Because higher patient satisfaction scores translate to higher Medicare reimbursements, how nurses interact and talk with patients has a demonstrable and significant impact on a hospital's bottom line.
When a patient in pain cries for help, it's almost always a nurse who responds. But how swiftly that response comes and how effectively the interaction that follows satisfies the patient's needs has repercussions far beyond the bedside.
The way nurses interact and talk with their patients could have an impact on a hospital's bottom line, concludes a new study. It finds that how hospitals perform on the "communication with nurses" dimension of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey strongly influences several other "Patient Experience of Care" dimensions.
And as we all know, higher patient satisfaction = higher reimbursements.
Here's a refresher about the areas in which patients rate their care within HCAHPS [PDF]:
- Communication with doctors
- Communication with nurses
- Responsiveness of hospital staff
- Pain management
- Communication about medication
- Cleanliness/quietness of hospital environment
- Discharge information
- Overall hospital rating
The Press Ganey study aimed to find out which of these measures influenced each other. Researchers used data from a sample of 3,062 acute care hospitals to conduct what's called a "hierarchical variable clustering analysis" on the HCAHPS dimensions. This analysis identifies multiple measures that are consistently grouped together and pinpoints which measures lead the others.
It found that communication with nurses, pain management, communication about medication, responsiveness of the hospital staff, and the overall rating of the hospital were consistently clustered together, and that communication with nurses leads the way.
Translation? Efforts to improve scores in the area of communication with nurses will likely lead to higher scores in the other dimensions within that cluster, too. It's for this reason that the study calls nurse communication a "rising tide measure;" something for hospitals to focus on and improve that will set off a chain reaction of improvements in multiple areas.
This study uses appropriately rigorous methodology, but really, connecting the dots on these quality measures is just common sense.
Think about it. Nurses ask patients to rate their pain and are the ones who keep the pain meds coming, so it makes sense that quality measures connected with pain management and communication about medicines would be associated with nursing quality.
Also, when patients need help, nurses are the ones who answer their calls and pages with a visit to the bedside. Therefore, having nurses who are very responsive to those requests will likely help improve the "responsiveness of hospital staff" measure, too.
Plus, among all hospital staff they encounter, patients interact most frequently and regularly with nurses. Surely the quality of those nurse interactions color patients' overall perception of their hospital experience.
Research has consistently shown that nursing quality influences quality of care across wide measures of quality, and better nurses result in better quality.
For example, one study found that higher levels of RN hours per patient day (nurse staffing ratios) were associated with lower central line-associated blood stream infections (CLABSI); catheter-associated urinary tract infections (CAUTI) rates. It also found that critical care units with higher percentages of RNs holding national specialty certifications had lower CLABSI and CAUTI rates.
Here's the clincher: The reverse is also true. A different study showed that nurse burnout is linked to higher healthcare-associated infection rates (HAIs), and as a result, higher costs.
According to the Press Ganey study [resgistration required], the closer a measure is statistically to the "communication with nurses" measure, the more it will improve after the nursing measure is improved.
Another example: "responsiveness of hospital staff" follows communications with nurses very closely, and will improve more and at a faster clip than other measures, such as "overall rating" which is further behind.
The study calls for investing significant time and resources into improving the "communication with nurses" measure, and recommends several best practices for hospitals: "Consistent and purposeful hourly rounding, bedside shift reporting, use of scripts, post-discharge phone calls, hiring nursing candidates who exhibit strong interpersonal skills, and providing service skills training with periodic reinforcement."
Are you managing your nursing staff in a way that's consistent with preserving reimbursements?
Alexandra Wilson Pecci is an editor for HealthLeaders.
