Northern Westchester Hospital is a state-of-the-art, award-winning community hospital located in Mount Kisco, New York, less than an hour’s drive from Manhattan. It has been recognized as among the best hospitals in the U.S. (U.S. News & World Report for 2012–13), and is the only hospital in the nation to be both a nationally designated Planetree Hospital with Distinction (recognizing exceptional patient-centered care) and a recipient of Magnet® Recognition for excellence in nursing service and overall quality of patient care.
As a hospital committed to being the leader in patient and family centered care, Northern Westchester (NWH) embarked on a comprehensive process re-design of its inpatient MedicalSurgical units. The goal—to ensure processes are truly centered around the needs of the patient, and that the patient, family caregiver, and staff are all involved in and informed of the patient’s plan of care.
“Our expert staff is always focused on providing the highest-quality patient care. Our patient satisfaction scores are consistently in the top 10% of hospitals in the nation. However, NWH wants to ensure our patient satisfaction reaches and sustains the top one percent in the nation. To achieve this, we had to re-examine the patient experience through the lens of the patient and create processes that are reliable, consistent, and responsive,” said Maria Hale, VP, Office of Patient and Family Advocacy for Northern Westchester Hospital. “When you are a patient in a hospital, getting a quick response to a need or request is really important. We knew that we could significantly enhance the patient experience by ensuring that when a patient pressed the nurse call button, the voice of his or her own nurse would be heard. What is more reassuring than that?”
With this patient-centered goal in mind, Northern Westchester Hospital designed a process which required the use of the Vocera hands-free communication system to integrate with the hospital’s nurse call system. The result, after a carefully planned and executed implementation, was a dramatic improvement in HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) responsiveness scores. NWH now calls this process Patient-Nurse Call.
HCAHPS Standardizes Measures of Patient Satisfaction
The HCAHPS survey asks hospital patients a series of questions about their stay, across a variety of domains, including communication with physicians and nurses, responsiveness of the hospital staff, pain control, quiet/cleanliness of the hospital environment, and an overall rating of the hospital. As NWH’s Chief Nursing Officer, Lauraine Szekely states, “The HCAHPS survey is measuring the ‘% of always’—meaning that our patients are evaluating the consistency of the way we execute our patient-centered processes. Let’s face it, when you are a patient and you need help to go to the bathroom—you don’t want to wait, it’s very uncomfortable and stressful.” With this being said, NWH was disappointed with patients’ perception of staff responsiveness. To address this challenge, NWH implemented a number of critical success factors.
Focusing on Communication Pays Off
“We started with improvements in our staff-to-staff communication,” said Hale. “Before we took on integrating our nurse call system with Vocera, we had to make sure the fundamental infrastructure was in place and the clinical and support staff were very comfortable using the Vocera technology to communicate with each other. We also had to make sure our clinical team was effectively communicating the plan of care clearly and compassionately to our patients and families. We needed to walk before we started to run.”
The staff-to-staff communication improvements included:
• Vocera® Badge training—NWH made sure everyone on the clinical and support team not only had the wireless Vocera Badges in place, but also knew how to use them most effectively
• Bedside rounding at shift change, with the patient and the ongoing and off-going nurses
• Redesigned shift handoff process between Nurse-to-Nurse and Nurse-to-Physician; the newly designed structured process included discussion about the expressed needs of each patient and communication of the plan with the patient’s primary caregiver
• Specially designed in-room communication boards to keep patients and families updated on the plan of care progression
• Changes to the staffing ratios, included a “dyad” model with one RN and one Patient Care Associate starting and ending their shift together, caring for five or six patients
“We heard loud and clear from our patients that they wanted to talk directly to their nurses without going through a middleman,” said Szekely. “Vocera was already our communication solution internally, so integrating with nurse call was a logical extension.”
NWH first began its nurse call and Vocera integration with the Maternity unit. Why? A generally healthier patient demographic with less complex needs, and the staff was eager to integrate the technology since the HCAHPS score for responsiveness on the Maternity unit was registering at the lower quartile.
“In our old workflow, a patient would hit the nurse call button and be connected with a telecommunications operator who would find the appropriate nurse and relay the message. The nurse would then get back to the patient. This involved many handoffs and possible delay points,” said Szekely. “Now, the patient hits the nurse call button and the message is conveyed directly to the Vocera Badge of the nurse assigned to that patient.” The nurse responds immediately, through an audible call speaker next to the patient’s pillow. The primary nurse acts as the “quarterback” for whatever the patient may need, providing answers, attending to the patient, or marshaling resources as needed. In the event a patient’s nurse is unavailable, NWH built a robust escalation path to ensure every call is always answered promptly. “Every patient has an assigned nurse and a ‘Nurse Buddy,’” says Szekely. “This way when patients call, they always speak to their nurse or another nurse on the unit.”
In only a few months following the integration of Vocera and the nurse call system, the Maternity unit’s HCAHPS responsiveness score skyrocketed to the top one percent in the nation. Next, NWH integrated Vocera with the nurse call system on the medical-surgical units. The Maternity nurses assisted with the support and implementation of the process on the Medical/Surgical Units. “The addition of the nurses acting as coaches to their fellow colleagues was invaluable,” says Hale. “I believe this peer coaching methodology is a primary reason why the implementation was so successful.” After only two months, the HCAHPS scores for the medical/surgical unit also climbed to the top one percent in the nation.
Making the Promise of Patient-Centered Care a Reality
Of course, a hospital encompasses much more than any single metric. However, HCAHPS scores are a very important, credible reference point since they represent patients’ direct assessment of their hospital experience. Raising the scores so significantly demonstrates the seriousness of NWH’s commitment to listening to the voice of the patient and creating processes to exceed patient expectations for their hospital stay.
“From the patient’s perspective, our integration of Vocera and nurse call, in conjunction with all the other improvements we’ve made with communication, means that our patients now have the shortest path to the right person to respond to their needs,” said Joel Seligman, Hospital President and CEO. “It means patients don’t have to tell their story or give their request to a message-taker, or re-tell it two or three times to different people. It means demonstrably faster response times by the clinical staff. And it restores the human connection to care—establishing that direct, one-to-one communication that is so crucial to a patient’s care, recovery, and experience while they’re in the hospital.”
“It’s important to us that we partner with companies whose products and strategies are patient-centered, and that’s why we’re so pleased to be working with Vocera,” said Seligman. “Now that our integration of Vocera with Patient-Nurse Call is nearly complete, we’re evaluating how other Vocera solutions might further augment our goals of providing the best possible quality, patient-centered care to our patients and families.”