The FIVE P's to Patient Satisfaction

Patient experience is the major revenue driving force for hospitals throughout the United States. Hospitals can lose up to 3% of their Medicare revenues by not providing a positive patient experience to their Medicare patients. The new HCAHPS reporting surveys have many hospitals scrambling to educate staff with scripting, one hour patient rounding, white boards, and the hiring of Patient Experience Directors. Hospitals are spending lots of money on the patient experience surveys, patient experience directors, discharge phone calls, and marketing, which many feel could be better used for staff education and additional bedside nursing staff.

Customer Is Always Right

The slogan "the customer is always right" has made it into the healthcare arena and is changing the way hospitals do business. Patient experience is affecting every department within the organization and at all levels. However, the most affected is the bedside nursing staff, who already feel they are over burdened by regulatory mandates, and feel they provide the best care possible to their patients. Directors of Nursing and nurse managers are given a productivity system that does not measure the staff's true workload nor promotes teamwork or continuity of patient care. In addition, directors are challenged to meet budgetary constraints by daily downstaffing of nursing personnel, which drives the patient experience scores downwards and demoralizes the employees' engagement. With that being said, the director's main focus is to increase the patient experience scores through many different and innovative mechanisms and with minimal bedside staffing. The biggest challenge is to get the physicians to realize their role in moving the survey scores upward, and achieving their buy-in.

4 P's: Pain, Position, Potty, and Personal items + (should be) Psych

Directors of Nursing need to ensure all bedside staff, including ancillary staff and physicians, are trained in hourly rounding scripting. Most organizations have labeled the patient experience as the 4 P's: Pain, Position, Potty, and Personal items. However, as a mental health professional, I suggest adding a fifth P; Psych to the hourly rounding. It is my firm belief that every patient in the hospital has a psychological issue, which the healthcare employee must recognize by establishing a patient rapport. Allowing the patient to offload stress and the introduction of new coping skills will have a direct affect on positive patient outcome. The social work department or psychiatric departments are excellent resources for hospital staff to consult. With this Fifth P Philosophy, every patient should be visited by a licensed social worker within 24 hours of admission and issues related directly back to the care team for implementation into the patient's nursing care plan.

Maslow's Hierarchy Of Needs And Erikson's Stages Of Development

So many times I have heard, "I am not a psychiatric nurse" but every healthcare employee should know and understand Maslow's hierarchy of needs and Erikson's stages of development; only then can they provide holistic patient care. A prime example is the geriatric patient's nursing care plan. It is quite different than that of an adulthood patient. The geriatric's psyche is interrupted with short term memory lapses,requiring repetition in explanation of procedures and medications teaching. The daily nursing plan of care may need to be explained several times; therefore, hourly rounding should be patient specific and modified based on specific patient needs. Some patients may need rounding every 30 minutes, while others may feel you are interrupting them by rounding every hour. Most hospital believes that hourly rounding will have positive upward movement of their patient satisfaction scores and some statistics show such a correlation. However, to reach the percentile goals, administrators need to focus on improving communication techniques by doctors/nurses through patient education, emphatic conversation (5P's), cleanliness, quietness, overall hospital recommendation, and making certain that patients understand their discharge education and medication protocols.

"P" Is Psychological Assessment

The most important "P" is psychological assessment of every patient. The uncertainty of the hospital admission, finances, fear of dying, pets alone at home, having a roommate, noise levels, alteration of life style, loss of independence, and a considerable list of other concerns that are specific to each patient, all contribute to the patient's ability to heal themselves and have positive hospital experiences. Notwithstanding is the staff's ability to provide additional support services to the patients that otherwise would go unnoticed. For example, community action social programs such as energy assistance, weatherization programs, handicap issues, and child and adult protection services could alleviate "outside" concerns that have an effect on a patient during their stay. In other words, if someone does not take the time to care for the patient's psyche, the patient's recovery and experience will be slower and experience less positive.

Divisional Activity

Anyone who has been a nurse, or in the industry for any amount of time, can relate to a patient that has benefited from someone taking the time to hold their hand or talk about things other than why they were hospitalized. This technique is called divisional activity. Many hospitals have started divisional activities such as pet therapy, music therapy, aroma therapy, massage, guided imagery, and Reiki allowing the patient to concentrate on things other than their illness. These therapies decrease stress; decrease pain thresholds, and alter the patient's psyche to a state of relaxation and comfort.

Addressing the patient's psychosocial concerns is paramount in providing holistic patient care. In order to take the patient experience scores to the next level, as healthcare employees, the fifth "P" needs to be hardwired into every healthcare employee conversation and treatment modality.

Dale Griffis, RN, BSN, MBA
Director of Nursing, BMU, Intake, IOP