Greenville Health System’s (GHS) Patewood Memorial Hospital participated in a national research study by the Agency for Healthcare Research and Quality (AHRQ) focusing on improving patient and family engagement. PMH placed an emphasis on partnership as an important part of increasing patient satisfaction by having patients and families participate in bedside shift report. Patient safety and satisfaction are important and including patients in bedside shift reports is one example of how we transformed health care for the community we serve. The quantitative findings suggest high levels of patient satisfaction because the Hospital Consumer Assessment for Healthcare Providers and Systems (HCAHPS) scores have shown an overall rating in the 99th percentile nationally.
Innovation: Innovation in health care begins in nursing with Florence Nightingale. The way clinical staff approaches the patient and the partnership that is formed between patients, families, and staff at the bedside is not new to nursing, but it’s bringing it back to basics. “Nursing is an art: and if it is to be made an art, it requires an exclusive devotion as hard a preparation, as any painter’s or sculptor’s work.” -Florence Nightingale. Patient engagement is innovative because it can be accomplished in many ways. Bedside shift report is one of the ways that the Ortho/Spine Unit partners with their patients and families.
Transformation: Transforming to patient and family engagement was done by initiating bedside shift report and having patients and families as advisors. Working with patient and families as advisors is a critical part of improving quality and safety, and they are valuable partners in efforts to reduce medical errors and improve the safety and quality of health care. They offer insight and input to help hospitals provide care and services that are based on patient-and family-identified needs rather than the assumptions of clinicians or other hospital staff about what patients and families want.
Collaboration: The success of patient and family engagement is the collaboration of the interdisciplinary team, the support of physicians, hospital leadership and the patients and families who want to be directly involved in their care. Leadership sets the tone by creating a culture for successful health care initiatives, a manager who leads by example, and an interdisciplinary team that fully engages in the implementation of patient and family engagement.
Communication: Communication during transitions in care, such as bedside shift report, is extremely important for ensuring that the handoff is safe and effective. Allowing the patient and family to be involved in the change of shift report gives them the opportunity to hear what has occurred throughout the shift and the next steps in their care. It also gives them a chance to ask questions and provide input into the care process. This partnership for the Ortho/Spine Unit began in April 2012. Bedside shift report occurs two times a day, increasing patient safety and quality, the patient care experience, nursing staff satisfaction, and time management and accountability between nurses.
Inspiration: Our inspiration for initiating and continuing to improve upon family and patient engagement through bedside shift report came to us from patients, families and staff. Staff embraces the concept of bedside shift report and engaging the patient and family, feeling that it has true value in providing quality care to our patients. Patients have made positive comments indicating that they like being included in the bedside shift process-Patients described their experiences of bedside shift report as “very positive and personal, stating that nurses were talking with patients, instead of at them and it showed the nurses operating more as a team”. It is perceived by patients and families that bedside shift report reduces, chaos, increases transparency and there is more positive personalized care. – Post Implementation Focus Group. “I like the procedure of both nurses coming in and discussing my case with me at shift change” – Press Ganey Comments
System’s Change: The success of patient and family engagement at Patewood Memorial Hospital has lead our organization to initiate bedside shift report throughout the organization starting late March 2014 with the creation of guidelines, marketing materials, and prepping and training the staff for a “go-live” date in May 2014. This initiative is strategic with organization and nursing goals by analyzing the gains in correlation with reducing never events, and improving patient outcomes and satisfaction scores.
When Patewood Memorial’s Ortho/Spine Unit initiated patient and family engagement, the overall rating of the hospital with HCAHPS was 86%, with the January 2014 rating at 100%. The January 2014 Communication with nurses is 87.2%, and the initial rating was 87%. Pain management went from 79% to 88.5%, and communication with medication was initially 65% and as of January 2014 is 75.6%.
Although we have remained in the 99th percentile for the overall rating of the hospital, the Ortho/Spine Unit feels there is greater satisfaction as evidenced by patient comments and continued success in HCAHPS scores regarding patient engagement. “I liked the procedure of both nurses coming in and discussing my case with me at the change of shift” – Press Ganey comment. Patients described their experiences of bedside shift report as “very positive and personal, stating that nurses were talking with patients, instead of at them” – Post Implementation Focus Group with Patients and Families.
Recruiting patients and families as advisors for patient engagement had positive outcomes for Patewood Memorial Hospital. The advisors known as Patewood Health Partners, were invaluable reviewing education material for the Joint Replacement Center of Excellence Program. The education material is utilized today for the patients having joint replacement surgery.
Results show that engaging patients at the transition of care creates a partnership between health care systems, health care practitioners, patients and families and at the same time facilitating patient-centered care. Engaging patients also improves quality and safety and patient outcomes while achieving communication, inspiration, collaboration, transformation, innovation, and systems change.