical team.

Over the course of the study, 42 percent of hospitals improved in all three improvement imperatives, Press Ganey found. Of those hospitals, 86 percent were able to improve their top-box scores.

Conversely, 17 percent of hospitals did not improve in any of the three priority areas. Only 29 percent of those hospitals managed to make an improvement in their top-box scores.

Healthcare organizations looking to improve in these three priority areas – nurse courtesy, nurse friendliness, and teamwork – must look at evidence-based solutions. Drawing effective strategies from successful hospitals will be helpful, Press Ganey suggested.

For example, top-performing hospitals had nurses who employed proven communication strategies, communicated with great transparency, and facilitated shared decision-making between the care team and the patient.

Other top-performing hospitals had a specific structure in place to drive care team coordination and cooperation. Multidisciplinary councils were helpful for these hospitals, Press Ganey found.

“By providing a framework for staff and leadership to share in responsibility, problem solving and authority, multidisciplinary unit-based councils give everyone in the unit a voice in the way patients are cared for and how staff are treated, and the practice encourages accountability and ownership of patient care outcomes on the unit,” the organization wrote.

Other effective score improvement strategies included hourly rounding, transparency about patient experience data, safety culture assessments, interventions that promote caregiver coordination, patient-centered communication, and shared decision-making with patients.

The good news is that, on the whole, patient experience scores are improving. As noted above, more patients are giving better scores to their hospitals at a rate of 0.6 percent. However, most of the hospitals that improved were those that had room to do so.

Hospitals within the bottom quartile for 2015 HCAHPS scores improved more in 2016 than those that ranked in upper quartiles in 2015. Hospitals with room for improvement indeed ended up improving.

Seventy percent of hospitals stayed in the same quartile between 2015 and 2016, the researchers found. Fifteen percent of hospitals moved up a quartile and 14 percent moved down.

These findings, coupled with the notion that patient experience scores generally improved during the study period, suggested that hospitals that do not make any improvements are in fact falling behind.

“To continue improving, organizations must commit to actively learning and implementing best practices, and holding themselves accountable for continually raising the performance bar,” Press Ganey concluded. “Given the important interrelationships between the patient experience of care and safety, quality and financial outcomes, flat performance in any one area increases the risk of falling behind in all of them.”

To prevent a drop in patient care experience rankings, hospitals must employ evidence-based strategies to drive performance in the key three areas: nurse courtesy, nurse friendliness, and care team coordination. In doing so, healthcare organizations can work toward better top-box scores and maintain better care quality and care experiences for patients.