Hospitals are increasingly focusing on patient satisfaction as they attempt to differentiate themselves in a competitive environment. Improving patient satisfaction can do more than secure a hospital's market share, however. Analyzing patient safety measures can alert hospitals to communication breakdowns that lead to lapses in care. Increasing patient satisfaction can thus significantly impact the quality of care and patient safety. Carrie Bennett, senior director of customer service for Brentwood, Tenn.-based LifePoint Hospitals, explains how patient satisfaction scores can help hospitals and health systems measure and lower readmissions.
HCAHPS
LifePoint Hospitals analyzes patient responses to the Hospital Consumer Assessment of Healthcare Providers and Systems survey to assess their hospitals' performance during discharge. Two questions in HCAHPS pertain to discharge processes; they ask whether the patient has received discharge instructions in writing and whether hospital staff asked if the patient might need help post-discharge. "Patient understanding of discharge instructions is a critical component of delivering quality care and good patient outcomes," Ms. Bennett says.
While these HCAHPS questions have only 'yes or no' answers, they give LifePoint Hospitals a starting point when attempting to improve the discharge process. "Using data alone doesn't lower readmission rates, but because there is research out there showing that clear discharge instructions and asking the right questions can lower readmissions, we use that dimension score to help us figure out which hospitals and/or units may need more support in improving these areas and adopting specific best practices," Ms. Bennett says.
Discharge instructions
There are several ways to communicate discharge instructions to patients. Some hospitals have dedicated discharge nurses or advocates who round on patients scheduled for discharge and educate them on their medications, diet or exercise guidelines, and resources for care outside the hospital. The instructions are important not only because they guide patients on post-discharge behavior, but also because they decrease patients' anxiety and increase their confidence in themselves and the organization, according to Ms. Bennett.
Communication tools
LifePoint Hospitals coaches staff on specific communication tools to help patients understand their responsibilities after discharge. Some hospitals have created a multidisciplinary care team that meets regularly to discuss each patient's discharge plan and ensure everyone understands the patient's needs. For example, the pharmacist can be involved in discharge planning to explain to patients what prescriptions they need, how to take the medications and possible side effects. Another useful tool is repetition and teach back, which LifePoint Hospitals has focused on in the last year. In this technique, providers ask patients to repeat the instructions they heard and "teach" the providers what they understand their responsibilities to be.
Some hospitals under LifePoint have also established a care partner program to ensure patients and their loved ones understand their discharge instructions. Under this program, patients identify a family member or friend who will listen to the instructions with them so the "partner" can help the patients get their prescriptions and schedule appointments once they are home. In addition, some hospitals are turning to third parties to access standardized discharge materials at an appropriate reading level for the patient population, Ms. Bennett says.
Follow-up
Following up with patients after discharge is critical to preventing readmissions. Ms. Bennett says some LifePoint hospitals schedule patients' follow-up appointments before discharge and give patients a card with the appointment date and time as a reminder. Calling patients post-discharge can also be helpful in ensuring patients understand their condition and that they filled their prescriptions. Hospitalists are a useful resource for managing follow-up visits, because they can notify the primary care physician when a patient is discharged and provide discharge notes.
Engagement
Another strategy in reducing readmissions is engaging staff and physicians in improvement efforts. "Education and engagement of hospital leaders, staff and physicians are key," Ms. Bennett says. Staff and physicians need to understand how their actions affect patient satisfaction and outcomes, and collaborate to improve processes. Some hospitals have HCAHPS improvement teams comprised of department leaders and line staff who discuss ideas to improve patient satisfaction and quality. LifePoint hospitals also have physician engagement groups, comprised of roughly eight to 12 physicians per hospital, who brainstorm ways to improve quality.
Seeking input from those who work directly with patients is essential in gaining both buy-in for initiatives and insight into patient processes, such as discharge. "Make sure you bring to the table physicians and staff to talk about how to better prepare patients," Ms. Bennett says. "Giving them a chance to say 'Here's where we see gaps that need to be filled' is a critical piece."
Sharing best practices
Different hospitals within LifePoint have slightly different approaches to reducing readmissions. To learn from each other and develop best practices, hospitals collect data and present results from their initiatives to the other hospitals. Hospitals can then adopt strategies from other hospitals and build upon others' experiences.
Sharing practices can be difficult, however. "One of the biggest challenges from a system level is that our system has more than 50 hospitals across 18 states. The dynamics are different, the resources are different and the populations are different. What works in one hospital may not work in another," Ms. Bennett says. While adapting new approaches to different hospitals is a challenge, it gives hospitals the opportunity to benchmark their performance and access a range of resources. "As you identify top performers, it creates networking opportunities."
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HCAHPS
LifePoint Hospitals analyzes patient responses to the Hospital Consumer Assessment of Healthcare Providers and Systems survey to assess their hospitals' performance during discharge. Two questions in HCAHPS pertain to discharge processes; they ask whether the patient has received discharge instructions in writing and whether hospital staff asked if the patient might need help post-discharge. "Patient understanding of discharge instructions is a critical component of delivering quality care and good patient outcomes," Ms. Bennett says.
While these HCAHPS questions have only 'yes or no' answers, they give LifePoint Hospitals a starting point when attempting to improve the discharge process. "Using data alone doesn't lower readmission rates, but because there is research out there showing that clear discharge instructions and asking the right questions can lower readmissions, we use that dimension score to help us figure out which hospitals and/or units may need more support in improving these areas and adopting specific best practices," Ms. Bennett says.
Discharge instructions
There are several ways to communicate discharge instructions to patients. Some hospitals have dedicated discharge nurses or advocates who round on patients scheduled for discharge and educate them on their medications, diet or exercise guidelines, and resources for care outside the hospital. The instructions are important not only because they guide patients on post-discharge behavior, but also because they decrease patients' anxiety and increase their confidence in themselves and the organization, according to Ms. Bennett.
Communication tools
LifePoint Hospitals coaches staff on specific communication tools to help patients understand their responsibilities after discharge. Some hospitals have created a multidisciplinary care team that meets regularly to discuss each patient's discharge plan and ensure everyone understands the patient's needs. For example, the pharmacist can be involved in discharge planning to explain to patients what prescriptions they need, how to take the medications and possible side effects. Another useful tool is repetition and teach back, which LifePoint Hospitals has focused on in the last year. In this technique, providers ask patients to repeat the instructions they heard and "teach" the providers what they understand their responsibilities to be.
Some hospitals under LifePoint have also established a care partner program to ensure patients and their loved ones understand their discharge instructions. Under this program, patients identify a family member or friend who will listen to the instructions with them so the "partner" can help the patients get their prescriptions and schedule appointments once they are home. In addition, some hospitals are turning to third parties to access standardized discharge materials at an appropriate reading level for the patient population, Ms. Bennett says.
Follow-up
Following up with patients after discharge is critical to preventing readmissions. Ms. Bennett says some LifePoint hospitals schedule patients' follow-up appointments before discharge and give patients a card with the appointment date and time as a reminder. Calling patients post-discharge can also be helpful in ensuring patients understand their condition and that they filled their prescriptions. Hospitalists are a useful resource for managing follow-up visits, because they can notify the primary care physician when a patient is discharged and provide discharge notes.
Engagement
Another strategy in reducing readmissions is engaging staff and physicians in improvement efforts. "Education and engagement of hospital leaders, staff and physicians are key," Ms. Bennett says. Staff and physicians need to understand how their actions affect patient satisfaction and outcomes, and collaborate to improve processes. Some hospitals have HCAHPS improvement teams comprised of department leaders and line staff who discuss ideas to improve patient satisfaction and quality. LifePoint hospitals also have physician engagement groups, comprised of roughly eight to 12 physicians per hospital, who brainstorm ways to improve quality.
Seeking input from those who work directly with patients is essential in gaining both buy-in for initiatives and insight into patient processes, such as discharge. "Make sure you bring to the table physicians and staff to talk about how to better prepare patients," Ms. Bennett says. "Giving them a chance to say 'Here's where we see gaps that need to be filled' is a critical piece."
Sharing best practices
Different hospitals within LifePoint have slightly different approaches to reducing readmissions. To learn from each other and develop best practices, hospitals collect data and present results from their initiatives to the other hospitals. Hospitals can then adopt strategies from other hospitals and build upon others' experiences.
Sharing practices can be difficult, however. "One of the biggest challenges from a system level is that our system has more than 50 hospitals across 18 states. The dynamics are different, the resources are different and the populations are different. What works in one hospital may not work in another," Ms. Bennett says. While adapting new approaches to different hospitals is a challenge, it gives hospitals the opportunity to benchmark their performance and access a range of resources. "As you identify top performers, it creates networking opportunities."
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