1. Swan, Beth Ann PhD, CRNP, FAAN
  2. McGinley, Mary Ann PhD, RN

Article Content

With the establishment of the Affordable Care Act in 2010, healthcare providers are now required to take steps to measure and report on patient satisfaction. Growing evidence reveals that improving communication between nurses and patients, and involving patients more closely in their care, results in greater adherence to the care plan, fewer hospital readmissions, and better patient health.1

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We know that nurse-patient communication is a characteristic of high-performing hospitals and a "rising tide" measure, so how can we boost nurse communication performance not only to improve the care experience, but also transform the care transitions experience? An assessment of communication effectiveness resulted in one organization creating a broader approach to enhancing communication across the care continuum. Although the organization provided in-hospital communication education at orientation, during nurse residency programs, and through in-service programs, a decision was made to expand communication education by investing in an evidence-based, patient-centered solution.


The road so far

Since 2006, nurse-patient communication has been measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. HCAHPS survey results allow organizations to target areas for improvement, and hospital Medicare payments are partially tied to survey scores. Developed and administered by the Centers for Medicare and Medicaid Services and the Agency for Healthcare Research and Quality, the HCAHPS survey is given to a random sample of adult patients between 48 hours and 6 weeks after discharge. It surveys 21 patient perspectives on care, with patients rating nine key topics:


* communication with physicians


* communication with nurses


* responsiveness of hospital staff


* pain management


* communication about medications


* discharge information


* cleanliness


* quietness of the hospital environment


* transition of care.



A 2013 Press Ganey study using national HCAHPS data showed that performance on the communication with nurses dimension strongly influences other experience of care dimensions within the Value-Based Purchasing framework.2 Specifically, the study demonstrated that when hospitals improve nurses' communication with patients, they see associated gains in other scores-responsiveness of hospital staff, pain management, and communication about medication-and increased overall patient experience scores. Treating nurse communication as a rising tide measure, and focusing improvement efforts on the factors that drive these scores, is seen as an effective way to raise hospital performance on other pay-for-performance initiatives.3 Ultimately, these efforts have a substantial impact on the delivery of true patient-centered care and the hospital's ability to transform the patient care experience, as well as the care transitions experience.


In 2015, a national study of high-performing U.S. hospitals examined the facilities with the best HCAHPS ratings to link their best practices with improved patient care and care transitions. Efforts to improve care experiences were associated with the hospital's mission and commitment to patients, families, and employees, and delivering safe, high-quality care. Of note, nurse communication was the top ranked and most improved hospital characteristic of the high performers that were enrolled in the study.4


Aligning expectations with service

Focused on providing patients with a better care transitions experience through improving nurse communication, the Communication Catalyst program was launched in response to patients' feedback about their care experience expectations. The goals of the program were to improve the quality of the care transitions experience and patient outcomes, increase nurse communication HCAHPS scores, and provide a unique and high-quality professional development opportunity to raise nurse satisfaction scores.


The senior vice president and CNO met with the organization's vice presidents and clinical nurse specialists (CNSs) to share information from patient surveys, discuss reactions, and request possible interventions. In response, the nurse leadership group dialogued and requested additional data from patient surveys, such as patient engagement scores and length of stay by patient care unit. The vice presidents caucused and selected the units for participation. A search of literature and programs that addressed nurse communication during care transitions and across the care continuum was completed. The dean of the College of Nursing shared the work of the American Academy of Ambulatory Care Nursing's expert panels on care coordination and transitions management. Copies of the Care Coordination and Transition Management (CCTM) Core Curriculum were reviewed by the CNS group.5


The organization embarked on the 12-month Communication Catalyst program to educate 300 clinical nurses in the CCTM Core Curriculum. The curriculum, and the associated scope and standards of practice for RNs, covered the following 12 topics:


* advocacy


* education and engagement of patients and families


* coaching and counseling of patients and families


* patient-centered care planning


* support for self-management


* nursing process (proxy for monitoring and evaluation)


* teamwork and collaboration


* cross-setting communication and care transitions


* population health management


* care coordination and transition management between acute care and ambulatory care


* informatics nursing practice


* telehealth nursing practice.6



The curriculum was composed of an online education component, as well as in-person, unit-based, active-learning sessions. The online training modules utilized a software platform that all staff members currently use for regular trainings. Each month, program participants completed four online education modules and also attended four in-person, active-learning sessions related to one of the 12 topics. Twelve master's-prepared CNS instructors were each assigned to one of the 12 curriculum topics. The CNS instructors guided the online modules and led the in-person interactive classroom sessions. Following the completion of all CCTM modules and active-learning sessions, nurses were eligible to take the CCTM certification exam.


Nurses were grouped into 10 cohorts of 30 clinical nurses each. These 300 clinical nurses represented the entire staff of selected inpatient units. Units were selected based on unsatisfactory past performance on HCAHPS survey nurse communication scores. Educating all nurses within these selected units built a critical mass for the greatest impact on nurse communication, patient satisfaction, and, ultimately, the care transitions experience.


Developing stronger partnerships

Early lessons learned include delivering several topics in dedicated blocks of time-rather than one topic per month-so that nurses spend less time away from patient care and are able to focus solely on the program. A second lesson learned is the need for a broader education-practice partnership related to nurse communication and quality care delivery across the continuum. Program success is being measured by improved patient and nurse satisfaction scores, and an increase in nurse certification.


As a result of the Communication Catalyst program, the organization is strengthening nurse-patient communication, thus supporting an enhanced care transitions experience and positive patient outcomes. The program enables and empowers nurses to deliver better care through the use of effective communication and developing a sense of partnership between clinical teams and patients. Investing in education, and particularly cohort education, reflects the organization's commitment to supporting nurses and their role in providing quality evidence-based care.




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