HCAHPS Improvment and the Nurse

I am taking a break from new nurse teaching blog to consider a concept for all nurses, can a nurse or nurses actually improve a floor or unit’s HCAHPS scores? This is a hot topic with the thought that a poor HCAHPS scores will directly affect the reimbursement for patient care. You tell a nurse that the HCAHPS scores are down or low and you get something to the effect, this is not a hotel, this is a hospital, I am trying to keep my patients safe and alive, not pamper them. The gift of life should be pampering enough. Well, unfortunately society today is all about the experience and ratings! I guess the blame is on our society that is too afraid to make a decision without reviews and that same society interacts more online than they do in real life.

Alright, this blog is not about why or how this became mainstream, but how to excel. I bet some nurses already moved passed this blog by now. Yes, it can happen, if we can convert the thinking from solely keeping the patients alive to include some patient pampering. You will also find pampering can lead to more time in the day for the nurse to get tasks completed. Now, that just sounds crazy, but so true.

First item to improve HCAHPS scores is effective communication. Nurses think, I talk to my patients. Talking is one thing, effective communication is something different. Now a nurse gets a new patient, to add to his\her patient load, and the nurse rushes in tries to get the whole admission done fast and moves to the next task at hand. Can a patient detect a rush job compared to someone who actually is interested in that person’s wellbeing or recovery? By rushing, think how much is missed in teaching at the admission. This does not mean go slow on purpose, but it does mean look for queues to instruct the patient. Do not think that the patient will get all this instruction at discharge. Start teaching at the admission, it helps the patient digest the instruction and when discharge comes, it fortifies that teaching. Take the “rush” mentality out of the admission. If nurses are said to be excellent observers, why do we miss the obvious queues patients have burning questions? Answering questions at the start of a hospital stay and observing the patient for queues of concern, that will improve HCAHPS scores. Next, during the stay, fortify the teaching. Ask questions in report such as the following: What was taught during your shift today, Did the family have any questions today, Did the doctor talk with the patient today and how did the patient take the interaction with the doctor, and How many new medications were ordered today? It may add a little more time to the report, but you get a better understanding of your patients. Also, during the stay, keep your patients updated. Saying to them, “You are scheduled for a test today,” may give them a visible itinerary of the day, but effective communication will explain what the test is for in terms the patient comprehends. Also, let the patient know what you are doing and why it needs to be done. Nurses are getting less engaged with their patients and more engaged in their documentation. I say do both! The mode of documentation has changed from paper to electronic, but it is still about the patient. Just because you type, does not mean the patient does not need to know what is going on and what is in store for him\her. Patients are human too. Did you know when you round and see a patient for about 11 seconds to say you are making sure that person is ok can save you hours of calls lights throughout the day! Also, when you give medications, do not just pour six plus tablets in a cup and say here, take these. Look for queues that the patient may have a question about one or two, or even a question about something they took for years and no one has been able to answer. If the patient detects rushed or busy nonverbal cues from the nurse giving them their medications, they will be afraid to ask. Not getting their questions answered, that leads to lower HCAHPS scores.

Lastly, at discharge, slowly infuse the teaching. I see nurses going through 2 hours of teaching in 15 minutes and then asking the patient to sign the paperwork so they can get them out. I am all for fast discharges, but discharge teaching should start at admission. By flooding the patient and family with two hours of teaching in 15 minutes, they retain little. Little retaining of teaching leads to readmissions and lower HCAHPS scores. If you must wait till the end to go over the majority of discharge teaching, make that teaching in such a way that the patient comprehends. Sometimes illustrations help retain the information because there is a story behind it. I love to tell stories and most love to hear stories, especially if that story will reduce the risk of that patient coming back to the hospital for the same diagnosis. Lastly, making the doctor’s and testing appointments for the patient before they leave is also helpful with improving HCAHPS scores.

Now, what to do after the patient has gone home. Is there things to do at this time, well, yes. First, call the next day and see if the patient had any questions. There maybe things that developed over the first night home or the patient forgot to ask while in the hospital. Peace of mind from the patient’s standpoint improves scores as well. Makes sure you call later in the day or early afternoon as to not wake up the patient. Next, send the patient a thank you card for choosing your facility. An even better idea, have all the people caring for the patient while in the facility sign the card too. It puts a human aspect back into healthcare. Most see healthcare as a business that preys on a person’s health to get rich, almost like the facility is more interested in their wallet then they ever are of the patient’s wellbeing. Sickness pays, but if you get a chance, show the human side of healthcare, the caring and concern part of it.

Is it possible to raise HCAHPS scores? I would say yes it is, but it takes some work. It takes time management, effective communication, and a display of the human side of healthcare.