1. Responding to Our Patients
Signature Healthcare Brockton Hospital

2. Patient Surveys
Names of all our patients are sent to Press Ganey and randomly they send our patients surveys
They send a regular survey to some and a HCAHPS survey to others

3. HCAHPS Surveys
“HCAHPS” stands for Healthcare Consumer Assessment of Hospital Providers and Systems”
First national survey of patients’ perspectives of hospital care
Developed by CMS and the Department of Health and Human Services

4. HCAHPS Surveys What areas are measured? Global
Communication with Nurses
Response of Staff
Communication with Doctors
Pain Management
Communication about Medications
Discharge Information

5. HCAHPS Surveys Established in 2006
HCAHPS participation was voluntary for first two years
Data started to be required and publicly reported in 2008

6. Healthcare Reform
Results of HCAHPS surveys publicly reported on
In 2010, Healthcare Reform (Patient Protection and Affordable Care Act) changed hospital reimbursement to a Value Based Purchasing system
Value Based Purchasing is a system where the hospital is paid for the quality of care delivered

7. Value Based Purchasing
Quality of care is determined by our patients through the HCAHPS survey results and our core measure results

8. Communication with Nurses

9. Response of Staff

10. So What Do We Do?
Review of the literature
Studer Group

11. What Does the Literature Say?
Quality and patient satisfaction are connected
Nursing communication is highly correlated with patient satisfaction
If we want to do well on HCAHPS, we need a consistent culture of excellence

12. What Does Studer Say?
To be truly responsive to a patient, the patient must believe their care is important to us
The patient must believe they and their care are a priority to us
A proven method to accomplish this is “Hourly Rounding” on patients.

13. Hourly Rounding Powerful tactic proven to: Improve clinical outcomes
Decrease risk
Reduce call lights
Increase patient satisfaction
Improve employee satisfaction

14. Rounding Results Data shows rounding: Decreases call lights by 38%
Decreases falls by 50%
Decreases hospital acquired decubiti by 14%
Improves patient perception by 12 mean points

15. Hourly Rounding Defined
Nurses and nursing assistants going to the patient room and “rounding” on patients hourly while demonstrating specific behaviors.
6 AM to 10 PM- hourly
10 PM to 6 AM- every 2 hours

16. Rounding Specific Behaviors
Address patient’s most frequent requests based on research
Keeps nursing in control of workflow instead of the patient controlling it
Address patient needs in advance instead of waiting for the patient to ask

17. Rounding Specific Behaviors
Not just “checking in” but completing specific behaviors
Staff are tempted to modify rounds but it has been shown that this will decrease impact

18. Specific Behaviors Use opening key words
Let the patient know your name and role
Tell them you are here to do the “hourly round”
Explain that you are here to check on their needs.

19. Specific Behaviors Complete scheduled tasks
Perform tasks that are scheduled such as medication administration, treatments, procedures, etc.

20. Specific Behaviors
Assess and address
Pain
Privy
Positioning

21. Specific Behaviors Personal comfort needs
Fluff pillow, straighten sheets, fill water pitchers, offer something to drink, etc.

22. Specific Behaviors Prevention by checking environmental needs
Call light within reach?
Telephone within reach?
Light switch and TV control within reach?
Bedside table within reach?
Trash can within reach?
Does the patient appear comfortable?
Path to BR free of clutter?

23. Specific Behaviors Use closing key words
Ask if there is anything else you can do for them before you leave
Tell them you will return in the next hour (two hours from 10 PM to 6 AM)

24. Specific Behaviors Document on the Rounding Log
Rounds logged every hour (or two on nights)
Able to track compliance
Assures patient you will be returning

25. Rounding Log Sample ROUNDING LOG
Unit _____ Room ________ Date: __________ Name: _________________________________
PLEASE INITIAL AND CHECK EACH HOUR WHEN BEHAVIORS COMPLETED
TIME
INITIALS
PAIN
POSITION
PRIVY
PERSONAL
PREVENTION
PERIOD
Notify nurse or medicate as appropriate
Reposition and observe for pressure/ friction
Offer toileting, check for incontinence
Personal needs such as water, other drink, blanket, tissues are met
Call light, TV remote, bedside table, light control, path to BR clear AM
2 - 4 AM
4 - 6 AM
6 - 7 AM AM

26. Rounding Wrap-up
Opening- name, role and rounding to see if they have any needs
Medications, treatments, procedures
Pain
Privy- bathroom
Position- reposition, chair, etc.
Personal needs- water, tissues, etc.
Prevention of injury- table, call light, clear path
Closing- is there anything else?, return in next hour
Document- on log