Improving Patient Experience by Implementing an Evidence-Based Nurse Leader Rounding Tool

Abstract

Problem: An identified clinical unit, in a large community hospital was failing to meet organizational expectations of benchmarked top box scoring on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). HCAHPS measures patient experience and impacts hospital reimbursement. The project unit’s HCAHPS score was at 74.4%, versus national top box reporting at 87.4%. Purpose: Intent of this initiative was to optimize service recovery by standardizing and enhancing the unit-based approach to Nurse Leader Rounding (NLR) with the use of a new electronic evidence-based tool to drive process and improve patient experience. It was intended that staff would adopt the project tool to guide their rounding, and that patients would report improved quality of care. The project anticipated that staff would report improved understanding of service recovery and satisfaction with use of a standardized approach. Outcomes were measured by an electronic software solution that patients used to provide real-time feedback on NLR quality and service recovery. Methods: Methodology included assessing participant nurse’s knowledge/ competency, and then implementing formal education for those who conduct unit-based NLR. The project leader, unit educator and nurse manager were identified as key stakeholders. Pre/post review of educational training was analyzed to evaluate feedback. Implementation included establishment of secure data collection plans and baseline data capture. Strategies and tactics to achieve the project goals included training of all staff members who conducted NLR, implementation of an evidence-based best-practice intervention tool, creation of an outcome tool that reflected key questions measured in HCAHPS, and auditing of process with regular team feedback on project outcomes. Patients were given opportunity to provide real-time feedback on the quality of Nurse Leader Rounding. Results: Nurses universally adopted the intervention tool to drive improved process. Patients reported that the quality of NLR improved by at least 25% across all survey questions. Conclusions: Expansion of the evidence-based methodology may yield improved patient experience reporting in similar clinical settings, in key elements of HCAHPS, both at the organization, and potentially beyond.