The Easiest Way to Raise Your HCAHPS Scores

These are both true stories about real people. 

Scenario 1
 
A patient arrives for his HIDA scan. If you’re a nonmedical person, this is also known as a cholescintigraphy or hepatobiliary scintigraphy scan. It tests the gallbladder. Basically, a nurse injects a radioactive tracer into a vein in the patient’s arm.
 
After briefly speaking with the patient, having him sign the standard release forms and explaining that the dye is mostly harmless, the nurse leaves the room. 
 
When the nurse comes back, she is suited up in a radioactive suit, carrying a steal box that contains the injection. During the quick consult, she neglected to mention this part, so the patient is surprised when the nurse comes back in. 
 
Because the patient doesn’t know why he’s been in pain for three months, and because the nurse had just finished telling him that the dye was safe, the patient’s anxiety rises substantially upon the nurse’s re-entrance in her protective garb. 
 
Seeing the change in the patient, the nurse leaves and—within earshot of the patient, says to her colleague, “I think we’re going to have a problem with this one.” 
 
The patient immediately tries doing deep breathing exercises to bring his blood pressure down for the nurse. 
 
When the nurse comes back in, the patient explains that he just didn’t expect the suit, and the word “radioactive” makes him nervous. 
 
The nurse shrugs and says OK, then proceeds to inject the dye.
 
The patient leaves the room feeling scared and like he did something wrong. Because he was frightened. 
 
Scenario 2
 
A patient arrives for an appointment with her primary care physician. The appointment is for talking about pharmacological options that might help her relax. 
 
Upon the vitals check with the nurse, the patient expresses that she feels guilty because she’s essentially asking for drugs.
 
Her PCP’s nurse stops her assessment and sits down. The nurse explains that sometimes people need help, and that it was wise of the patient to make the appointment. 
 
The patient’s PCP arrives a moment later. We can assume that the nurse has informed the PCP of her own conversation with the patient.
 
The PCP puts her laptop on the desk, and before opening it, sits down, looks at the patient, and simply asks, “How are you?” 
 
The patient explains her recent stressors, and lets her PCP know that she isn’t sleeping, but instead wakes up, and that it feels like all her muscles are clenched. 
 
Like the nurse, the PCP is extraordinarily validating and—with just her words and manner—absolves the patient of any guilt caused by the need to request a prescription to help her relax.
 
The PCP gives the patient a gentle, nonjudgmental reminder that sometimes people need pharmacological help. This patient’s prescription is temporary (the option they decided on can be addictive), and the PCP encourages the patient to take care of herself. 
 
The patient leaves with a sense of relief, and a sense of feeling understood. Even if she’s still clenched up.
 
In the first scenario, we have a very task-centered staff member. In the second one, we have a very person-centered staff. 
 
I don’t mean for this post to address which approach is the best way to do one’s job. Instead, this is a plea to all healthcare staff to create an improved balance between these two approaches. 
 
The Oxford English Dictionary defines the verb care as to:
 
1. feel concern or interest; attach importance to something.
 
2. look after and provide for the needs of.
 
In terms of patient satisfaction surveys and HCAHPS scores, evidence suggests that results are higher when patients feel cared about.
 
This is an excellent reason to layer person-centeredness into our lists of tasks that need to get done. 
 
But I don’t have time!”
 
We can pay now, or we can pay later.
 
When we put forth more effort on the front end, the payouts can be greater later on: happier patients, happier families, fewer staff injuries, higher staff morale, fewer medical errors.
 
So where should we exert this extra effort?
 
In CPI training, we suggest that the answer is as simple as this:
 
In everything we do, assume the baseline of taking a Supportive approach.
 
And then think of that baseline Supportive approach as good customer (patient) service.
 

 

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Here are a few ways to do this, which take little time on our parts:
 

 

1. Use good manners and be respectful.

 

This sounds obvious and simple, but it’s so often overlooked when we’re in a rush, under pressure, bogged down, and stressed out.
 
But don’t forget! “Please,” “Thank you,” “Excuse me,” “You’re welcome” … these simple graces go a long way. Phrases like this, spoken with genuine courtesy, show respect for a person. It might sound surprising, but the truth is that manners can often calm anyone down. These tiny niceties also show appreciation that the person is there. Most (though certainly not all) patients don’t wake up in the morning and think, “I’d really like to sustain an injury that lands me in the emergency room!”
 
Considering that a visit to the ED is probably a major disruption to everyone’s day, we have an opportunity here.
 
Do they want to be with us?
 
Nope.
 
But if our behavior is such that patients enjoy their time with each of our staff members (though likely not with their current circumstances), everything will go more smoothly for them and for us.
 

2. Keep people informed.

 

Of all the kinds of situations that tend to escalate, it’s the most frustrating for me to hear about the ones that escalate simply because of a lack of communication.
 
Take long waiting times as an example. Often, they can’t be avoided due to the unpredictability of the healthcare environment. Staff often say, “I’m sorry—we’ll let you know as soon as we hear something.” While staff’s intent is to be Supportive with this statement, unfortunately this approach can often backfire.
 
Instead, try this:
 
If staff notice that a patient is looking anxious and it’s been a few minutes, say, “I want you to know that we haven’t forgotten about you. The doctor is still on her way,” or something that lets the person know that we haven’t forgotten about them.
 
As a family member and as a patient, I can tell you that there are at least two types of anxiety present anytime we need to wait, whether we’re in the ED, Med/Surg, Urgent Care, or anywhere where we’re worried about our pain, or our family’s pain, and waiting desperately for help: Anxiety due to the injury/illness that brought us here, and the anxiety that staff have forgotten about us.
 
If possible, offer the person something (within reason): a cup of water or coffee (granted, this depends on the circumstances around their visit), let them know where the bathrooms are, or offer them whatever you feel might calm and reassure them. A tissue? A magazine? A lower volume on the TV?
 
Admittedly these are little things, but they can make a world of difference to help the patient feel cared about and remembered. And if we think about the impact of the Integrated Experience (how my attitudes and behaviors affect yours and vice versa), we’ve probably made our own day a bit easier, too. Patients who feel cared about are often more pleasant to their care team.
 

3. Allow just a bit of extra time—when possible, of course.

 

Healthcare can be a high-stress occupation. That said, some of the best staff I’ve seen, worked with, trained, and have been a patient of have taken a few extra seconds to make sure their patients had the opportunity to express themselves and explain their symptoms in their own words. They take a few extra moments to make sure the patient understands the information being provided.
 
When people are experiencing anxiety, their rational thinking process slows down. Their irrational thinking process speeds up. The primal brain starts to take over. As staff, it’s on us to adjust to the patient’s level of processing. If we, as staff, don’t understand this and move too fast or assume perfect comprehension, it could be very detrimental.
 

4. Listen. Truly listen.

 

This is so easy to say and yet, honestly, so few people actually do it well. In Scenario 2, the PCP spent approximately 10 minutes with the patient, which is pretty standard, and it’s not a lot of time. She spent the majority of that time listening to her patient. She asked questions when she needed to, and then made sure to ask the patient for her questions at the end. It’s a misconception that listening needs to involve a lot of time. And in the healthcare field, it has the potential to save time—and lives, too. 
 
The healthcare field can be so rewarding—for staff as well as patients. There are a lot of kind, caring, patient staff out there who make it a part of their habitual care practice to do the things listed above. If you know one of them, watch them. Learn from them. If you are one of them, be a model. Show. Teach.
 
Listeners are the true healers, because they heal their patients’ spirits as well as their bodies.
 
In our scenarios, two patients had two experiences. In neither scenario was the patient healed, but in the second scenario, the patient didn’t leave feeling like “a problem.”
 
Before we begin our interactions with patients, let’s pause for a moment and ask ourselves how we want the person to feel when it’s over.
 
How would we want to feel?

 
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