Where Is the Soap? Why Communication Is No. 1 in the Continuum of Care
Cynthia Hanna, BSN, RN, director of clinical operations for Beryl Health
Now that patient satisfaction scores have been tied to reimbursement, hospitals are scrambling to create an environment that is welcoming, safe and comfortable. They're spending money to beautify their rooms, update their systems with electronic medical records, and provide patient rooms with the latest and greatest technology, such as fancy flat screen televisions that also function as meal planners and patient education tools. Who wouldn't want to be admitted to a room with beautiful hardwood floors, soothing wall colors and a room layout designed for patient comfort?
The question is: If everything is supposed to be getting better, why are there poor HCAHPS scores?
Not very long ago, healthcare was very different.
Mrs. White, a middle age librarian, experienced a sudden onset of abdominal pain. She was admitted to her community hospital (the only hospital in town). Every morning, her cold and bland breakfast arrived (some things never change) around 7 a.m. Afterward, her nurse urged her out of bed for a shower and made certain that all the IV lines are covered and secured and that the bath cloth and towels were within reach, along with the bar of soap. If Mrs. White forgot her toothpaste, it wasn't a problem because necessary toiletries were included in the bedside bath kit.
While Mrs. White showered, a patient care associate arrived and changed her sheets and blankets, replaced the washcloths and towels and left an extra hospital gown. The nurse returned to the room at just the "right" time to help Mrs. White out of the shower and back into bed. At this point, Mrs. White's long-time family physician, Dr. Jones, (she's taught all three of his children) came to the room to discuss the lab tests ordered for the day. Dr. Jones would be her only point of contact and would come to her room every day to check on her. There are no medical students, residents or nursing students to question or examine her without his permission or knowledge. Mrs. White was diagnosed with a stomach ulcer and was discharged from the hospital and told to eat a bland diet of mashed potatoes and unseasoned green beans, drink lots of milk and down thick, white chalky antacid twice a day.
The scenario describes Mrs. White's simple expectations of care. Patient expectations haven't changed. However, the reality is that today's hospital environment is different. For example, today dry shampoo and body wipes may have replaced bar soap, linens and blankets may not be changed on a daily basis due to the hospital "going green" initiative, and patients are often seen by a hospitalist if his/her physician doesn't "round." This can be confusing for patients and their families and has a huge impact on how they perceive their care.
In hospitals all over the country, I hear that patients feel they were not given proper care because they weren't offered a shower or bed bath. Sometimes, other aspects of good medical care become secondary to something as simple as a bath or those squeaky wheels on the food cart.
The challenge is that nurses have too many jobs on their plate. This is not a new issue and most likely won't be resolved any time soon. However, technology cannot replace the human factor of bedside care.
Are there solutions available to help hospitals address this seemingly insurmountable problem of how to improve patient satisfaction? Or more importantly, is there such a thing as a satisfied patient? The answers do not come in pretty tied up packages of fancy technology, 5x7 custom, high-gloss white boards hung on walls or name badges in size 36 black font. While these things are wonderful, the only way patients will be satisfied is if their expectations are set on the front end.
No one likes surprises, at least not in an acute hospital setting. That's why hospital staff need to talk to patients to make sure they know what to expect during their hospital stay.
When people know what to expect, they have the illusion of control. Then, the decisions or actions needed from patients will be based upon information and knowledge rather than anger and fear.
It's OK if the bar of soap is gone. As long as patients know that they can wash up and their needs will be met. After all, isn't that what we all want?