Nursing initiatives improve patient satisfaction at Grady

Across the country, hospitals are taking a page out of the hospitality industry’s book to improve  customer satisfaction. Grady Memorial Hospital  is no exception and is continually looking for ways to ask patients, “How may I help you?”

Traditionally, hospitals have focused on quality care and patient safety, but now they’re also seeking positive approval ratings from their customers.

“We’ve always been interested in patient satisfaction and collected data on it, but the new focus nationwide ties back to money,” said Rhonda Scott, Ph.D., RN, chief nursing officer for Grady Health System.

Beginning on Oct. 1, 2012, the government’s Centers for Medicare and Medicaid linked reimbursement to a hospital’s quality of care and patient satisfaction. The expectation is that patients should undergo hospital procedures with no complications, such as catheter-associated blood stream infections or pressure ulcers, Scott explained. If there are problems, some money would be deducted from the reimbursement fee.

“But patients are also asked to complete a customer satisfaction survey that asks about everything from room cleanliness to pain management,” Scott said. “The standard the government expects is perfection.”

Only survey scores of 9 or a perfect 10 count toward full reimbursement. It’s tough to score that high with questions such as “Did the hospital staff always manage your pain to your satisfaction?”

“This isn’t Disney World they’re coming to,” Scott explained. “Our patients are in pain when they come into the ER. It’s frustrating to pull someone back from the brink of death and get them back to a good quality of life, only to get (our scores) dinged because the Jell-O wasn’t cold.”

Part of the challenge is that the survey questions ask if something is always done, such as explaining the purpose and side effects of medication every time it is administered.

“Still, if the goal is perfection, you know that we’ll strive for it,” Scott said. “It’s good for the public that hospitals across the country are improving on all fronts.”

Grady has taken that goal to heart. While there is no pool on campus yet, Scott joked, Grady has been consistently upgrading its facility. For example, most rooms are now private.

“We have the Rolls Royce of hospital beds. They vibrate, rotate, talk to you in 13 different languages and play music. They’ve increased satisfaction, but also greatly reduced pressure ulcers,” she said.

Each of the neuroscience intensive care unit rooms has an adjoining room with a leather sofa, a flatscreen TV, Internet access, laundry service and a private bath for families, who are encouraged to stay 24 hours a day if they like. Evidence has shown that patients do better when families are involved in their care.

'Quarterbacks of health care’

It’s no surprise that many of the improvements and new initiatives come from Grady Memorial’s Nurse Executive Council, of which Scott is a member.

“Nurses are the quarterbacks of health care,” Scott said. “They spend more time with patients, are constantly assessing their needs and know who to call when there’s a special need. Patients are here because they need 24-hour nursing care and support services, so nurses are at the center of everything we do.”

Grady began launching the new initiatives late in 2012. The 6-A surgery unit has been a pilot for many of them.

What has changed?

“We have a new nurse call system that is more efficient,” said Jackie Kennel, RN, BSN, 6-A surgery unit director.

Grady issued  cellphones so that patients and doctors could call nurses directly instead of using the call button and going through the nurses’ station.

“It cuts down on walking and waiting,” Kennel said. “Patients can say they need pain medication and nurses can bring it in one trip, or they can ask questions and get them answered immediately. The patients and doctors love it, and nurses are seeing the efficiency of it.”

To further improve communication, each room has a  white board with useful information, such as the date, names of the care team members, frequently dialed hospital numbers and the times when pain medication can be administered. There’s space for families to write their contact information and ask questions for doctors.

Another new practice is for nurses to call patients 24 to 48 hours after discharge to answer questions, explain medications or help schedule appointments.

“Patients are surprised and pleased to hear from us. They’re often in a hurry to leave and don’t listen to all the instructions. We can walk them through a dressing change,” Kennel said.

Every shift now begins with a proactive , five-minute nursing huddle.

“We begin with wins, any successes people want to report about patients or themselves,” Kennel said. “Then we talk about the number of patients, who is having surgery, and special nursing challenges. Thinking ahead helps us to anticipate problems and has greatly boosted morale.”

The nursing staff now goes on rounds for patients every hour during the day and every two hours at night. They  check on the five Ps:  pain, potty, position (in the bed), pump (IVs and other) and personal items. Asking patients if they need help going to the bathroom has decreased falls and has provided more comprehensive care.

“By rounding frequently, we can remove Foley catheters quicker, which has reduced the incidence of urinary track infections,” Kennel said.

Numbers getting better

While the initiatives took extra work and training, Kennel is proud that Grady’s Hazard Analysis and Critical Control Points patient satisfaction numbers are climbing.

“Last year, we were only meeting the necessary standards on one out of eight sections of the patient surveys, and that one pertained to physicians, not nursing,” Kennel said. “In April, we were meeting five out of eight sections, and four were for nursing. We still want to improve, but I’m proud of those numbers.”

Scott adds that the hospital has moved from the 63rd percentile to the 93rd percentile for nursing communication and has scored higher on other benchmarks in the National Association of Public Hospital’s rankings.

“If you’re going to improve patient satisfaction, you need to focus on the people who are giving the service,” she said.

Revamping orientation and following up to make sure that employees have the tools and support they need has improved employee engagement, patient satisfaction and quality of care, Kennell said.

“Nurses were afraid that all the changes would add to their workload at first, but now they’re excited about the changes,” she said. “We all know that we’re moving in the right direction.”