Patient-Centered Care: Engagement Matters
2 Tools to Improve Engagement for Patients, Employees and Physicians
by Craig Deao, MHA, Studer Group senior leader and speaker
Remember the days when it was all about patient satisfaction? We spent a lot of time trying to understand how we could help our patients and employees like us more.
Then HCAHPS arrived and we focused on creating a great patient experience. While satisfaction and patient experience don’t matter any less than they always have, many organizations are also beginning to consider the importance of increasing engagement. As healthcare continues to shift away from fee-for-service towards managing wellness and a patient-centered home, patient engagement will be critical to achieving higher compliance and better clinical outcomes.
How Engaged Are Patients?
Not very engaged, on average. For instance, 40 percent of deaths are caused by modifiable behavioral issues. Furthermore, 50 percent of patients don’t follow referral advice and 75 percent of them do not keep follow-up appointments. Those with chronic diseases take only 50 percent of prescribed doses on average1. But the only way to fix the healthcare cost crisis is to turn this tide…particularly when it comes to expensive but preventable chronic disorders like obesity, smoking, and lack of exercise.
The problem, of course, is that the average patient spends just 20 minutes three times per year with his or her physician. What about the other 8,674 hours? Accountable care requires each patient to be accountable. When he is, the rewards—in both better outcomes and lower cost—can be both tangible and dramatic.
The Power of Bedside Shift Report
One key to improving patient engagement is ensuring that patients understand what is happening during their care, that caregivers understand their needs and concerns, and what will happen next. Studer Group tactics like Individualized Patient Care and AIDET® can all be helpful to meeting these goals. But a particularly vulnerable time for patients is during nurse shift changes during an ED or inpatient stay, as patients prepare to say goodbye to a nurse they’ve bonded with and feel anxious about who might replace them.
That’s why Bedside Shift Report can be such a powerful tool. When it’s done right, it’s not about nurses talking together at the end of a patient’s bed. The handover includes the patient, manages expectations, provides training on medication or a medical device, and validates the patient’s understanding using the teach-back method.
In fact, when Susan Murray, senior vice president and COO of Queen’s Medical Center (QMC) opened a brand new hospital in West Oahu, HI, hardwiring bedside shift report was a top priority. “I felt like it was a ‘Must-Have®’ immediately, particularly because nurses were new to working with each other,” she explains. “Patients feel less vulnerable—they gain an important sense of control—because bedside shift report brings them into the care team. They’re more cooperative because they are informed and they feel that things are being done ‘with’ them instead of ‘to’ them.”
QMC worked with Studer Group coaches Barbara Hotko and Stephanie Baker for five months to hardwire bedside shift report, along with other patient-ready tactics prior to opening the hospital in May 2014. They first used a train-the-trainer approach and then competency assessments to observe and validate all staff.
The coaches began rolling it out by communicating the “why” of the tool, emphasizing why it was good for patients. Once nurses understood the value, they became more likely to execute it with every patient every time…to realize Murray’s goal for a consistent patient experience from the ED to inpatient rooms hospital wide. Leaders also walked the hallways to observe shift changes and ensure nurses were in patient rooms during those times.
“We took pictures of ‘what right looks like’ on the communication boards in the rooms and charge nurses came up with their own checklists to validate that,” Murrays notes. “Success begins and ends with leadership, but it’s essential to have coaches to hold the bar where it needs to be.” One year after opening in June 2015, QMC was ranked in the HCAHPS top quartile for “would recommend” and 87th percentile on the HCAHPS nurse communication bundle.
Use Stoplight Report
A key foundation to high engagement of both physicians and employees is trust. While rounding on these stakeholders is key, it’s only effective if we follow-up consistently to let individuals know what actions we will be taking place based on their input.
A stoplight report is a simple but powerful tool that shows the status of items physicians or employees have requested and the action being taken. It also helps to keep “wins” at the forefront for high engagement and a focus on positive accomplishments. Items are color coded so everyone understands if an action item or idea has been implemented, is under review, or can’t be completed and why.
In summary, think of high engagement—of patients, physicians, and employees—as a core competency for meeting your organization’s goals. Since trust precedes engagement, be sure to hardwire the tools and processes that build it at every opportunity. The rewards are worth it.
Download a full-size blank template of the stoplight report at StuderGroup.com/Stoplight_Template
1 Source: Parekh, A. K. (2011). Winning their trust. N Engl J Med, 364(24), e51