Improving HCAHPS Communication with Nurses and Responsiveness of Staff

Case Study

A 275+bed not-for-profit Catholic health care provider contracted with HCT Consulting
in order to perform an assessment on their Hospital Consumer Assessment of Healthcare
Providers and Systems (HCAHPS) scores and to implement an action plan based on that
assessment. This hospital was concerned that their first publically reported HCAHPS
scores were below their direct competitor’s in every domain of the survey by an
average of 8%.

HCT used their unique Transformation Intervention™ process to address the goals of the
hospital. Initially HCT performed a thorough assessment by evaluating the HCAHPS
data, performing direct staff observations, and interviewing staff, patients, and
physicians. HCT compiled all the data and presented administration with an action
plan to raise their HCAHPS scores. Among the recommendations, HCT proposed
forming a service team of managers and staff members across all inpatient units in
order to develop and implement specific initiatives to address the HCAHPS service
domains. To ensure symmetry with the Senior Leadership group, a steering committee
composed of hospital senior leadership was formed to offer continuous guidance to the
team. The service team developed targeted initiatives such as; senior leader rounding,
nursing leader rounding, nursing hourly rounding, scripting, standardization of hourly
rounding documentation, and improved patient education materials. HCT was
intimately involved with the development and the implementation of every initiative
and its consultants worked side by side with hospital staff in order to ensure success.
Recognizing the importance of facility-wide training and communication, 20+ hours of
classroom offerings were conducted reaching hundreds of employees.

In a very short period, the hospital has been very successful in raising their HCAHPS
scores by using the Transformation Intervention™ process. Post implementation they
have enjoyed a 4 point increase in willingness to recommend, a 9 point increase in
communication with nurses, a 7 point increase in communication with doctors, a 1
point increase in explanation of new medications, a 17 point increase in responsiveness
with staff, a 6 point increase in discharge information, a 13 point increase in pain
management and a 7 point increase in quietness at night. On average, each domain
increased by 7.64%.

Service has a direct connection to quality as evidenced by a 33% decrease in

falls/month post implementation of hourly rounding. This decrease in falls amounts to a
savings of $38,800/month based on a decrease of 2 falls/month at a cost of
$19,400/fall *. The decrease in falls is not the only return on investment that the hospital
HealthCare Transformation, LLC.
70 W. Madison, Three First National Plaza, Suite 1400, Chicago, IL 60602
Telephone: 312-214-7216 Fax: 312-214-3110 www.hctconsulting.net
will realize. While it is too early to measure the financial impact, research has shown
that hourly rounding results in reduction in the rate of pressure ulcers by 50%. The
additional cost per discharge for a pressure ulcer is $15,958**. Additionally, the hospital
should experience an increase in growth as beds become available from a decrease in
length of stay resulting from fewer never events. Growth will also occur through the
positive word of mouth that will occur within the community.

HCT has worked very closely with the hospital in training the leaders in the skills they
need for sustainability. This includes bi-weekly steering committee meeting, on-going
education and orientation to new staff on customer service skills. HCT will maintain a
close relationship through a post engagement contract in order to ensure the hospital’s
momentum so that they can continue to see success on the HCAHPS survey and
provide their patients with quality care.

* National Prevention Center for Injury Prevention and Control, Division of Unintentional
Injury Prevention; May 2007
** AHRQ, 2005, “Payments for Adverse Events”

Post Intervention
HCAHPSImprovement
95.00
90.00
85.00
80.00
75.00
70.00
65.00 AVG
60.00 Jan - Apr 08
55.00 May-08
50.00

HealthCare Transformation, LLC.

70 W. Madison, Three First National Plaza, Suite 1400, Chicago, IL 60602
Telephone: 312-214-7216 Fax: 312-214-3110 www.hctconsulting.net