The DNP Project: Introduction, Background and Problem

 

Using ‘Commit to Sit’ to Impact Patient Satisfaction on a Pediatric Medical-Surgical Floor

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          In healthcare, organizations are strategizing methods to improve the patient’s experience, by staying current and agile to meet consumer expectations and prevent mistrust and poor health outcomes.  (Lidgett, 2016; Loos, 2021; Mazurenko et al., 2017; Merel et al., 2016; Odai-Afotey et al., 2018; Shin & Park, 2018; Trotta, 2020).  Performance of person and community engagement, clinical outcomes, safety, efficiency, and cost reduction are subject to financial reimbursement through the Centers for Medicare and Medicaid Services (CMS) Value-Based Purchasing Program which has a significant impact on an organization overall well-being (Centers for Medicare, and Medicaid Services [CMS], 2018; Mazurenko et al., 2017). The act of listening and effective health care communication has been linked to increased trust between patients and caregivers, improved perceptions of care,  improved health outcomes, medication compliance, patient satisfaction scores, and lower readmission rates (George et al., 2018; Gilligan et al., 2017; Loos, 2021; McCaffrey et al., 2020).  

          To best impact, these key performance and strategic measures, creating a culture that fosters a positive experience through interactions that emanate caring behaviors, staying present in the moment, empathy, and therapeutic verbal and non-verbal communications are key for organizational success (Merel et al., 2016; Orloski et al., 2019; Owens et al., 2017). The purpose of the proposed Doctor Nursing Practice (DNP) project is to improve patient satisfaction scores through the integration of the evidence-based intervention (EBI) ‘commit to sit’ to nurse rounding (George, 2018; Lidgett, 2016; Merel et al., 2016; Orloski et al., 2019; Pattison et al., 2017). This manuscript will describe an assessment of the practice problem and its significance, evidence synthesis of the intervention, translational science model and methodology, implementation plan, evaluation, and data analysis plan, and the sustainability of this EBI practice change.

Problem

          The lens around patient experience has increased significantly over the past decade. Nationally, patient and family expectations are steadily increasing and requiring changes in practices to meet their needs (Lidgett, 2016; Loos, 2021; Mazurenko et al., 2017; Merel et al., 2016; Odai-Afotey et al., 2018; Shin & Park, 2018; Trotta, 2020). Alignment to the consumers’ needs of trust and safety is critical to provide an optimal experience that yields improved health outcomes (Loos, 2021; Merel et al., 2016; Odai-Afotey et al., 2018; Shin & Park, 2018).  The Centers for Medicare and Medicaid Services (CMS) Value-Based Purchasing Program established by the Affordable Care Act, provides compensation based upon the overall quality of care provided, rather than volume of services (Centers for Medicare, and Medicaid Services [CMS], 2018; Mazurenko et al., 2017).  Performance and hospital reimbursement are measured by four key components: person and community engagement (25%), clinical outcomes (25%), safety (25%), and efficiency and cost reduction (25%) (CMS, 2018; Mazurenko et al., 2017).  Performance related to person and community engagement or consumer satisfaction is measured through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction survey scores (Mazurenko et al., 2017; Orloski et al., 2019; Owens et al., 2017; Trotta et al., 2020).

          The HCAHPS survey is the first national, public, and standardized, data collection repository, and benchmarking tool dedicated to ascertaining the patient’s perceptions of the care they were provided (CMS, 2018; Mazurenko et al., 2017; Owens et al., 2017; Trotta et al., 2020).  The HCAHPS scores determine financial reimbursement from CMS, consumer trust, and reputation to remain competitive in the healthcare arena (CMS, 2018; Mazurenko et al., 2017; Owens et al., 2017; Trotta et al., 2020).  Understanding the significant impact of enhancing current practices to impact patient experience scores has on an organization it is critical for facilities to pivot from current practices and embrace new evidence-based interventions to improve the experience and health outcomes of the consumer and a more favorable financial outcome. In the United States over 7,700 HCAHPS surveys are completed daily by patients and families (Hospital Consumer Assessment of Healthcare Providers and Systems, 2021).  One dissatisfied patient can lead to a financial loss of approximately $200,000 to an institution (February & Holmes, 2020).

          On a local level, New York State data shows that a positive experience can enhance an institution’s marketability and attraction by 10%, whereas a poor experience can make a negative impact by 20%, as well as negatively impact the financial wellness and overall patient volume of an organization (February & Holmes, 2020).  For many families, the act of listening and communicating effectively has been linked to improved perceptions of care, quality health outcomes, compliance, and higher satisfaction scores (Gilligan et al., 2017; Loos, 2021). Making these connections during patient interactions makes a significant impact on the overall patient experience and satisfaction scores.  Campbell & Li (2018) discusses how both positive and negative interactions are cataloged on social media platforms and will correlate to an institution’s overall HCAHPS scores.

          At the practicum site, HCAHPS scores are tracked, trended, and analyzed to ensure alignment to the patients’ and families’ voices.  Over the past year, this organization has seen a decrease in the HCAHPS scores, particularly around the nursing communication domain.  Further analysis of the HCAHPS data revealed opportunities to improve the current practices to aid and support the nurse to stay present in the interaction and positively impact a patient’s experience (George, 2018; Lidgett, 2016; Merel et al., 2016; Orloski et al., 2019; Pattison et al., 2017).                                                                                                                                                                       

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