worked with a Vice President of Supply Chain of a large integrated delivery
network who used to tell his value analysis team, "Do you want stuff or
staff?"
This question has always resonated with me,
particularly when the conversation continues to revolve around "stuff." As a
nurse, patient satisfaction was the most frustrating quality initiative to
tackle. Catheter-associated urinary tract infection (CAUTI) was a tangible
goal I knew we could improve.
Patient satisfaction is purely subjective, not a
tangible medical practice I could simply measure. As a value analysis
professional I better understand the financial implications of improving
these satisfaction scores, but I still struggle with how to get at the
problem. The more I think about "products to boost patient satisfaction" I
can’t help but wonder if products are really the answer to patient
satisfaction? Do we really need more ... stuff?
According to a report published by Healthgrades, a
leading online resource for physician and hospital information, "the
personal impact of caregiving — like responsiveness to needs, communication
and pain control — is what is most important to patients."1 The
personal impact of caregiving. I wonder where products fall into this
impact. As a bedside nurse I spent most of my time in the ER, and I also
spent a number of years in the cardiac step-down unit. I saw very different
aspects of "personal caregiving" as the patients on these two units had very
different needs. However, looking back at both of those experiences, I can
see how Healthgrades came up with their conclusion. Whether you are in a
loud, crazy emergency department with people yelling and ambulances running
in and out, or a quiet cardiac unit where the most noise comes from the
constant beep of heart monitors, when a patient feels they are attended to,
they will be satisfied.
Knowing that the personal impact is most important
to patients, why are we looking to products to boost patient satisfaction?
Rather, we should be asking how we can help nursing staff provide the
"personal impact of caregiving." Do "products that boost patient
satisfaction" really exist? I propose that we focus on processes to boost
patient satisfaction instead.
When a patient receives a Hospital Consumer
Assessment of Healthcare Providers and Systems (HCAHPS) questionnaire they
are asked about communication from physicians and nurses, timely pain
control, understanding their care and hospital cleanliness. You won’t find a
question about products, so why are we focusing so heavily on them?
Processes and practice is where the difference is
made for patients — not products. Yes, getting a nice-smelling name-brand
lotion, a hospital-branded water pitcher and a single-brewed cup of coffee
are nice, but if brewing me coffee is taking away the time you have to spend
explaining my post-op care, you can keep it.
Yet, I have asked supply chain teams about these
exact products and have been told it’s to "boost patient satisfaction." You
may as well be telling me "because I said so." When we continue to provide
and introduce new, fancy products in the name of patient satisfaction, we
lose focus on what will really improve those HCSPHS scores — personal
caregiving.
Supply chain powers
Consider the bath-in-a-bag product. This item is
advertised as a waterless bathing product to increase nursing and patient
satisfaction, decrease nursing time and prevent nosocomial infections. Let’s
think about this for a minute. Didn’t we just see evidence showing patients
really respond to "the personal impact of caregiving?"
Nosocomial infections acquired from a bath are not
from the type of cleanser being used. They are a result of re-infecting the
patients with their own germs through incorrect bathing processes.
Decreasing the nurse’s time with the patient by giving a quick wipe down
with pre-moistened cloths isn’t exactly providing personal nursing care.
Nurses want to spend time with their patients; they just aren’t given the
opportunity in their busy day. Taking the time to give the patient a full,
proper bed-bath allows the nurse to perform a head-to-toe assessment, talk
to the patient, explain their plan of care, and collect the social and
emotional information that is so important but easily overlooked.
Communication happens during this time and that is what is measured on the
HCAHPS survey — not the type of bath you received.
There are even more potential downsides to this
bath-in-a-bag, as well. Patients that would otherwise have gotten out of bed
to bathe can now stay in bed and wipe themselves down instead. Sounds great,
right? Except ambulation and independence are important factors necessary
for discharge. The patient walks less and his muscles weaken. He takes fewer
deep breaths causing the lower airways to close and increasing his risk for
pneumonia. All of a sudden you have a patient who can no longer ambulate as
well, and has a potential for hospital-acquired pneumonia — affecting two
other quality measures you would not necessarily relate to the
bath-in-a-bag.
I left my bedside nursing career three years ago,
opting for a change in scenery and perspective, and found myself on the
supply chain and value analysis side of healthcare. From this viewpoint, I
see what hospitals are purchasing in the name of boosting patient
satisfaction, and more importantly, the value or lack thereof, of these
purchases. I see hospitals spending $100,000 annually on these bath-in-a-bag
products, but I am sorry to say patient satisfaction cannot be purchased on
a purchase order. What a PO could do is replace that bath-in-a-bag with a
lower-cost bathing product that can be used multiple times by the same
patient and provide the waterless functionality for half the cost. Take the
extra $50,000 and add a full-time eqiuivalent. Provide the nurse with
increased personnel to assist him or assign him one less patient so he can
provide "personal caregiving." Let’s use our supply chain powers to find the
functionality in the newest products and see what else is out there offering
the same function — without the bells and whistles and extra cost.
Beware the freebie geebies
We should also remember the hidden costs of some
of these new products. Admit it, we all like fancy freebies, and we want as
many of them as we can get, whether we need them or not. I experienced this
impulse first-hand when giving birth to my children. Per the advice of my
nurse, I emptied the drawer full of the brand-name diapers daily so it would
be continuously refilled.
By the end of my two day post-partum stay I had an
entire case of free diapers at my house waiting for me. Turns out, my
nine-pound baby boy only fit into the newborn diapers for two weeks, so I
didn’t even use all of the diapers I hoarded. Would I have hoarded the
generic brand? Probably not. How many bottles of the nice-smelling
brand-name lotion do you think I asked for? And I "lost" my water pitcher at
least twice. Those bath-in-a-bag products provide so much convenience that
when a patient needs their hands washed after dinner, guess what is being
used — an eight-pack of pre-moistened washcloths. The overall theme being
that you are not only paying a few dollars and cents more for the
bath-in-a-bag, a name-brand diaper, or a fancy lotion, you will also be
using more of them unnecessarily because the patients inherently want more
of them, and the nurses are striving for better satisfaction scores,
throwing anything they can at the issue. Not only have line-item costs
increased, but the overall utilization of the product has skyrocketed as
well, all the while providing little-to-no value to the patient or your
HCAHPS scores.
In contrast, hourly rounding has become a standard
of practice in hospitals today, requiring every patient to be checked on by
staff at least once per hour. Research shows that hourly rounding leads to
52 percent reduction in falls, 37 percent decrease in call light use, and a
12 percent increase in patient satisfaction scores.2 Hourly
rounding substantially increased patient satisfaction in all of the Press
Ganey and HCAHPS subscales.
Changing the personal impact of caregiving has
nothing to do with products, but has proven value. I challenge hospitals
that are looking for "products to boost patient satisfaction" to stop and
consider that the biggest factor in patient satisfaction is the "impact of
personal caregiving." Let’s look for ways to foster practices that provide
the personal touch and instead of relying on products, find processes to
boost patient satisfaction.
