Patient experience scores at Joe DiMaggio Children’s Hospital had been lagging behind national benchmarks. The hospital’s medical-surgical unit consistently scored below their peers on patient experience responses across six survey questions, including care coordination, careful listening, courtesy and respect, and patient engagement.
For hospital leadership, it was clear who should lead the efforts to reverse this trend.
“Clinical nurses are the eyes and ears of everything that's going on,” said Amy Jones, BSN, RN, NPD-BC, CPEN, nursing quality data specialist in the Center for Nursing Excellence, Education, and Innovation at Joe DiMaggio Children’s Hospital in Hollywood, Florida. “They have the experience and the innovation to drive changes — especially in nursing-sensitive indicators.”
Jones went straight to the nurses to spearhead a project aimed at enhancing the patient experience, resulting in a significant improvement in survey scores across all categories.
Getting started
The first step was to educate nurses on why the survey data was important and relevant to them. The next was asking them to reflect on the data and consider why families were providing negative feedback.
From there, Jones and her team assembled a workgroup led by five clinical nurses who met regularly over the next four months to assess the data, determine the problems’ roots, and devise an action plan. They deliberately selected nurses with various lengths of tenure, shift schedules, and previous engagement levels to ensure a robust representation of viewpoints.
Based on the workgroup’s findings — and aided by the survey vendor’s recommendations — they decided to focus on improving responses related to a single topic: nurses’ attitudes toward patient and family requests.
“When trying to improve patient experience, often the instinct is to throw the entire kitchen sink at it,” Jones said. “Our group felt that this question was most within their locus of control and could best impact the culture of the unit.”
Two key factors for higher scores
Jones and her team launched “Strive for 95,” a campaign aimed at achieving monthly satisfaction scores of 95% from patients and their families when asked about “nurses’ attitudes toward requests.” To get there, the workgroup used established research and feedback from clinical staffers to focus on two priorities:
- Scripting. Standardized language ensures a consistently positive message. Guidelines include asking open-ended questions (“What else can I do for you?”), using the child’s name to personalize care, and assuring the patient and their family that they’ve been heard (“Let’s talk more about your concerns.”)
- Body language. Good scripting is meaningless without a positive attitude, so the interventions stressed more attentiveness during rounds, a friendly tone of voice, eye contact, and sincerity in listening.
To hone their skills, nurses role-played body language and scripting exercises during morning huddles. Jones and the workgroup leaders shared updates of the team’s progress during huddles and staff meetings to ensure the nurses remained engaged.
The nursing staff’s efforts were well-recognized by Joe DiMaggio Children’s Hospital’s patients and their families. Before the workgroup’s interventions, the unit averaged an 86% score related to the nurse attitude question. In the first quarter after the intervention, they achieved a 96% rating. Further, they’ve maintained that performance level for six successive quarters.
And the improvements were not limited to the nurse attitude question. Joe DiMaggio Children’s Hospital’s overall rankings nationally across all patient experience measures have risen from the 78th percentile pre-intervention to the 99th percentile following the initiative.
The clinical nurse’s voice is critical to QI success
The hospital continues to post its quarterly nursing-sensitive patient experience scores in units to keep nurses apprised of ongoing progress, stressing the importance of improving one question at a time. Jones said this project’s results demonstrate the effectiveness of its approach, with one key aspect as the lynchpin.
“Shared governance and the involvement of the clinical nursing staff provides a better experience for patients and families as well as employee engagement and satisfaction,” Jones said. “Nursing-sensitive indicators are the signature of the care given, so it’s vital that their voice is heard.”
