Effective Nurse Communication Key To Patient Satisfaction In Health Care System

HCAHPS Offers Nurses Opportunity to Make A Difference in Health Care Profession

The impact of nursing care on patient satisfaction and patient outcomes has long been established but hadn't been linked to financial incentives - until now, with the Hospital Consumer Assessment of Healthcare Providers and Systems initiative. (Abbreviated as HCAHPS and often pronounced as "H-caps.") According to one nursing educator, HCAHPS is poised to have a profound impact on health care and offers a positive and unexpected opportunity to advance the entire nursing profession.

"The power of HCAHPS is that it has forced institutions to take the patient's perspective into serious consideration," says Elaine Townsley, DHA, MSN, MBA, faculty, health sciences and nursing at American Sentinel University. "We now have a science focused around patient-centered care and a way to measure care that was not in place before. When a nurse is aware of the patient's perception of the care they are receiving, the nurse can now take measures to correct any negative habits and use the information as a learning tool to increase quality of patient care."

How HCAHPS Works
HCAHPS is part of Medicare's new value-based purchasing program, which is an effort to shift to reimbursement models that pay for high-quality care rather than a high quantity of care. HCAHPS itself is a survey instrument that aims to measure patient satisfaction with the entire hospital experience.

Recently discharged patients are asked to answer 27 questions that are used to measure how they feel about the care they received in the hospital. It includes seven key topic areas: responsiveness of hospital staff, nursing communication skills, physician communication skills, pain management, quietness and cleanliness, explanations about medications and discharge instructions. View the actual survey questions online at http://www.hcahpsonline.org/surveyinstrument.aspx.

The survey is designed to allow objective and meaningful comparisons between hospitals in areas that are important to consumers. Results are published online and can be viewed by the public at www.hospitalcompare.hhs.gov.

The data will be used to determine reimbursement - and hospitals can gain or lose up to two percent of their Medicare reimbursement fees, depending on how well they score. (A hospital that chooses not to participate in HCAHPS is automatically docked two percent.)

"All effective communications between health care providers increases the continuity of care between providers which should equate to better patient outcomes," says Dr. Townsley.  "Organizations need to promote total customer satisfaction to their patient, their vendor, but even more so - their staff."

HCAHPS survey data is already being collected and tallied and the Centers for Medicare and Medicaid Services (CMS) will begin implementing value-based incentive payments for hospitals in 2013.

HCAHPS Benefits Nurses
Nurses are the backbone of any health care institution and are the 'face' of the daily care that patients receive. So it's no surprise that the HCAHPS survey section on nurses' communication has been found to have the greatest impact on overall patient satisfaction and likelihood to recommend the hospital to family and friends. But some nurses are uneasy about being held accountable for overall patient satisfaction, based on comments posted on online nursing discussion forums.

The most oft-cited concern relates to the way patient responses are weighted for reimbursement purposes. The survey asks questions like how often nurses communicate well or respond quickly to a patient request. Patients can respond with 'Always,' 'Usually,' 'Sometimes,' or 'Never' - but hospitals only receive credit for the 'Always' responses.

Health care providers know that this all-or-nothing approach can be troublesome. Even when they're providing very high quality care, there's sometimes a situation that keeps them from answering a patient's call light as quickly as they may have liked to.

Still, Dr. Townsley says that nurses can view the HCAHPS initiative as a positive and unexpected opportunity to advance nursing interests.

For example, studies have shown that patient satisfaction is higher when nurses have a better work environment, greater collaboration with physicians and more favorable staffing ratios. Hospitals haven't always taken note of this data, but now they may have to - and nurses are poised to benefit when they do.

In addition, HCAHPS is the opportunity for which nurses have waited to demonstrate that what they do does make a difference in health care.

"I think HCAHPS is just a step, but nurses need to be on the frontline of opening communications with the upper level of management in their health care organization," says Dr. Townsley.

Dr. Townsley points out that health care organizations will worry about their bottom line and they are going to shift their thoughts to increasing quality of care while receiving a different reimbursement for a while. If health care organizations can see that nurses are there to work with them and increase the overall quality of care, payment for services will also increase.

"Quality of care, patient care, patient satisfaction and reimbursement should be viewed together and not as separate entities," says Dr. Townsley.

It looks like the stars are finally aligning for nursing to be seen as a revenue-producing department as nurses will be measured by their contribution to the solvency of the nation's hospitals. Nurses now have the opportunity to demonstrate that what they do indeed makes a difference.

How Nurses Can Make Difference
Every patient interaction with which a nurse is involved now has the ability to affect hospital revenue. View the actual HCAHPS questionnaire at http://www.hcahpsonline.org/surveyinstrument.aspx and become familiar with the topics patients will be asked about.

It's the patients' perception of care that will matter and nurses can sometimes influence that perception in positive ways through their dialogue.

"It's critical that nurses practice communication, continuity and compassion," says Dr. Townsley.  She offers the following tips for improving patient satisfaction.

-Listen to the patient - don't just hear them. Listening takes many avenues, but if the patient knows that the nurse is listening and that he or she will act on their concern and then follow up with the patient - this is the first step to increasing patient satisfaction.

-Think like a patient. Reflect about how it would feel to be complaining about something and nothing was being done because a nurse chooses not to communicate.

-Be responsive. Don't tell the patient something is going to be done to help them in specific timeframe and not meet that timeframe.

-Practice communication skills. If a patient is complaining, don't think the patient is just a complainer: use your critical-thinking skills to assess their complaint. It is important to keep in constant contact with the person making the complaint and letting them know that their issue is being investigated.

-Show compassion. Refer to a patient by real names, not by the names that they are often given during their hospital stay (e.g. "the complainer," "the person who stays on the call light," "the person who falls"). Remember that they are not only a patient, but also a member of a family who should receive the best quality of care while maintaining their dignity.

Reviewing HCAHPS Scores
When your hospital's HCAHPS scores are released, be sure to review the data and compare it to other hospitals in the area as well as to national averages. Share ideas for changes that might improve the patient experience and discuss them with the nursing supervisor.

Education and acquired skills put nurses in a better position to able to persuade, influence and advance nursing interests. If HCAHPS is the opportunity nurses have waited for to demonstrate that what they do does make a difference in health care, then now is a great time for nurses to become empowered with knowledge through an online RN to BSN or RN to MSN degree.

American Sentinel University is an innovative, accredited provider of online nursing degrees, including programs that prepare nurses for a specialty in case management, infection control, and executive leadership.

Learn more about American Sentinel University's CCNE-accredited online RN to BSN programs at http://www.americansentinel.edu/health-care/rn-to-b-s-nursing or online RN to MSN program at http://www.americansentinel.edu/health-care/rn-to-m-s-nursing.  

About American Sentinel University
American Sentinel University delivers the competitive advantages of accredited online degree programs in nursing, informatics, MBA Health Care, DNP Executive Leadership and DNP Educational Leadership. Its affordable, flexible bachelor's and master's nursing degree programs are accredited by the Commission for the Collegiate Nursing Education (CCNE). The university is accredited by the Distance Education and Training Council (DETC). The Accrediting Commission of DETC is listed by the U.S. Department of Education as a nationally recognized accrediting agency and is a recognized member of the Council for Higher Education Accreditation.