A Maryland hospital has found a way to involve nonclinical staff in quality improvement and patient satisfaction, helping instill a culture in which everyone feels responsible for the patient experience.
The Adopt-a-Room initiative was developed because there was a gap in addressing the patient experience, says DeeDee Smith Foster, MSN, RN, quality advisor with the Quality & Safety Services Department at Adventist HealthCare Fort Washington (MD) Medical Center.
“A lot of times, people see nursing and the providers as the people who directly impact patient experience. I knew it would be important to develop a program that helped everyone in the hospital see themselves as responsible for making sure the patient experience was the best it could be,” Foster says. “I wanted to get every department involved in the patient experience, have them round on a regular basis, and hear the patient feedback.”
In February 2019, every department was assigned an inpatient room and a representative of that department visits that room every day to check on the patient. Adventist HealthCare Fort Washington is a 32-bed hospital, with about 16 beds typically occupied. With 16 nonclinical departments, the numbers were easy to work out, Foster says.
A larger hospital can use the same approach, but might need to adjust the assignments. For instance, each department might assign two or three staff members to each room. Foster’s team did not want the department leader assigned to a room, preferring for lower-level staff to meet patients.
Staff Member Visits, Asks Questions
The visitor does not provide any kind of service or make any kind of delivery. The staff member stops by to say hello, ask how everything is going for the patient, and offer to address any requests or problems. These staff members include laboratory workers, billing staff, IT technicians, and others.
The hospital held regular meetings of the Interdisciplinary Patient Experience Committee. During these sessions, staff members shared what they had learned.
“It is so impactful because these staff who normally would have little interaction with patients got to hear everything the patient thought about their stay in the hospital, good and bad. Some patients were very happy with their experience, and others had issues that were not being addressed in the day-to-day care by the clinical staff,” Foster says. “We emphasized to them that when they own that room, they own the compliment and the complaint. When there was a concern, you had to try to fix it.”
The assigned staff members were provided with a reference card for how to contact the right person about patient needs, such as a complaint about dietary selections. Many issues were resolved on the spot without going through a lengthy process and waiting for a resolution.
“You didn’t have to worry about six weeks later when you got your comments from Press Ganey or HealthStream and see how you were doing. We knew in real time how we were doing because we had people in there every day, asking and fixing what they could,” Foster says. “The ancillary staff felt like they had a real impact. They were proud when they presented their observations and the impact.”
One patient asked for a newspaper to read. The staff member assigned to that room made a point of picking up a newspaper every day before going to see that patient. When she brought that experience to the committee, Foster and other hospital leaders realized they could easily obtain a newspaper subscription for patients.
Selling the Concept
The biggest challenge was simply explaining the concept of directing nonclinical staff to round on patients every day. Some were wary about what the staff members were going to say and if this was some effort to uncover failings by nurses and other staff. Foster assured them it was a simple concept with no hidden motives.
Leaders urged staff not to overthink it. The staff member only has to visit the room, introduce himself or herself, and ask how things are going.
Only nonclinical staff were assigned rooms for the Adopt-a-Room initiative. Nurses and physicians already conducted rounds regularly. Leaders figured it would be redundant and unproductive for those employees.
“We wanted the nurses to be able to do their work, and the rest of us would take care of this task,” Foster says. “If we had patients express concerns about the care they received from nurses, that got reported up to the leadership of that department. But we didn’t have much of that. If anything, we had nurses focused on making sure everything was OK because they knew someone was going to round on that patient every day.”
One patient complained to the rounding staff member that the patient room was cluttered and did not feel like a healing environment. That concern was reported to leadership. On rounding the next day, the room had been properly cleaned and organized.
Not Easy for Some Staff
For some staff members assigned to rooms, the task was a stretch. Some were uncomfortable with the idea of going to meet a complete stranger and interacting. Foster conducted role-modeling for some reluctant staffers, walking them through the scenario and suggesting questions to ask.
“Some departments did it better than others, and some needed more coaching,” Foster recalls. “Asking someone in the IT department to leave their computer and go talk to a stranger? That was a challenge. Role-playing and coaching can get them past that initial fear.” Patients generally responded well to this nonclinical staff rounding. Patients are used to people coming in and out of their rooms all the time, so that was not an issue. Still, staff members were coached to knock before entering, introduce themselves, and explain why they were there. They were instructed not to wake sleeping patients.
The Quality Departments’ Performance Improvement Coordinators managed the documentation from the rounding, providing monthly reports for the Interdisciplinary Patient Experience Committee meeting. The Quality Department reported the number of rounds each department completed per month to leaders to ensure accountability.
The advent of the COVID-19 pandemic brought the program to a halt to minimize the number of people in treatment areas, but Foster says the hospital plans to resume the Adopt-a-Room initiative as soon as conditions allow. After eight months, the Adopt-a-Room initiative had contributed to a 12% improvement in HCAHPS overall hospital rating and a 10.2% increase in the HCAHPS nurse communication score, Foster reports. Not all of that improvement is attributable to the Adopt-a-Room initiative, but Foster believes it played a role.
“Even better than the HCAHPS rating was the granular data we were able to collect and track. That made it possible for us to see what was happening in real time, whether that patient completed the patient survey when they left the hospital or not,” Foster says.
- DeeDee Smith Foster, MSN, RN, Quality Advisor, Quality & Safety Services Department, Adventist HealthCare Fort Washington (MD) Medical Center. Phone: (240) 687-3635. Email: firstname.lastname@example.org.