INSTITUTIONAL ASSESSMENT FOR CHANGE ON PATIENT

SATISFACTION

Auburn University/Auburn University at Montgomery

Sharon Gross

Cathy Quick

Andrea Sport

Institutional Assessment

Northeast Alabama Regional Medical Center in Anniston, Alabama– Intensive Care Unit

East Alabama Medical Center in Opelika, Alabama—Progressive Care Unit

DCH Medical Center in Tuscaloosa, Alabama- Surgical Unit

Assessment Theories

Watson’s Assessment Theory Witkin and Altschuld’s Three Phase Needs Assessment

Model Maslow’s Hierarchy of Needs

Watson’s Assessment Theory

A theory based on human caring relationships and the deep human experiences of life

Caring= encompassing presence, attentiveness, consciousness, and intentionality

Nursing is focused on patient-centered care in which the patient can achieve a higher degree of harmony within the mind, body, and soul

Witkin and Altschuld’s Three Phase Needs Assessment Model

Combines analysis, assessment, and action into one plan

Phases= pre-assessment, assessment, and post-assessment

Ideal model for problem identification and resolution

Focuses on improvement and achievement of institutional goals for individuals or small groups

Maslow’s Hierarchy of Needs

Human needs are hierarchical—unfulfilled lower needs dominate one’s thinking until the needs are satisfied

Maslow’s theory is a framework for understanding and action

Why Maslow’s? The theory of the hierarchy of needs can enable health care professionals to care for patients in a holistic manner

Maslow’s Hierarchy of Needs

And The Winner Is……

Watson’s Assessment Theory Why—it is based on caring relationships

which are fundamental for nursing care Results—promotes optimal patient-

centered care resulting in improved patient outcomes

After the institutional assessments, an identified common need for change is INCREASED PATIENT SATISFACTION!

Need for Change: Increasing Patient Satisfaction

Patient satisfaction is greatly influenced by nurses who can listen, respect, help, teach, support, protect/advocate, provide sensitive care, deliver medications on time, and those who maintain trusting relationships with patients (Suliman, Welmann, Omer, & Thomas, 2009).

Thus, the nature of change is determined as behavioral change.

Simple change.

Stakeholders

Patients and their families

CEO/Board of Directors Doctors Nurses Ancillary Staff

Stakeholders-Patients

In terms of patients, stakeholder's: Are customers that

provide revenue; Prefer to seek treatment

from local, qualified clinicians;

If dissatisfied, will seek care elsewhere even driving great distance to get alternate care.

Stakeholders-CEO/Board

The main focus of the CEO and the board of directors is to maintain profitability

Identify methods to attract new and retain current patients is also part of their consideration

Another focus is to create and implement new policies

Devise plan to reduce patient wait time.

Stakeholders-Doctors

Doctors ensure resources are available to provide quality care;

By assessing patient’s medical needs in timely manner this will improve patient satisfaction;

The physician sets the standard for interpersonal communication between patients.

Stakeholders-Nurses

Nurses ensure patients understand medications and procedures;

They provide friendly high quality care despite any situation;

Also, they follow-up quickly to make certain patients needs are addressed.

Stakeholders-Ancillary staff

Unit secretary- ensures doctors orders are entered in computer and notifies other departments of changes in unit

Housekeeping-provides the hospital with a clean environment for patients

Respiratory therapist-administers breathing treatments, performs bedside care i.e. trach care, abg’s, EKG’s and trouble shooting vent problems

Nurses aide/tech-assist patients with needs i.e., bathroom assistance, repositioning, and transport throughout facility

Patient Satisfaction

0%10%20%30%40%50%60%70%80%90%

100%

13-Aug13-SepAv-er-age

Patient Satisfaction

Is very significant to all stakeholders due to the accessibility of different hospitals they could visit for the finest care.

This is a standard of care, starting this year the Center for Medicare & Medicaid Services (CMS) Medicare reimbursements are directly linked through their Hospital Inpatient Value-Based Purchasing (HIVBP) program and patient surveys (Department of Health and Human Services, 2013).

Hospitals must strive to improve satisfaction scores to be eligible for maximum compensation.

Compliance is Needed

In order for behavioral changes to occur among health care professionals, all must be on board.

Compliance with the change is needed from the bottom to the top!

Result= increased patient satisfaction!!

Resistance to Change

The main resistance to change would be within the intra professional team with the nurses and their time .

Changing behavior and habits is difficult to accomplish.

Research revealed a decline in patient satisfaction for September was correlated with decrease in staff especially on nights with an increase in patient census as well as their acuity.

Transtheoretical Model (TTM) for behavioral change

In this model people are in the process of making a change, those whom decided to transform and those whom have not yet decided to improve.

Success is better found from more individualized interventions than cookie cutter universal interventions.

TTM is divide into five steps with two stages.

The first three are motivational stages they are: precontemplation- no plan to change in next six months, contemplation- change one to six months in the future, preparation- made for the immediate future within a month.

Action- desired behavior continued for six months or less, maintenance - temporally strong behavior change lasting longer than six months both these are action stages (Bridle, 2005).

TTM

Based on research conducted at Northeast Alabama Regional Medical Center (NEARMC) in the Intensive Care Unit (ICU) areas of greatest concern are: call light and toileting needs not answered as soon as patient wanted it, as well as the area around the room not quiet at night.

Based on research conducted at East Alabama Medical Center in the Progressive Care Unit areas of greatest concern are: call light and toileting needs not answered as soon as patient wanted it

Based on research conducted at DCH medical Center in the surgical unit the areas of greatest concern are: help as soon as patient wanted it and pain control.

The area common between all three facilities was the call lights not answered as soon as patients wanted it.

Vested Interest in Patient Satisfaction

Grol (2011) suggests there is significant evidence linking patient satisfaction to positive clinical healthcare outcomes (Grol, 2011, p. 2579).

McEwen and Dumpel (2010) articulate improved patient perception of care directly impacts how the patient perceives his/her overall care and experience (McEwen & Dumpel, 2010, p. 21)1.

McEwen and Dumpel (2010) contend patient satisfaction scores have become the driver in the healthcare agenda as state and federal contributions are based on these scores rather than patient health (p. 21)2.

Vested Interest in Patient Satisfaction

According to the Centers for Medicaid and Medicare Services (2013) satisfaction scores are used to measure quality of care and reimbursing hospitals for care patient's received (CMS.gov).

According to the US Department of Health and Human Services (2011), holding hospitals accountable will improve the quality of care and improve the health of patients (CMS.gov)3.

Sebelius (2011) contends as stakeholders in reimbursements, all members of the hospital staff have an opportunity to impact the level of care patient’s receive. (Sebelius, 2011, p. 2).

Vested Interest: Losses & Gains

Gains Better healthcare outcomes in health services provided Financial stability and increased funding from federal & state programs Increased pool of income for pay increases for all employees Higher quality of care for patients More efficient processes Create a more personalized level of care for patients

Losses Increased reporting requirements for all employees Extended work hours due to more personal level of care given to

patients Potential loss of power at every level due to requirements of CMS for

reimbursements

Drivers and Resistors of Change

According to the National Healthcare Services Institute for Innovation and Improvement (2005), gaining the commitment of all those likely to be impact by change is essential to meeting your change objective(NHS.org).

Drivers of Change

Resistors to Change

Patients Doctors/Nurses

Doctors/Nurses

Any unreceptive staff

Scrub Technician/ Nurses assistant

Individual members of hospital administration

Hospital Administration

Lon-term members of staff

Resource Implications for Change

New policies and procedural changes may be stressful for employees to learn quickly.

Changes in training material and retraining all employees according to new processes.

Costs associated with not changing how patients are serviced or the quality of care given.

Costs associated with updating technological resources including software and applications for proposed changes.

Patient empowerment is gained through increased resources, information, and quality of care.

Evaluation

Promoting Action on Research Implementation in Health Services (PARIHS) Model

Evaluation of patient satisfaction would be determined through patient satisfaction surveys administered to patients after discharge

Desired result= increase in patient satisfaction scores after implementation of the behavioral changes as previously mentioned

References

Bridle, C., Riemsma, R., Pattenden,J., Sowden, A., Mather, L., Watt, I., & Walker, A. (2005). Systematic review of the effectiveness of health behavior interventions based on the transtheoretical model. Psychology & Health, 20(3), 283-301. doi: 10.1080/08870440512331333997

Campobasso, F., & Kucharz, J. (2012). Developing healthcare facilities for a changing environment. Hfm (Healthcare Financial Management), 66(5), 102-106. Retrieved from http://ehis.ebscohost.com.spot.lib.auburn.edu/ehost/pdfviewer/pdfviewer?sid=100650c4-a4d8-48b3-8ec4-cd8b9d2245d0%40sessionmgr113&vid=45&hid=16

Centers for Medicaid and Medicare (2013). HCAHPS: Patients' perspectives of care survey. Retrieved Oct. 27, 2013 from www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment Instruments/HospitalQualityInits/HospitalHCAHPS.html

Grol, R. (2011). Improving the quality of medical care: Building bridges among professional pride, payer profit, and patient satisfaction. Journal of American Medical Association, 286(20), 2578-2585. Retrieved Oct. 26, 2013 from www.ncbi.nlm.nih.gov/ pubmed/11722272.

Jeffs, L., Sidani, S., Rose, D., Espin, S., Smith, O., Martin, & K., Ferris, E. (2013). Using theory and evidence to drive measurement of patient, nurse and organizational outcomes of professional nursing practice. International Journal of Nursing Practice, 19(2), 141-148. doi:10.1111/ijn.12048

Leigh, D., Watkins, R., Platt, W., & Kaufman, R. (2000). Alternate models of needs assessment: Selecting the right one for your organization. Human Resource Development Quarterly, 11(1), 87-93. Retrieved from http://home.gwu.edu/~rwatkins/articles/alternatemodels.pdf

References

McEwen, D. & Dumpel, H. (2010). Scripting and rounding: Impact of the corporate care model on RN autonomy and patient advocacy. National Nurses. Retrieved Oct. 27, 2013 fromhttp://www.austincc.edu/nursmods/online/online_lev4/rnsg_2221/documents/Scripting_and_Rounding_Nurse_Autonomy_and_Patient_Advocacypart_two.pdf.

National Healthcare Service (2005). Leading change: Personal and organizational development. Retrieved Oct. 26, 2013 from http://www.clahrc-northwestlondon.nihr.ac.uk/inc/files/documents/ improvement-methodology-

resources-section/ilg_3.4_leading_improvement.pdf.

Samaras, E. A., Real, S. D., Curtis, A. M., & Meunier, T. S. (2012). Recognizing nurse stakeholder dissonance as a critical determinant of patient safety in new healthcare information technologies. Work, 41,1904-1910. doi: 10.3233/WOR-2012-0406-1904

Suliman, W., Welmann, E., Omer, T., & Thomas, L. (2009). Applying Watson's Nursing Theory to assess patient perceptions of being cared for in a multicultural environment . Journal of Nursing Research, 17(4), 293-300. Retrieved from http://ehis.ebscohost.com.spot.lib.auburn.edu/ehost/pdfviewer/pdfviewer?sid=af4af306-9220-4a67-b711-fa2b6740ed26%40sessionmgr13&vid=15&hid=106

Witkin, B. R. & Altschuld, J. W. (1995). Planning and Conducting Needs Assessments: A Practical Guide.  Thousand Oaks, CA: Sage Publications. Retrieved from http://needsassessment.org/

Word, C. (2013). No pass zone. Personal communication. Posted October 18, 2013.

Zalenski, R. & Raspa, R. (2006). Maslow’s Hierarchy of Needs: A framework for achieving human potential in hospice. Journal of Palliative Medicine, 9(5), 1120-1127. doi: 10.1089/jpm.2006.9.1120