Initiatives Aim to Increase HCAHPS Scores

Euclid Hospital improves the patient experience

The patient experience took center stage at Cleveland Clinic’s Euclid Hospital in October 2008 when the regional hospital hired its first patient experience director. Since then, the hospital has been committed to the patient experience and improving its HCAHPS scores. Several initiatives have contributed to improvements during the last five years, including the following:

Advertising Policy

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services Policy

  • Leader Rounding
  • HCAHPS Refresher Class
  • Engagement Refresher Class
  • Daily Nurse Manager Rounding
  • Weekly Information Sharing/Weekly Reports
  • HCAHPS/Patient Experience Monthly Meeting
  • Frontline Dream Team

Below is a breakdown of six nursing-related HCAHPS domains and what the hospital did to help improve its scores.

Communication with nurses

The first two initiatives that helped increase nurse communication scores were adding white boards in every patient room (except in the Emergency Department) and sharing the daily communication planner with patients and families. A patient focus group and nurses provided input on the white boards to ensure that they capture what is most important for patients and nurses to know. The daily communication planner is a tool in EPIC, Euclid Hospital’s electronic medical record system, which allows patients to view all of their orders. The hospital unit coordinator prints out the daily planners, then nurses deliver them to patients every morning so they can see any new orders.

Both tools have aided communication with patients and their families. The hospital also implemented the “testing and treatment” sheet. These sheets give a pictorial narrative to explain tests or treatments ordered for patients. They provide a step-by-step look at what patients can expect during their tests/treatments. Below is a table showing yearly progress in Communication with Nurses as publically reported by the Centers for Medicare and Medicaid Services (CMS):

Domain CMSReport Period Top Box Response Percentage
Nurse
Communication
2008
2009
2010
2011
2012
2013
71%
71%
77%
78%
82%
82%

*Current data collection period is 1/1/13 through 12/31/13.

Communication about medicines

Euclid Hospital has changed the way it communicates with patients about new medication. It implemented the “ask three, teach three” process for confirming medication competencies with nurse managers. Patients and family members are encouraged to ask three important questions upon receiving medication. In addition, nurses are to relay three points—the name of the medication, why it is needed and possible side effects.

Nurses also distribute the medication explanation and side effect user guide. In addition, the hospital now posts side effects signs on all workstations on wheels (WOWs) to help improve ratings on the “communication about medicines” question concerning side effects. In addition, the pharmacy has taken a more active role in educating patients regarding new medications and side effects. Below is a table showing yearly progress in “communication about medicine” as publically reported by the Centers for Medicare and Medicaid Services (CMS):

Advertising Policy
Domain CMSReport Period Top Box Response Percentage
Medication Communication 2008
2009
2010
2011
2012
2013
55%
54%
60%
62%
68%
67%

*Current data collection period is 1/1/13 through 12/31/13.

Responsiveness of hospital staff

The nursing staff has spent a lot of time and energy on improving responsiveness scores. Nurse manager rounding was implemented to check on patients every day and to inquire if the nursing staff is checking on the patient hourly. Hourly rounding was initiated to make sure someone was checking on every patient every hour. The nursing team adopted the 4Ps program (pain, position, personal items, potty) to help reduce the usage of call lights. When nurses round, they check on these four points.

Most recently, the hospital adopted a “WOW culture” on all nursing units. Nursing staff should complete all charting and computer work on the WOWs in hallways by their assigned rooms so they are more visible and readily available to assist patients and families when needed. Below is a table showing yearly progress in “responsiveness of hospital staff” as publically reported by the Centers for Medicare and Medicaid Services (CMS):

Domain CMSReport Period Top Box Response Percentage
 Staff Responsiveness 2008
2009
2010
2011
2012
2013
51%
50%
58%
63%
69%
71%

*Current data collection period is 1/1/13 through 12/31/13.

Discharge information

The discharge information domain has been Euclid Hospital’s strongest scoring domain during the past five years. Elements that contribute to the success of this domain include discharge phone calls, care manager rounds, and signs and symptoms sheets provided to patients to educate them on what to look for once they are home regarding their health and healthcare needs. Below is a table showing yearly progress in the “discharge information” domain as publically reported by the Centers for Medicare and Medicaid Services (CMS):

Domain CMSReport Period Top Box Response Percentage
 Discharge Information 2008
2009
2010
2011
2012
2013
82%
83%
86%
87%
91%
91%

*Current data collection period is 1/1/13 through 12/31/13.

Advertising Policy

Quietness of the hospital environment

Euclid Hospital has given the “quietness of the hospital environment” domain a lot attention during the past five years. While this domain historically scores low and is difficult to improve, Euclid Hospital has implemented several initiatives through the years to raise scores. Some initiatives have included NOM (nursing operations manager) nightly rounding, a noise committee, no noise posters, a HUSH program and the health unit coordinator greeting the patient upon arrival to explain the call light system and how staff will answer call lights in the room during quiet hours. Below is a table showing yearly progress in “quietness of the hospital environment” as publically reported by the Centers for Medicare and Medicaid Services (CMS):

Domain CMSReport Period Top Box Response Percentage
 Quiet at Night 2008
2009
2010
2011
2012
2013
51%
49%
52%
56%
61%
65%

*Current data collection period is 1/1/13 through 12/31/13.

Pain management

“Pain management” has shown great success from year to year. Euclid Hospital scored in the 90th percentile in 2012. The hospital had a slight dip from 2012 to 2013, but the score is still very strong. To assist with improving pain management scores, nurses utilize patient white boards to set pain goals and expectations for all patients, provide pain management education for patients and check on pain during hourly rounds. Below is a table showing yearly progress in the “pain management” domain as publically reported by the Centers for Medicare and Medicaid Services (CMS):

Domain CMSReport Period Top Box Response Percentage
  Pain Management 2008
2009
2010
2011
2012
2013
61%
65%
68%
71%
76%
74%

*Current data collection period is 1/1/13 through 12/31/13.

By implementing a variety of initiatives, Euclid Hospital has gradually raised its HCAHPS scores and subsequently improved the patient experience.