As healthcare moves from a fee-for-service system to a pay-for-performance system, patient experience is becoming more and more important. Patient experience scores can not only reflect a hospital's quality, but can also affect a hospital's patient volume and reimbursement under new payment models. Paul Clarke, patient experience coordinator at NCH Healthcare System in Naples, Fla., explains how a post-discharge call program increased the system's Hospital Consumer Assessment of Healthcare Providers and Systems scores.
Pick up the phone
In January 2010, Mr. Clarke began to develop a plan to increase the health system's HCAHPS scores. Improving patients' experience aligns with NCH Healthcare System's mission of providing compassionate care and with value-based purchasing, which will reward hospitals for high HCAHPS scores. Mr. Clarke studied hospitals with the top HCAHPS scores and found post-discharge calls were a common theme. While NCH Healthcare System conducted these calls, they were not done in a formal manner.
To create a structured program for post-discharge calls, the health system extended an existing partnership with BerylHealth to provide the calls. In April 2010, BerylHealth began making post-discharge calls on behalf of NCH Healthcare System to patients from four adult inpatient units. The callers ask questions about patients' experiences and give patients the opportunity to ask questions and provide feedback on their stay during the call. Examples of questions include the following:
• Did you understand your discharge instructions?
• Were you able to get your prescriptions filled?
• Are there any physicians or staff you would like to recognize?
• Do you have any recommendations/suggestions on how we could improve?
Dialing in to patients' feelings
Callers ask these questions in a conversational tone to avoid the perception that the call is another survey, as 60 percent of patients receiving calls later receive a paper survey. "The ultimate goal was to give the impression that we still cared for them once they left the system," Mr. Clarke says. "We want to say, 'We care about you. You have an opportunity to answer some questions. How are you feeling?'"
The post-discharge calls are made by non-clinical BerylHealth staff and are meant to gauge patients' overall experience rather than discuss specific clinical issues. If patients do have clinical questions, however, they have the option of speaking to a nurse manager of their unit, who will call back within 24 hours.
Within a few weeks of the pilot project, the system's HCAHPS scores had improved, according to Mr. Clarke. Now, all the system's 14 inpatient units conduct post-discharge calls, and the system is considering rolling the program out to its inpatient rehabilitation hospital.
Conducting post-discharge phone calls speaks directly to a yes-or-no question on an HCAHPS Integrated survey: "Did you receive a post-discharge call?" However, the call indirectly affects responses to many more HCAHPS questions, such as "Would you recommend this hospital to your friends and family?" Overall, patients who received a post-discharge call gave higher scores than those who did not receive the call, at 86.5 percent and 81.7 percent, respectively. Seventy-five percent of patients who received a post-discharge call would recommend the hospital compared to 64 percent of patients who did not receive a call. Similarly, 73 percent of patients who received a call would rate the hospital a nine or 10 compared with 57 percent of patients who did not receive a call.
Call and response
Each post-discharge call is recorded, transcribed and automatically delivered to an online database so NCH Healthcare System can identify trends and respond accordingly. Mr. Clarke says he listens to the recordings once a quarter but looks at the transcripts daily to monitor patients' experience.
One trend Mr. Clarke identified was a feeling among patients from a certain unit that nursing assistants did not spend enough time with them. To address this concern, the health system held a workshop for the nursing assistants and role played different scenarios to teach strategies the assistants could use to appear more personable without spending any more physical time with patients. Talking to patients when taking vital signs, for instance, does not take more time but gives a more positive impression on patients.
The unit role played taking patients' blood pressure. Originally, the nursing assistants were very focused on completing the task: wrapping the blood pressure cuff around the patient's arm and taking the measurement. If patients commented that the cuff was very tight, the nursing assistants responded that the tightness was normal, but in a way that did not seem compassionate to patients, according to Mr. Clarke. In the workshop, nursing assistants learned key phrases and behaviors to make patients feel more comfortable and cared for. For example, before wrapping the cuff around the patient's arm, the assistant learned to say, "I'm going to wrap this cuff around your arm. It will get a little tight, but that will be normal. I don't intend to cause you any discomfort."
"Simple key words like, 'I'm sorry you're feeling discomfort, it will only last a few seconds,'" make a big difference, Mr. Clarke says. In fact, post-discharge calls after this workshop did not include concerns about the nursing unit.
Phone calls vs. paper
The post-discharge phone calls take only about 20 minutes, but they can generate a great deal of information that is more specific than responses to paper surveys, according to Mr. Clarke. Answers to paper surveys tend to be quick, short and vague, whereas responses to questions over the phone can be more lengthy and detailed. In addition, the phone caller can ask clarifying questions. These more specific answers allow the health system to respond more directly to problems that patients identify. For example, Mr. Clarke says patients who respond to a question about noise level on a paper survey may simply write "noisy" or "very loud" without specifying whether the noise came from visitors, nurses, other patients, equipment or other sources. In a phone call, the caller can ask what caused the noise, which gives NCH Healthcare System the opportunity to quickly address root causes of complaints.
Pick up the phone
In January 2010, Mr. Clarke began to develop a plan to increase the health system's HCAHPS scores. Improving patients' experience aligns with NCH Healthcare System's mission of providing compassionate care and with value-based purchasing, which will reward hospitals for high HCAHPS scores. Mr. Clarke studied hospitals with the top HCAHPS scores and found post-discharge calls were a common theme. While NCH Healthcare System conducted these calls, they were not done in a formal manner.
To create a structured program for post-discharge calls, the health system extended an existing partnership with BerylHealth to provide the calls. In April 2010, BerylHealth began making post-discharge calls on behalf of NCH Healthcare System to patients from four adult inpatient units. The callers ask questions about patients' experiences and give patients the opportunity to ask questions and provide feedback on their stay during the call. Examples of questions include the following:
• Did you understand your discharge instructions?
• Were you able to get your prescriptions filled?
• Are there any physicians or staff you would like to recognize?
• Do you have any recommendations/suggestions on how we could improve?
Dialing in to patients' feelings
Callers ask these questions in a conversational tone to avoid the perception that the call is another survey, as 60 percent of patients receiving calls later receive a paper survey. "The ultimate goal was to give the impression that we still cared for them once they left the system," Mr. Clarke says. "We want to say, 'We care about you. You have an opportunity to answer some questions. How are you feeling?'"
The post-discharge calls are made by non-clinical BerylHealth staff and are meant to gauge patients' overall experience rather than discuss specific clinical issues. If patients do have clinical questions, however, they have the option of speaking to a nurse manager of their unit, who will call back within 24 hours.
Within a few weeks of the pilot project, the system's HCAHPS scores had improved, according to Mr. Clarke. Now, all the system's 14 inpatient units conduct post-discharge calls, and the system is considering rolling the program out to its inpatient rehabilitation hospital.
Conducting post-discharge phone calls speaks directly to a yes-or-no question on an HCAHPS Integrated survey: "Did you receive a post-discharge call?" However, the call indirectly affects responses to many more HCAHPS questions, such as "Would you recommend this hospital to your friends and family?" Overall, patients who received a post-discharge call gave higher scores than those who did not receive the call, at 86.5 percent and 81.7 percent, respectively. Seventy-five percent of patients who received a post-discharge call would recommend the hospital compared to 64 percent of patients who did not receive a call. Similarly, 73 percent of patients who received a call would rate the hospital a nine or 10 compared with 57 percent of patients who did not receive a call.
Call and response
Each post-discharge call is recorded, transcribed and automatically delivered to an online database so NCH Healthcare System can identify trends and respond accordingly. Mr. Clarke says he listens to the recordings once a quarter but looks at the transcripts daily to monitor patients' experience.
One trend Mr. Clarke identified was a feeling among patients from a certain unit that nursing assistants did not spend enough time with them. To address this concern, the health system held a workshop for the nursing assistants and role played different scenarios to teach strategies the assistants could use to appear more personable without spending any more physical time with patients. Talking to patients when taking vital signs, for instance, does not take more time but gives a more positive impression on patients.
The unit role played taking patients' blood pressure. Originally, the nursing assistants were very focused on completing the task: wrapping the blood pressure cuff around the patient's arm and taking the measurement. If patients commented that the cuff was very tight, the nursing assistants responded that the tightness was normal, but in a way that did not seem compassionate to patients, according to Mr. Clarke. In the workshop, nursing assistants learned key phrases and behaviors to make patients feel more comfortable and cared for. For example, before wrapping the cuff around the patient's arm, the assistant learned to say, "I'm going to wrap this cuff around your arm. It will get a little tight, but that will be normal. I don't intend to cause you any discomfort."
"Simple key words like, 'I'm sorry you're feeling discomfort, it will only last a few seconds,'" make a big difference, Mr. Clarke says. In fact, post-discharge calls after this workshop did not include concerns about the nursing unit.
Phone calls vs. paper
The post-discharge phone calls take only about 20 minutes, but they can generate a great deal of information that is more specific than responses to paper surveys, according to Mr. Clarke. Answers to paper surveys tend to be quick, short and vague, whereas responses to questions over the phone can be more lengthy and detailed. In addition, the phone caller can ask clarifying questions. These more specific answers allow the health system to respond more directly to problems that patients identify. For example, Mr. Clarke says patients who respond to a question about noise level on a paper survey may simply write "noisy" or "very loud" without specifying whether the noise came from visitors, nurses, other patients, equipment or other sources. In a phone call, the caller can ask what caused the noise, which gives NCH Healthcare System the opportunity to quickly address root causes of complaints.
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