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Discharge planning: Best practices can result in better customer service, market share
Patient Access Advisor, July 3, 2007
Pricing and quality transparency are now buzzwords with long-reaching financial implications for both providers and patients. Now, more than ever, hospital administrators believe strong customer service may be the "X" factor that will retain customers and their business.
Providers must examine every process to ensure that it's not only efficient for the hospital, but also appealing for the patient.
However, one particular process--discharge planning--can be a headache in any setting. Leaving the hospital ranks among the most anticipated and stressful moments of a hospital experience for patients and their families. Yet, all too often, patients get delayed in the discharge stage of their hospital visit, just when they're ready to go home.
Delays in discharge have long affected length of stay and patient flow, but numerous studies now show a direct link between a hospital's discharge planning process and overall patient satisfaction. A patient's perception of the discharge process has become a crucial component to overall satisfaction and hospital loyalty.
"A good discharge experience leaves the patient with positive emotions and a strong affinity for returning to the facility," said Paul Clark,senior knowledge manager for Press Ganey Associates in South Bend, IN, during the HCPro audioconference "Optimizing the Discharge Process: Improve Patient Flow, Reduce Length of Stay, and Increase Patient Satisfaction."
"A negative experience can override the good impressions and positive considerations that were formed throughout the patient's stay in the hospital," said Clark. Since 2002, Clark and other researchers at Press Ganey have studied ways of optimizing the discharge planning process using evidence-based best practice methodologies.
They performed a data analysis of more than 1,600 of their top-scoring and top-performing facilities and conducted interviews with officials at each hospital to generate in-depth feedback.
Change begins in the mirror
The first step to optimize your discharge planning process is understanding what it looks like from the patient's perspective, said Clark. "Then you can start to envision your own ideal process. You can start to identify the gaps between reality and your envisioned ideal."
Next, to help understand and create an ideal discharge planning process, Clark recommended using the Joint Commission and American Medical Association standards for discharge planning as a framework.
Both The Joint Commission and the AMA require hospitals to provide an assessment of a patient's learning needs, abilities, preferences, and readiness that considers culture, religion, emotional barriers, physical and cognitive limitations, language barriers, and financial implications.
"The standards are very comprehensive and challenging, but they're good," said Clark. "You should ask yourself, 'How often are we hitting these standards'? How do we do this? Do we do it each and every time or only when we have complex cases?"
After framing your discharge process around the Joint Commission and AMA standards, the Press Ganey researchers recommend you structure your process based on your patients' needs. "Patients need to know many things," said Clark. "They want to know when they will be going home and what they will have to go through on the day of discharge. They want to feel safe and prepared for a transfer, if needed. They want all of their questions answered, their feelings considered, their families involved, and a continuous healing relationship with their care providers."
To measure and quantify these goals, Press Ganey divided the discharge process into four distinct areas of evaluation on their surveys. Press Ganey judges a hospital's discharge process largely by how patients respond to these crucial factors:
Patients' personal readiness
Many top facilities using Press Ganey recommendations address the readiness issue by giving each patient a "questions for my doctor" notepad that stays at the patient's bedside and that physicians read every time they make rounds and again at the time of discharge.
"An even better way to prepare patients is to act proactively through preadmission education," said Martin Wright, solutions consultant for Press Ganey Associates, during the audioconference.
For common procedures, many high-scoring Press Ganey hospitals meet with patients the day before surgery and go over the procedure, recovery, and rehab periods. They explain what type of pain to expect and what the staff will do to relieve symptoms.
One simple way to ease anxiety and prepare patients for a discharge is through a contact information sheet, said Wright.
"A lot of hospitals use this, but it should be done every time and it should be done right," explained Wright. "You should include a direct way of reaching real staff members, instead of listing an 800 number or general line. This will mitigate a patient's fears by providing a level of assurance."
Speed of discharge
At many Press Ganey hospitals, managers communicate LOS early and educate patients and their families about the steps of the discharge process.
Patients are often frustrated and anxious because they simply aren't aware of what's involved in the discharge process, or what staff members are doing on their behalf.
Wright also recommended standardizing the events that occur during the day of discharge to improve speed. "If we're not doing special things all the time, but instead doing the same things consistently, communication and coordination will improve," he said.
One way to standardize events is to establish a universal discharge time, said Wright. This makes it easy for staff members to stay informed and prepared, so when the physician makes his or her rounds, everything is ready and the patient can leave immediately,said Wright.
Another option is having specific discharge appointments for each patient. Scheduling appointments ahead of time eliminates the mad scramble to get everything done after a physician writes the discharge order.
"We found that top-performing hospitals used one of these two systems to improve speed," said Wright. "It doesn't matter which one you chose, only that you adhere to it rigorously."
Discharge instructions
Many patients misunderstand discharge instructions due to either a language barrier or poor communication by staff members.
To overcome language barriers, hospitals should have an interpreter on staff or access to a language service. To eliminate poor communication, staff members should deliver all discharge instructions both verbally and through printed handouts such as brochures and pamphlets, said Clark.
Clark recommended going a step further by investing in a patient resource center that provides multimedia take-home materials, such as color pictures, videotapes, and audiotapes.
"Such materials humanize an illness and bring to life printed descriptions for self-care and symptoms that patients may have difficulty visualizing," said Clark. "Multimedia instructions substantially improve patients' recall and compliance."
Postacute care arrangements
Whether it's fair or not, if postacute discharge plans fall through or are unsatisfactory, the patient usually blames the inpatient facility. Satisfaction scores then go down, said Molly B. LeBel, researcher at Press Ganey, during the audioconference.
"These final impressions are huge. Therefore, inpatient facilities have a vested interest in ensuring a successful patient experience," said LeBel.
While researching postacute care at top-performing hospitals, LeBel identified three important areas in which most of these hospitals excelled:
Customer satisfaction is greatly improved when patients have a contact from the acute-care side who is in direct communication with someone on the postacute side, said LeBel.
Satisfaction scores also increase when hospitals effectively manage patients' expectations during the transition to postacute care.
"Occasionally, patients have the misconception that a home health agency will provide services such as cooking, household chores, or social visiting when relatives are not available," said LeBel. "By being clear about expectations, the hospital clearly spells out what a provider will and will not do, and patients very much appreciate that."
Finally, many top facilities collect and share clinical, social, and demographic information with postacute providers. "Sharing of information makes a [skilled nursing facility] or home health agency more knowledgeable, and all patients benefit from this continuum of care."
Corey Goodman is the editor of Patient Access Advisor. He may be reached at cgoodman@hcpro.com. This story first appeared in the July edition of Patient Access Advisor, a monthly newsletter by HCPro Inc. For information on all of HCPro's products, visit www.hcmarketplace.com.
Providers must examine every process to ensure that it's not only efficient for the hospital, but also appealing for the patient.
However, one particular process--discharge planning--can be a headache in any setting. Leaving the hospital ranks among the most anticipated and stressful moments of a hospital experience for patients and their families. Yet, all too often, patients get delayed in the discharge stage of their hospital visit, just when they're ready to go home.
Delays in discharge have long affected length of stay and patient flow, but numerous studies now show a direct link between a hospital's discharge planning process and overall patient satisfaction. A patient's perception of the discharge process has become a crucial component to overall satisfaction and hospital loyalty.
"A good discharge experience leaves the patient with positive emotions and a strong affinity for returning to the facility," said Paul Clark,senior knowledge manager for Press Ganey Associates in South Bend, IN, during the HCPro audioconference "Optimizing the Discharge Process: Improve Patient Flow, Reduce Length of Stay, and Increase Patient Satisfaction."
"A negative experience can override the good impressions and positive considerations that were formed throughout the patient's stay in the hospital," said Clark. Since 2002, Clark and other researchers at Press Ganey have studied ways of optimizing the discharge planning process using evidence-based best practice methodologies.
They performed a data analysis of more than 1,600 of their top-scoring and top-performing facilities and conducted interviews with officials at each hospital to generate in-depth feedback.
Change begins in the mirror
The first step to optimize your discharge planning process is understanding what it looks like from the patient's perspective, said Clark. "Then you can start to envision your own ideal process. You can start to identify the gaps between reality and your envisioned ideal."
Next, to help understand and create an ideal discharge planning process, Clark recommended using the Joint Commission and American Medical Association standards for discharge planning as a framework.
Both The Joint Commission and the AMA require hospitals to provide an assessment of a patient's learning needs, abilities, preferences, and readiness that considers culture, religion, emotional barriers, physical and cognitive limitations, language barriers, and financial implications.
"The standards are very comprehensive and challenging, but they're good," said Clark. "You should ask yourself, 'How often are we hitting these standards'? How do we do this? Do we do it each and every time or only when we have complex cases?"
After framing your discharge process around the Joint Commission and AMA standards, the Press Ganey researchers recommend you structure your process based on your patients' needs. "Patients need to know many things," said Clark. "They want to know when they will be going home and what they will have to go through on the day of discharge. They want to feel safe and prepared for a transfer, if needed. They want all of their questions answered, their feelings considered, their families involved, and a continuous healing relationship with their care providers."
To measure and quantify these goals, Press Ganey divided the discharge process into four distinct areas of evaluation on their surveys. Press Ganey judges a hospital's discharge process largely by how patients respond to these crucial factors:
- The extent to which the patient feels ready for the hospital to discharge him or her
- The speed of the discharge process after the patient is told that he or she is ready to be discharged
- The instructions given to the patient about how to care for him- or herself at home
- The assistance the staff offers to arrange home services
Patients' personal readiness
Many top facilities using Press Ganey recommendations address the readiness issue by giving each patient a "questions for my doctor" notepad that stays at the patient's bedside and that physicians read every time they make rounds and again at the time of discharge.
"An even better way to prepare patients is to act proactively through preadmission education," said Martin Wright, solutions consultant for Press Ganey Associates, during the audioconference.
For common procedures, many high-scoring Press Ganey hospitals meet with patients the day before surgery and go over the procedure, recovery, and rehab periods. They explain what type of pain to expect and what the staff will do to relieve symptoms.
One simple way to ease anxiety and prepare patients for a discharge is through a contact information sheet, said Wright.
"A lot of hospitals use this, but it should be done every time and it should be done right," explained Wright. "You should include a direct way of reaching real staff members, instead of listing an 800 number or general line. This will mitigate a patient's fears by providing a level of assurance."
Speed of discharge
At many Press Ganey hospitals, managers communicate LOS early and educate patients and their families about the steps of the discharge process.
Patients are often frustrated and anxious because they simply aren't aware of what's involved in the discharge process, or what staff members are doing on their behalf.
Wright also recommended standardizing the events that occur during the day of discharge to improve speed. "If we're not doing special things all the time, but instead doing the same things consistently, communication and coordination will improve," he said.
One way to standardize events is to establish a universal discharge time, said Wright. This makes it easy for staff members to stay informed and prepared, so when the physician makes his or her rounds, everything is ready and the patient can leave immediately,said Wright.
Another option is having specific discharge appointments for each patient. Scheduling appointments ahead of time eliminates the mad scramble to get everything done after a physician writes the discharge order.
"We found that top-performing hospitals used one of these two systems to improve speed," said Wright. "It doesn't matter which one you chose, only that you adhere to it rigorously."
Discharge instructions
Many patients misunderstand discharge instructions due to either a language barrier or poor communication by staff members.
To overcome language barriers, hospitals should have an interpreter on staff or access to a language service. To eliminate poor communication, staff members should deliver all discharge instructions both verbally and through printed handouts such as brochures and pamphlets, said Clark.
Clark recommended going a step further by investing in a patient resource center that provides multimedia take-home materials, such as color pictures, videotapes, and audiotapes.
"Such materials humanize an illness and bring to life printed descriptions for self-care and symptoms that patients may have difficulty visualizing," said Clark. "Multimedia instructions substantially improve patients' recall and compliance."
Postacute care arrangements
Whether it's fair or not, if postacute discharge plans fall through or are unsatisfactory, the patient usually blames the inpatient facility. Satisfaction scores then go down, said Molly B. LeBel, researcher at Press Ganey, during the audioconference.
"These final impressions are huge. Therefore, inpatient facilities have a vested interest in ensuring a successful patient experience," said LeBel.
While researching postacute care at top-performing hospitals, LeBel identified three important areas in which most of these hospitals excelled:
- Customer satisfaction
- Frequent and effective communication
- Utilization of information-sharing technologies
Customer satisfaction is greatly improved when patients have a contact from the acute-care side who is in direct communication with someone on the postacute side, said LeBel.
Satisfaction scores also increase when hospitals effectively manage patients' expectations during the transition to postacute care.
"Occasionally, patients have the misconception that a home health agency will provide services such as cooking, household chores, or social visiting when relatives are not available," said LeBel. "By being clear about expectations, the hospital clearly spells out what a provider will and will not do, and patients very much appreciate that."
Finally, many top facilities collect and share clinical, social, and demographic information with postacute providers. "Sharing of information makes a [skilled nursing facility] or home health agency more knowledgeable, and all patients benefit from this continuum of care."
Corey Goodman is the editor of Patient Access Advisor. He may be reached at cgoodman@hcpro.com. This story first appeared in the July edition of Patient Access Advisor, a monthly newsletter by HCPro Inc. For information on all of HCPro's products, visit www.hcmarketplace.com.
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