Patient experience has a direct impact on the bottom line of hospitals and health systems. Satisfied patients, and often their families, can lead to improved market share as the health system builds a positive reputation in the community. Additionally, physicians are becoming increasingly responsible for patient experience as payor contracts begin to incorporate value-based arrangements tied to performance demonstrated on quality metrics. There is additional value with future Medicare fee-for-service payments transitioning risk-based arrangements through programs under MACRA such as merit-based incentive payment systems (MIPS).1 Finally, there is a health and wellness impact of this transition to emphasizing patient experience. If a patient is satisfied with care, they are more likely to continue to seek care, and increase the likelihood of reduction in uncontrolled diseases as well as preventative care services.1 As an added benefit, increased health system employee satisfaction may also result indirectly from improved patient experience.
When looking at overall patient experience scores and how to improve them, it is easy to become overwhelmed. Patient satisfaction is after all a daunting, challenging, and multisystem problem. Over the last four years, a partnership between a large medical center in the Pacific Northwest and COPE Health Solutions was able to show significant improvement in patient experience.
COPE Health Solutions partnered with this medical center to implement the COPE Health Scholar program, an experiential learning and workforce development program. This program not only offers staff and patients additional support, but is also an educational resource for enrolled students to gain exposure to pathways in health care careers and employment. The COPE Health Scholar program (for college students or graduates) was launched at this medical center in July 2014. The Junior Health Scholar program (for high school students) began in August 2016. The majority of students have pre-health concentrations in college. The students come from diverse backgrounds and communities but have common interests in gaining employment in health care. As of July 2018, there were 375 enrolled Scholars providing nearly 7,500 hours of support in 24 departments within the hospital.
COPE Health Scholars helped to redistribute non-essential or non-specific tasks from employees to engaged students thus reducing the workload of current employees for non-clinical tasks. This contributes to improving the patient experience by providing patients with additional time and attention. Non-clinical tasks such as restocking supplies, tidying up patient care areas, and rounding on patients to assess for concerns are all skills that can be easily taught and performed independent of direct supervision.
NICU – Additional Hands to Hold Infants
At this medical center, leveraging student support is particularly impactful in Neonatal Intensive Care (NICU) departments. There are circumstances when a parent or clinician is not able to spend time with the infants in the NICU. Additional support can be provided by having students spend time holding the infants and providing human touch. The power of human touch has been widely researched as being beneficial for health outcomes of infants.2 Increase in human touch can lead to overall improvement in physical, emotional, social, and behavioral development. Currently, the COPE Health Scholars’ program at this medical center averages an additional 268 hours of support time in the NICU every three months. Since Scholars started in the NICU in 2016, there have been upwards of 2,500 additional hours of students holding infants.
Improved Patient Experience through Rounding
In addition to the positive outcomes experienced in the NICU, patient satisfaction can be enhanced in other units through rounding. Rounding on patients means having someone assigned to visit individual patients to make sure they feel their current needs are met as well as having an opportunity to anticipate their needs. Rounding provides patients an assurance that they are a priority and well cared for. Purposeful rounding not only improves the patient experience but also contributes to positive staff experience, as it allows staff to concentrate on more clinical tasks and reduce their overall workload. Rounding has shown improvements in reduction of patient falls, skin breakdown, call light utilization, as well as overall patient experience scores.3
Data Collection Support in Real Time
Patient satisfaction surveys like HCAHPS and Press Ganey are useful tools for hospitals to collect essential data on patient experience. Equally as important as these standardized patient surveys is a hospital’s ability to collect data on patient concerns in real time. This allows clinicians and administrators to react to data, and therefore respond to patients more quickly. Clinicians and students can employ this type of data collection through the use of data logs during patient rounding. At this partner hospital, the Scholars practice purposeful, hourly rounding, while also collecting data on patient concerns. This data is immediately shared with staff and later aggregated and analyzed to assess for trends. This method not only affects patients’ immediate needs, but also provides clinical insight, allowing clinicians to target specific concerns that may be more prevalent. HCAHPS surveys can often appear as a behind the scenes evaluation that distances patients from the work that goes into ensuring their concerns are being addressed. Similar to purposeful rounding, visible and tangible methods of communication and feedback collection gives patients and families many avenues to share their concerns and provide positive and negative feedback.
Patient Experience Ambassador (PXA) Program to Support Safety and Satisfaction
Another part of the Health Scholar program at this medical center is the Patient Experience Ambassador (PXA) program. This program engages Scholars who have been recognized for their service excellence by specifically training them to support key safety and satisfaction initiatives. These students have a specialized role and seek to make a connection with patients to reinforce and complement staff’s purposeful rounding. They emphasize satisfaction with the 4P’s (pain, potty, positioning, and possessions), patient safety and catheter associated urinary infection prevention measures. Students maintain a rounding log to document identified concerns, report any issues to staff, as well as visit the patient again to ensure the concern has been resolved. From May 2018 to July 2018, PXA students rounded on an average of 980 patients per month, identifying an average of 175 concerns each month, and resolved 94.5 percent of all concerns before the end of their shift. Preliminary data indicates a positive impact on Press Ganey score, particularly for the question regarding attention to special and personal needs. In comparing the three months prior to PXA presence and the four to six months post implementation, three of the four departments with PXA students had an increase in the mean response for the question regarding attention to special/personal needs section, with an average increase of 4.8 points.
There are multiple examples of programs like the one above that can show tangible benefits to patient experience as well as lead to significant financial benefits to a health care organization. Utilizing student training programs as an additional resource provides financially solvent solutions while establishing critical pathways to train the future health care workforce on the importance of creating a positive patient experience and equipping them with the skills to be exemplary change leaders.
1Agency for Healthcare Research and Quality. January 2018. Retrieved September 26, 2018 from https://www.ahrq.gov/cahps/quality-improvement/improvement-guide/2-why-improve/index.html
2 Benoit B, Boerner K, Campbell-Yeo M, Chambers C. The power of human touch for babies. Canadian Association of Pediatric Health Center. Retrieved on September 26, 2018 from https://static1.squarespace.com/static/50056474c4aa4387b4e629ea/t/5719260ac2ea517c03d5d582/1461265930827/ThePowerofHumanTouchforBabies.pdf
3 Mitchell M, Lavenberg J, Trotta R, Umscheid C. Hourly rounding to improve nursing responsiveness: a systematic review. Journal of Nursing Administration 2014;44(9):462-472. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4547690/.