SUNY Upstate University Hospital’s philosophy is centered around meeting and exceeding the needs of patients their families. Karen Wentworth, MPH, MSW, RRT is the hospital’s Director of Patient Experience, and Amit Dhamoon, MD, PhD is an Internist. In this blog, they each share a perspective on how they use rounding as a tool.
Access the recorded webinar Strategies for Improving Physician Communication and the Patient Experience to learn more about their approach.
At Upstate University Hospital and University Hospital Community Campus, we have made it a priority to improve engagement and strengthen relationships with patients by having more meaningful conversations with them and their loved ones at the bedside. Effective communication and trust between clinicians and their patients correlate with increased medication compliance, reduced readmission rates, and improved clinical outcomes.
Rounding to Proactively Manage the Patient Experience
HCAHPS scores, which measure patient satisfaction, are not available to our organization until at least one month after a patient survey is submitted. We want to be able to understand patients’ concerns and address their needs while they are still in the hospital.
In 2015, we decided to implement a mobile rounding solution. We chose Vocera Care Experience, which includes a solution called Rounds. The digital tool helps us standardize our rounding process enterprise-wide. It generates data which we review in a dashboard to identify trends in patients’ experience.
Customizing Rounding Questions for Relevance
The Rounds solution allows our care team members to provide a better healthcare experience in the emergency department and across our inpatient units. The solution is easy to customize, and we have designed several different types of rounds with patient-centric questions relevant to specific departments.
For example, our Family Birthing Center uses the Rounds tool to educate families about infant safe sleep practices and ensure these practices are met during the hospital stay. We’ve been recognized by the National Safe Sleep Hospital Certification Program as a “Gold Safe Sleep Champion” for our commitment to best practices and education on infant safe sleep. The mobile rounding solution has helped us standardize the safe-sleep rounding process throughout the hospital.
We currently use the Rounds solution in 46 units and several ancillary departments over both campuses. To determine rounding questions, we start by looking at areas where HCAHPS scores are not as high as we want them to be. For example, if we notice our HCAHPS scores around communication with physicians is low, we will focus on asking more questions around physician patient communication in Rounds. We evolve the questions by evaluating patient comments in the rounding data.
Continuous Improvement in Partnership with Clinicians
To ensure rounds are meaningful for patients, families, and staff, I round with nurse leaders five days a week. Together, we identify ways to improve the process or adjust questions we ask patients to make patient engagements as meaningful as possible.
My advice to anyone building out a rounding program is this: if you are not a clinician, partner with one. They can provide the clinical guidance needed to build out your rounding questions and advise how best to ask specific questions.
When I started medical school years ago, I was like many students who enter the medical profession – I wanted to help people. Over the long course of training, my goal became muddied with the many other responsibilities that come with being a healthcare provider. High inpatient volumes, pressures to admit and discharge patients quickly, and other administrative tensions can interfere with physician-patient communication. I have had days where I’ve spent more time with my computer than with my patients. The result is, oftentimes, our patients and their families don't see the work we put in to advocate for them every day.
Understanding What Makes Physician-Patient Communication Successful
As an educator, physician, and quality officer, I understand the importance of effective communication with patients. As an institution, we are recognizing more and more how important quality communication with patients is, and how it impacts trust, compliance, and outcomes. We aren’t sure why it’s easier for some physicians to connect with their patients than others. Similarly, we are not sure why certain patients trust certain physicians more than others. So, my colleagues and I decided to look at some basic behaviors to see if we could get to the bottom of what makes for successful physician-patient communication.
We knew we needed to implement a tool that would allow us to assess physician communication with patients to provide them with personalized feedback in real-time. We asked Karen, our patient experience director, for support and realized that nurses, respiratory therapists, and other professionals at Upstate had already been using Vocera Rounds for several years. They were having great success assessing clinician communication and the patient experience. We decided to use the same technology and began customizing Rounds for our needs.
Using Rounds as a Teaching Tool and to Help Build Trusted Relationships
Our team deliberated and landed on the core tenets we wanted all physicians to follow during every patient interaction. One of the surveys we built in Rounds is used by a medical resident who observes the attending physician’s behaviors and captures observations in the mobile application. Another survey we built is given to the patient after they meet with their physician. We ask the patient to assess their interaction with questions like,
Did your attending physician:
We are studying the effectiveness of our new approach to assessing physician-patient communication and its impact on patient satisfaction measured by HCAHPS surveys. The rounding tool has really brought into focus why we round – we are building trusted relationships with our patients. If our patients trust us, their experience is enhanced exponentially.
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