by Lisa Kersey
In today’s health care world, there’s no more room for a caregivers who are “good clinically, but….” This applies to nurses, doctors, technicians and others who come into contact with the patient. Whether you’re the one writing the orders, giving the meds, delivering the meals or cleaning the patient room, health care transparency and reporting require that everyone be on their A-game. Perception is reality and that reality now reaches all the way to the bottom line.
As a patient, you’re at your most vulnerable, miserable or maybe fearful. The last thing you need is a Nurse Ratched: a capricious, passive-aggressive tyrant, who does not realize that she (or he) is there to make you more comfortable, less stressed and healthy enough to leave the hospital in the shortest, appropriate time, without being readmitted in 30 days or less.
Not only are 30-day readmissions going to cost your hospital, but beginning in 2012, hospital reimbursement will be impacted by patient perceptions about their hospital experience. While the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) has been around since October 2006 and pay for performance was introduced in July 2007, the Patient Protection and Affordable Care Act of 2010 will take this one step further. Beginning in October 2012, HCAHPS scores will be among those measures used to calculate provider reimbursement under value-based purchasing.
This is where “One Flew Over the Cuckoo’s Nest” collides with “The Wizard of Oz.” An unsatisfied patient leaves your hospital with the words “I’ll get you, my pretty” on her lips – and the HCAHPS survey will give her that chance. So, if you have a caregiver that is “good clinically, but…,” your bottom line is at risk. If you have a caregiver who does not have enough time to spend with the patient, your bottom line is at risk. And if you are not talking to your patient within 72 hours of when they leave your hospital, your bottom line is at risk.
So, what should health care providers be doing to “wow” their patients and protect their bottom line?
- Selective Hiring – Pre-screen your employees for character, not just competence. You must create a culture where there is zero tolerance for the Nurse Ratcheds, and recognition and reward for Glenda the Good Witch (from the original movie, not the Broadway production of “Wicked,” in case there was any question).
- Maximize Nurse Time at the Bedside – Take a hard look at your nurse staffing, nurse ratios and nurse roles/responsibilities. Make sure you’re using your care team as effectively as possible and that you are giving patients meaningful face time with their nurses. Despite the increased regulations and management duties, the nurse’s primary role is at the bedside providing patient care. Anything that distracts from this should be carefully scrutinized to see if there is a better way to accomplish the task.
- Ensure a Closed Loop – Patient discharge is not the end of the care experience. Whether they are discharged to a post-acute facility or to their own home (or that of a family member), it is critical that you reach out to that patient to identify any issues they had while in the hospital. The sooner you resolve areas of dissatisfaction, the more loyal the patient and the less likely you are to receive low marks on your HCAHPS survey. In addition, post-discharge calls allow you to identify potential readmission triggers by ensuring that patients understand their discharge instructions, have no barriers to getting needed medications and have the follow-up appointments they need, both with a primary care physician, as well as any appropriate specialists. If you (or a vendor partner) make this call, you’re more likely to retain this patient.
Do you think you can’t afford it? You can’t afford not to.