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Leadership Q&A

Drake, Kirsten DNP, RN, OCN, NEA-BC

Nursing Management (Springhouse): June 2016 - Volume 47 - Issue 6 - p 56
doi: 10.1097/01.NUMA.0000483131.12943.91
Department: Leadership Q&A

Director, Med/Surg, Renal/Oncology Services, Texas Health Harris Methodist Fort Worth Hospital, Fort Worth, Tex.

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Get in the game!

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Q Our patient experience metrics fall short of the 50th percentile. What's the most important thing we can do to raise our scores?

The first and hardest thing to realize is that it isn't just about the numbers. This is really about improving patient and family experiences while they're guests at your organization. However, survey scores do provide feedback to guide your progress. Organizations tend to look to nurse leaders as the score owners because nurses have the majority of contact with patients. However, we all know that it's a team sport. It takes everyone at an organization to make the patient's experience the best it can be while in our care. For this reason, we should see ourselves as the team coach and embrace this role. So, Coach, let's take a look at the reasons why your team may not be winning the game.

The first thing a coach does is evaluate the team's players. Take a look at the staff members on your unit who interact with patients. Do you have the right people in place? Every unit is different and we don't all have the same skills. Is your area one in which the relationship with the patient plays a large role? Relationships are important in all settings; however, OR staff members have a very different relationship with patients than a discharging unit. Consider your players and make sure they have the skills for your unit. This spans from your direct reports in nursing to other departments, such as physical or respiratory therapy. If you find a staff member who doesn't have the necessary skills, help him or her attain them.

Remember that relationships within the team are just as important as those with patients. One key component is that team members have to be able to communicate with each other. For example, if a catcher in a baseball game gives a signal to the pitcher for the next pitch and the pitcher shakes him or her off, this can lead to an error/loss for the team. Just as the crowd notices the shake off, our patients notice when we don't communicate. One of the easiest ways to demonstrate effective communication is bedside reporting. Don't let the term mislead you—this type of handoff can be done in any healthcare environment as long as it's in front of and includes the patient. Patients can observe staff members exchanging information and add to the conversation.

Secondly, just as the coach reviews game videos, you need to analyze your patient experience metrics. Focus on all of the scores—good and bad. The coach learns what does and doesn't work for the team. Read the verbatim comments because patients and families will often provide specifics about their stay. When conducting your review, look for “low-hanging fruit,” or the items for which improvements are realistically attainable. For instance, it's easier to work with environmental service employees to keep a longstanding unit clean than to remodel the unit. When contemplating attainable wins, evaluate the answers selected, not just the percentile ranking. In many cases, you'll discover that the majority of your patients didn't answer questions about their experiences in the “never” or “sometimes” categories.

The coach must look for repeated plays that resulted in a win, and so should you. Examine what was happening on the unit when you had better scores and attempt to repeat those scenarios. Coaches don't introduce too many new or different skills to players at one time. Stay focused on the attainable win by changing small things one at a time. If you don't already, start tracking when you implement new skills/strategies and compare this to survey results. Look at the survey results by the patient's discharge date, not when the survey was received. This gives you information about whether the strategy was successful.

Lastly, the team does better when the coach focuses on members' strengths and builds on them. Your team will get discouraged if you consistently point out the negative and dwell on losses. As nurse leaders, we have the great opportunity to build a playbook that affects the perceived experiences of our patients through communication, relationships, and team skill-building.

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