In my career at Studer Group, I have had many conversations with leaders who will often voice this frustration: “When I round on my patients, they tell me great things about their nurses and say how happy they are with their care, but the surveys tell a different story. What’s going on?” If you are like these leaders, and patient experience survey results do not match what your patients are saying, take a closer look at the kind of information you are getting when you round. Many leaders ask patients, “Are you satisfied with your care?” While we want our patients to be satisfied, asking a question that measures “happiness” does not indicate how we are caring for our patients and does not give us direction as leaders. To get a better gauge of the patient experience, you must dig deeper. When you round, try asking questions that more clearly expose the gaps in patient care that affect your survey results.
Leader Rounding on Patients – Getting It Right
When you round on patients, ask questions that will give you actionable data. Then use that information to create simple reports that reveal what your patients are really experiencing and what you can do to improve their care.
- Ask patients why they use their call lights: Create a checklist with typical patient responses, and check off why the patient used their call light. Once you uncover a problem area, you’ll know better how to coach your team. For instance, if patients are consistently using their buttons to call for pain medicine, you now know to focus on strategies that specifically address pain management. Call light usage often means we are not proactively meeting our patients’ needs, and this gap may negatively affect HCAHPS responsiveness, pain, communication and overall rating results.
- Review the communication board: When you round, audit each patient’s board to make sure it is updated, complete and written in terms the patient can understand. Create a checklist, and during each round, write down any missing or incomplete elements. The communication board is the link that ensures that everyone is on the same page about the patient’s plan of care and serves as a visual reminder to the patient of what to expect and what we are doing for them. If the plan of care is missing on a patient’s board, it can contribute to low results in the care transitions composite. Also, keep in mind that some patients are admitted to the hospital from the emergency department (ED). An incomplete ED communication board can cause lower HCAHPS survey scores in the nurse communication composite. Creating an organization-wide standard for care boards is key to building consistent cross-departmental communication.
- Ask patients to describe the education they received before coming in for surgery. If a low percentage of patients can confirm the instructions you gave them, there is work to do. In the ambulatory setting, patient education can affect several domains on the OAS CAHPS survey (before your procedure; communications about your procedure; your recovery.) It is important to get this communication right by using key words, the teach-back method and clear language when instructing our patients.
The Importance of Data
Recently, I was meeting with a nurse leader whose unit had low results for responsiveness. As we were preparing to round on patients I asked, “Why do your patients say they use their call lights?” She quickly responded, “I already know why. They need help getting to the bathroom.”
I suggested that we pull the call light question report in MyRounding® to see if the data validated her assumption. The report showed that, while many patients had called to use the restroom, more called for pain medicine. Next, we rounded on ten patients with two objectives: 1) to ask each patient how quickly they received help with pain, and 2) to check the communication boards.
In each room, every patient said they used their call light to ask about pain medicine, and not coincidentally, the communication boards were also incomplete. This was a huge “a-ha” for the nurse manager. She immediately saw the connection between the communication boards and her patients’ call light use. The leader coached her team to update all information, including pain goals, on the boards and to schedule pain medicine. These changes decreased call light use and improved the unit’s scores in their HCAHPS responsiveness and pain management composites. Data from the call light question in MyRounding® helped the nurse leader quickly find the cause of her unit’s low survey results and execute strategies to get patients the help they needed. In 90 days, this nurse leader saw results on her unit.
After 90 days, the percentage of patients using call lights to ask for pain medicine decreased from 25.8% to 16.9%.
Answers for “Responsiveness: If you used your call light, what are some of the things you called for?
In 90 days, patients’ call light use decreased 16.6%, which is about five patients a day, or 450 patients in 90 days.
Answers for “Responsiveness: in the last 24 hours, have you used your call light?”
How MyRounding® Can Support Your Patient Experience Strategy
While paper logs can get the job done, they can be time-consuming and inefficient. I have even seen leaders spend extra time transferring rounding information from paper logs into spreadsheets. MyRounding® makes documentation more efficient because, as each round is completed, it is automatically saved in the software, which frees up time for more important tasks. It also helps leaders easily and quickly collect data that they can use to improve patient care in their departments (as illustrated in the example above). In research conducted by Studer Group, MyRounding® users experienced a significant increase in HCAHPS Top Box Results over non-users.
Whether you decide to use MyRounding® or paper logs, tracking and reporting meaningful data will help you get to the bottom of low survey results. Once you understand what your patients are really saying, you can give them the exceptional care they deserve.
Erin Shipley, RN, MSN has more than 15 years of leadership experience as a clinical nurse manager and service line administrator. As a Studer Group coach, Erin’s passion, entrepreneurial spirit and professional drive set the stage for a continued push towards operational excellence.