Las Vegas area hospitals working to treat patients as people, not diagnoses

They might not have the expertise, but their opinions carry more weight than ever in the U.S. health care industry.

Patient perspectives are being assessed, implemented and evaluated like never before and not just because hospitals are trying to gain a competitive advantage or improve their bottom lines.

Effort is being made to treat patients as people, not diagnoses, and to call them by their names, their nicknames or however else they might want to be called. Patient advisory councils have been created by several hospital groups in Southern Nevada, and their feedback has led to new ways of doing business on the floors.

Hospitals are starting customer satisfaction programs, rewriting mission and vision statements and employing consultants to get advice on how to make their facilities more hospitable.

“From what patients have told us, we know that they want to be heard,” said Maggie Ozan Rafferty, who in April 2013 became the first chief experience officer in Southern Nevada when Dignity Health Nevada created the position and added her to the team. “We want to connect with our patients as deeply as they’ll let us and customize the care for them.”

Improving the patient experience has become more of a priority because Medicare payments to hospitals are linked partly to patient satisfaction.

In the hiring process, prospective nurses, therapists, medical assistants and lab technicians are being evaluated, in addition to their clinical skills, on such criteria as compassion, warmth, empathy, ability to engage with patients and communication skills.

“We can teach the clinical skills,” said John Coldsmith, chief nursing officer at Centennial Hills Hospital. “What I’m looking for when I’m interviewing is a caring, compassionate way of engaging patients and families. I look for attributes in a nurse in terms of whether I would want that nurse to care for me or my family member.”

While hospital officials want to meet Medicare’s new thresholds, they point to higher reasons for meeting customer satisfaction: It’s the right thing to do to meet their goal of improving patient outcomes.

“We want to make sure we earn and receive every dollar we work so hard for, but that’s not the motivating factor,” University Medical Center CEO Mason VanHouweling said. “Patient perception is part of those thresholds, and we’re certainly up to that challenge.”

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Hospitals have used patient surveys in varying degrees for years, but such feedback is now standardized and publicly reported through the Hospital Consumer Assessment of Healthcare Providers and Systems. The survey asks discharged patients 27 questions about their stay, from how well doctors and nurses communicated with them to the responsiveness of the hospital staff. It also asks whether their pain was controlled and about the cleanliness and quietness of the hospital environment.

Data collection began in earnest in 2008, but it became a higher hospital priority when Medicare in late 2012 started cutting reimbursements to hospitals that fell short in patient satisfaction. The penalties are a very small part of the payments Medicare makes to hospitals. But more importantly, hospital officials say, patient feedback has led to subtle but important changes on hospital floors where the work schedule traditionally has been tailored to the needs of staff, not patients.

“Patients are spearheading this because they’re getting more involved with their care,” Rafferty said. “They’re better educated than ever because they have more access to information they didn’t have in the past.”

New protocols have been implemented to improve a patient’s stay:

■ No pass zones: Any hospital employee will respond to a call light or a patient in need and address the problem or situation.

■ Hourly rounding: Nurses check on their patients every hour in an effort to be proactive in meeting patient needs and preventing problems. Administrators also spend time regularly rounding in patient rooms.

■ A commitment to peace and quiet: Overhead page calls are being limited, doors are closed when a patient so desires and efforts are made to reduce alarms, pings and beeps at the bedside.

■ Dry erase boards in patient rooms: The boards have information about the health care providers assigned for that shift, and some identify exactly how the patient wants to be called.

“We have really worked with staff to stress that the person is not a diagnosis, and now that we’re asking patients how they want to be addressed, we can get even more comfortable,” Rafferty said.

At Centennial Hills, the routine for years included blood being drawn from new mothers at 3 a.m. so obstetricians could have the results when they did their rounds first thing in the morning. After complaints from new mothers about being awakened for those procedures, the schedule was changed. Now, they have the opportunity to sleep through the night.

Doctors, nurses, therapists, medical assistants and lab staff are encouraged to use terms more familiar to patients, such as high blood pressure as opposed to hypertension. Staff members are taught to meet the patients at eye level and to explain procedures and alarms fully so patients understand what is happening and why.

And staff members are charged with treating patients with kid gloves — in other words, gently.

“It doesn’t take any extra time to be nice,” Rafferty said.

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Health care professionals, some with decades of experience, have their own way of doing things. Hospital officials focused on the patient experience are trying to create a culture of customer service, but they have staff members with various styles of bedside manner.

There’s a common thread regarding staff: You can’t teach someone to be nice, so you had better hire employees who have those qualities to begin with.

At Centennial Hills, Coldsmith spends more time inquiring about a potential employees’ interpersonal and communication skills than he does about their clinical acumen. Coldsmith poses scenarios, wanting to know what actions and interactions an oncoming nurse faced with a problem should take.

“You come on duty, and a patient complains about pain,” he will say. “The patient or a family member complains that pain was not resolved because the previous nurse had not responded by giving a pain medication. What would you do to provide service recovery to that patient?”

How the prospective nurse responds shows Coldsmith how well the applicant might engage a patient or family member in an unpleasant situation. The correct response includes an apology, a pledge to take care of the problem, a plan to follow through and an investigation into what happened earlier.

“One of the things I’m looking for is that engagement with the patient,” Coldsmith said. “You’re coming into a new situation so you want to show empathy. You want to be responsive. You want to investigate what occurred.”

Such a scenario also illustrates how hospitals must delicately balance customer service and medical necessity. Hospitals want to address patient needs, but they can’t do things just to please the patient such as overprescribing painkillers. Continuing dialogue helps patients focus on the treatment plan while keeping expectations clearly understood, manageable and attainable.

“The goal is to explain to the patient that they might not be pain-free, but we will do everything we can to manage that pain,” UMC’s VanHouweling said.

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The customer service model from the hospitality sector is being applied in health care, and executives charged with improving the patient experience use phrases such as service recovery, value-based purchasing and culture change in their mantras to encourage hospital staff to engage with each patient.

Stowe Shoemaker, dean of the Harrah College of Hotel Administration at the University of Nevada, Las Vegas, has consulted with several hospitals, including MountainView, and he will be a principal player in the spring at a daylong seminar dedicated to improving the patient experience at health care organizations valleywide. The seminar is being staged by Las Vegas HEALS, a nonprofit organization committed to improving access and delivery of medical care in Southern Nevada.

Obviously, the ultimate goal is addressing patients’ medical needs, but hospitals couldn’t keep their accreditation if they failed that duty. Achieving excellence, Shoemaker said, requires hospital employees to move beyond the delivery of excellent medical care.

“Just giving 100 percent satisfaction is not enough,” Shoemaker said. “There’s more to it. That’s when we start looking at creating great experiences and reminding the customers we delivered great service.”

Shoemaker stresses the RATER model of customer service: Reliability, assurance, tangibles, empathy and responsiveness. The key is getting hospital workers to think about how patients regard all aspects of their stay and how an atmosphere can be created to set the stage for a superior experience, Shoemaker said.

“What it comes down to is understanding what patients are looking for when they enter the hospital,” he said. “The innate ability to help is there, and a lot of it comes down to reminding the patients that we are doing great things.”

The HCAHPS data and patient feedback are the tools patient experience officers are using to gauge their effectiveness and point out to all members of the care team when their jobs have been well done. At UMC, for example, doctors are told not just what patients are saying about their hospital stays, but also about interactions with their physicians.

“Once we share the data with the physicians, they’re looking forward to seeing the next report,” VanHouweling said. “They’re looking for ways that they can do things differently.”

Hospitals face an enormous challenge to improve their Hospital Consumer Assessment of Healthcare Providers and Systems scores because Medicare officials keep raising the bar and patients are becoming savvier, more demanding consumers. Hospital officials are optimistic that continued attention to the patient experience ultimately will bolster outcomes.

“It’s the best feedback we could possibly get, and it’s been the right thing to do all along,” VanHouweling said. “This is the era we’re living in, and it’s only the beginning.”

Contact Steven Moore at smoore@reviewjournal.com or 702-380-4563.