Patient Satisfaction, HCAHPS Scores Bolstered by 'Sacred Moment'

Twin Rivers Regional Medical Center in Kennett, MO, has been owned by four for-profit hospital companies over the past decades, including the current owners, Health Management Associates, Inc.

In that time, Medical Director Steve Pu, MD, a general surgeon at the 116-bed hospital, has seen various patient engagement initiatives launched with the best of intentions only to flounder months later.

"Every company that came in had some type of program that they wanted to initiate that would help with patient satisfaction. All of the programs were good. The principles they were founded on encouraged you do to all the right things, the rounding and the discharge goals," Pu says.

"I found over the years that you would initially gain a lot of momentum with these particular initiatives, and your (HCAHP) scores would go up. But usually after six to eight months things would start to decline.

The end result at Twin Rivers had been discouraging HCAHP patient engagement scores in the mid-30s as recently as one year ago.

"Most of the patients and their families were supportive of the staff, but they said they looked like they are so busy and [that they] have the time," Pu says. "That was true. That was really occurring. The staff became demoralized. Then their attitudes begin to deteriorate and the compassion wasn't there anymore. That is how the downfall started. At the end of 2011 we were just in the pits."

Pu and his colleagues concluded that the initiatives failed because they came as a mandate that did not engage physicians from the start, nor ask them to lead.

"When you look at these things, and you look at other health systems across the country and usually all of these initiatives are targeted at front-line staff. The physicians have always been left out of the loop," he says.

"You get informed about it but they're not asking us to lead it. You have to have the physicians out front because if the front-line staff sees that the medical staff not only buys into it but owns it they are much more responsive. You don't want them to perceive it as just another task."

During a brainstorming session to improve the patient experience, two physicians at Twin Rivers came up with the idea of a "sacred moment" between the physician and the patient shortly after they are admitted into the hospital.

"We asked why the initial conversation with the patient is so complicated. You have to fill out all this paperwork. 'Do you have a living will? What is your insurance?'" Pu says. "And my OB/GYN said, 'why can't we have a moment or a time at the beginning with the patient in that first 10 or 15 minutes where we really try to connect with the patient on a more-personal basis and try to address their immediate concerns and fears?' 'Do you know why you are here? Who is your support group? Do you have spiritual needs? Have you eaten in the last six hours?'"

Pu says the term 'sacred' is used not in a religious context but to re-affirm the caring bond between the physician and the patient. "That first 10 or 15 minutes the provider has with the patients means it is uninterrupted, sacred. You don't answer a cell phone or do anything else. You are completely focused on that 10 or 15 minutes with that particular patient," he says.

"We try to eliminate fears and address concerns. We found that not only can you do that but you also do something for the person who is giving the sacred moment. By making that connection you are tapping back into their original calling and mission. They feel like they are caring for somebody and it is not perceived as just another task."