My personal journey involving patient experience started in 2010 when I volunteered to lead the inpatient experience team at my hospital. At the time I was the director of cardiopulmonary services. Why did I volunteer? It’s in my nature to step up when there is a need; and the need was there. By volunteering to lead this committee, a fantastic journey started that has led to many doors opening. My role has grown within my organization and I am currently the director of respiratory care and the patient advocate with responsibilities to lead the respiratory department, facilitate patient experience, and handle concerns related to care. I am amazed and privileged; you never know which doors are going to open when you step up and take on a challenge or opportunity.
What is the patient experience?
Most respiratory therapists know that “patient experience” is tied to the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey mandated by the federal government. Over the years, patient experience has become more important to hospitals, and yet respiratory therapists still struggle to integrate ownership of survey results for their department.
HCAHPS results impact hospital reimbursement through the Value-Based Purchasing (VBP) program established by CMS. The current withheld amount is 2%, which can be “earned backed” when standards are met. Hospitals are currently in the performance measurement period for Fiscal Year 2019 and payment adjustments will affect discharges from October 1, 2018 through September 30, 2019. With this in mind, we must remember that what we do today will impact our ability to provide care in the future.
Why is this important to patient experience? Patient experience measured by HCAHPS survey domains account for 25% of the dollars available to earn back. It’s not just the technical tasks anymore; it’s the overall picture the patient, family, and visitor experience.
Defining our role
So how can a respiratory department become involved in the patient experience and which questions on the HCAHPS survey can we help monitor? While it is true that there are no specific questions related to respiratory on the survey, the HCAHPS survey has defined domains, or groups of questions, that respiratory impacts.
One of these questions involves communication about medication. This domain has questions that relate to new medication and education of side effects. A second domain is communication with nurses or physicians. It’s important to remember that most patients and families generally don’t differentiate between nurses and other licensed clinical professionals. It doesn’t matter who is communicating with the patient or family. When a patient thinks of their overall experience, any clinical staff they communicate with will be reflected in the communication domain.
This domain basically covers three questions, 1) Was the patient treated with respect? 2) Were things explained in a way the patient could understand? and 3) Was the patient listened to?
Other domains also impact respiratory, such as care transitions (good understanding of health and medication) and hospital environment (cleanliness and quietness of hospital). Just as our clinical skills are used throughout the facility, respiratory therapists can impact each and every aspect of the patient experience and every survey question.
Patient experience essentials
Here are some suggestions for making a positive impact:
- Use the Teach-Back methodology (or another standard) for communication about medications and therapy to ensure understanding.
- Use key words — especially “side effects” — when communicating about medications.
- Always ask, “Is there anything else I can help you with? I have the time to help you.” And then do what the patient asks; don’t just pass it on. If it is out of your ability, such as providing pain medications or helping the patient to the restroom, close the communication loop with the patient.
- Ensure equipment is well cared for so that it does not create noise in the hallways.
- See if care can be “bundled” to limit the number of times a patient is awakened at night for care.
- Participate in programs to decrease readmissions of COPD patients. This includes ensuring that patients know the information and are prepared to care for themselves outside of the hospital.
- As a department or facility, select a measure and create a program/process to improve it and measure and report on it. Make sure to set a measurable goal.
- As a leader, round on patients and make sure staff members are meeting expectations.
- Select “champions” within the department to ensure buy-in for initiatives.
- Emphasize to staff and leaders that all clinical areas need to be involved in improving patient experience.
- Utilize a program such as the No Pass Zone, where everyone is expected to respond to call lights and alarms and complete the communication loop if you are unable to assist.
Step out of your comfort zone on a task and focus on the person. You are not treating the AECOPD and hypoxia on the medical unit. You are treating Mr. Jones, whose first name is John, but prefers to be called Jack. He has limited reading ability and cannot read the instructions you provided him. How will you engage him in his care and make him feel like he is the only patient you have to care for at the moment?
Be part of the solution
When it comes to patient satisfaction, we can no longer lean on the “there is no specific question for us” mindset. We need to think outside of the box and become involved.
As a profession, we know we are important to our facilities and our patients. We are the clinical experts for all things pulmonary; therefore, we need to be involved in the development of protocols and practices. We need to have a seat at the table, serving as experts on teams involving COPD readmissions, patient education, and yes, patient experience. The VBP and CAHPS programs are only expanding. Soon there will be CAHPS programs for the emergency department and outpatient surgery.
We have the potential to touch every patient and family in the organization; therefore we need to take ownership and become involved. We need to be part of the solution.
