[PODCAST] How Nursing Leadership Can Move Surveys from Usually to Always

Nurses and nurse managers, strive to provide safe care along with an excellent patient experience. If your organization has attained that goal, then you may have found your hospital in the upper 25th percentile of the national database. That’s an accomplishment, so congratulations – high fives all around. The problem is once you meet that milestone, how can nursing leadership continue to improve?

Listen to the podcast to learn more: How Nursing Leadership Can Move Surveys from Usually to Always

5 Areas of Focus for HCAHPS eBook

How Nursing Leadership Can Move Surveys from Usually to Always

As a nurse or nurse manager, you strive to provide safe care along with an excellent patient experience. If you have attained that goal, then you may have found your hospital in the upper 25th percentile of the national database. That’s an accomplishment, so congratulations – high fives all around. The problem is once you meet that milestone, how can nursing leadership continue to improve?

nursing leadership in busy hospital

Taking the next step means moving those patient survey responses from “Usually” to “Always”. The idea is to provide care that will encourage your patients to pick “Always” on the HCAHPS survey in every domain, presenting you with top marks for your care, but how?


Adding Definition to Your Strategies

Consistency is the key to quality care and improved scores on the HCAHPS survey. It seems to make sense to dedicate your department to a “flavor of the month” enhancement like patient safety, communication, and responsiveness, but are you consistent in the way you deliver them?

To provide care that will make an impact on your patients, nursing leadership must be consistent in practicing core principles such as safety, communication, and responsiveness. This means focusing on a few basic tactics, that can make an impact on both your patient’s experience and how they score you on the HCAHPS survey.

Bulking Up Your Score with Regular Rounding

There are two major tactics to factor in consistently to further enhance your nurse to patient communications skills. Start by initiating regular rounding or hourly rounding. This is good for many reasons, but, ultimately, it sets the patient’s expectations. They never feel deprived or alone when they know you, their nurse, are coming around in regular intervals.

From the nurse’s standpoint, if they know you are coming back on a schedule, it keeps your patient from getting up over and over without assistance. That’s a point for patient safety. For nurses, it adds certain efficiency to the work, as well.

Making Use of the Communication Boards

Another underused but highly effective communication tool is the communication boards. This is powerful and engaging information for the nurse, regular staff, and the patient. Communications boards clearly state:

  • Upcoming appointments
  • Medications
  • Nurse’s name

By keeping that information current, nurses reduce patient and family anxiety and foster effective communication all around.

Nursing Leadership Can Get Better Responses with Enhanced Responsiveness

Consider two tactics that work well in the domain of responsiveness:

  • The “Five Foot Rule” states that a nurse should never be more than five feet away from a call coming in at the nurses’ station. It’s a simple concept that ensures the patient never has to wait once that button is pushed.
  • Establish a department-wide policy that states no member of staff should walk by an engaged patient’s assistance light without checking to see what the patient needs.

Those two enhancements really focus the entire staff’s attention on responsiveness to the patient’s needs.

The trick is to learn to improve those scores by figuring out what works for you and your hospital. Ask the nursing managers to talk about enhancement tactics like the ones listed here during meetings. Bring them up any chance you get, really, maybe at larger group meetings, as well. Promote the idea of a skills lab that video tapes staff working with mock patients to see what works and what doesn’t and improve skill sets. Staff can provide feedback to promote consistent delivery.

Instead of just picking out new tactics with each patient or each shift, focus relentlessly on the basics listed here and soon you will find yourself moving up to the “Always” rank.5 Areas of Focus for HCAHPS eBook

An L&D Story: How a Good Patient Experience Could Have Been Great

Patient Experience and L&D

In March, my wife and I were thrilled to welcome our second child to the world. Our baby boy was born healthy and we could not be more thankful. I did catch myself taking notes, however, as I’ve been working closely with Always Culture and learning about best practices for providing an optimal patient experience. Our overall experience was good, but there were some areas of opportunities that, if addressed, could have made it great.

Our son was a big boy – over 9 pounds, and my wife is very petite, so a few days before the due date her doctor advised that we schedule a cesarean. We gratefully accepted. My wife’s water broke with our first child, and it was like one of those movie scenes where you rush to the hospital, so it was weird just showing up at a certain time to have the baby. Weird, but nice. We stayed for two nights.


We didn’t have any really bad interactions with nurses, but we could tell a difference between the providers that were just going through the motions, trying to get through their shift, and the ones that were actually engaging with us. Right off the bat, they were asking some intake questions and mixed in with medical history, medications, and the like, was this one: “Have you ever thought of hurting yourself or anyone else?” The nurse asked it in the same casual tone that she asked about cigarette smoking. I couldn’t help but think that if the answer was “yes”, would anyone feel comfortable saying so? What would the follow-up be? It just seemed like a very personal and intimate detail that should have been approached with a bit more care.

After the baby came, we were like many parents with newborns; exhausted, delirious, and looking for the staff to assure us that our son was doing well. We may actually be a bit more sensitive than many parents. I know I tend to look for things to worry about when it comes to my kids. That’s why I replayed every word I heard from the care team over and over in my mind.

There is no “routine” for patients and their families

I remember at one point the pediatrician came in and asked us how the baby’s blood sugar was. I was thinking “I don’t know… let me ask the doctor!” The question was completely out of left field. I felt like there was something going on that we didn’t know about. I pestered the next few people who came in the room about “have you heard anything about his blood sugar?” They hadn’t. It was fine. I don’t know why the doctor asked the question, but I learned that routine communication is not routine for patients and caregivers.

Empathy goes a long way

We had a couple of nurses that I wish I could give a million dollars each. They were truly caring toward my wife. They listened, asked questions to discover what was important to her, and had empathetic responses that made us feel like we were in good hands. Breastfeeding was something that we were especially focused on because we had struggled with our first child. We knew we wanted to get as much advice as we could while we were in the hospital. Even though the nurses and lactation consultants didn’t have all the answers, the time spent with us “in the trenches” meant the world to us.

The last thing I would say about communication is that I wish that all of the staff had utilized the communication boards. Some did, but most didn’t. Time doesn’t seem to exist those first few days, so it’s helpful to know what meds you can have when, remember who your nurse is now, and how she can be reached if needed.


There were only a couple of times during our stay when I got upset. They both had to do with responsiveness. After my wife’s catheter was removed, it took a while before she could go to the restroom on her own. While she waited, her pain (and anxiety) continued to build until it became unbearable. She had been told not to try and use the restroom on her own, but she really wanted to try so she could relieve the pain. We were unable to get help to the restroom. Multiple calls using the call light didn’t work. The staff that answered the call seemed indifferent and a little put off that they had been bothered.

Eventually, I helped her to the toilet and she was able to relieve her pain (and bladder). The nurse arrived while she was in the restroom, and I was a little surprised that she didn’t stay to help her back to bed. In general, the call lights seemed to be completely ineffective. There were several occasions when she needed pain meds that I eventually went out to the nurse’s station because it was the only way we could get help. I don’t know what she would have done had she been alone.

Shift Reports and Rounding set the tone for attentive care

We never experienced a bedside shift report or regular rounding. We often found ourselves just hoping someone would show up soon, and often expecting to have to track someone down. Several hours after one shift change I went to the nurse’s station asking if we could get some medication and they asked who my nurse was. I had to respond, “I don’t know, we never met her.” Despite having some sub-par experiences, it’s amazing how one person can turn it around. It was the nurse at the station who asked me who my nurse was. She understood that the ball had been dropped and she picked it up. She got my wife’s medication and set clear expectations for when we could expect to see her again. After finding the nurse assigned to us, she had taken over our care personally. Each shift change we had been hoping that we would get a nurse who was paying attention. She was a breath of fresh air.

Any inpatient stay is a vulnerable time for patients and their families, even on joyous occasions like childbirth. Having a caregiver who is truly paying attention makes all the difference in the world. Implementing best practices like bedside shift reports, regular rounding and communication boards can help make a patient feel like they are being cared for and make a good experience an exceptional one.

5 Areas of Focus for HCAHPS eBook

Fostering Patient Loyalty in the Age of Value Based Care

How loyal are your patients? That depends on who you ask. According to a consumer study from Accenture, patients nationwide are as likely to switch doctors as they are hotels or airlines if they do not receive the service and experience they expect.

Additional findings from the study include:

  • 61% of patients are willing to change providers to get an appointment more quickly
  • 52% of patients would change providers to get an appointment in a more convenient location
  • 47% of patients would switch for a stronger understanding of care costs
  • 50% of patients are willing to pay more for weekend or after-hours appointments, or to have more personal time with their clinician

value based care

While many providers and healthcare organizations assume that if they offer excellent quality of care, patient loyalty will follow. This may not always be the case. Times have changed, and a large majority of consumers expect convenience, quick access, and prompt responsiveness from all of their business interactions whether banking, travel, retail, or healthcare.

Two additional findings from the research that were important to note, include:

  • Patients want responsiveness and convenience – As patients are paying more out of their pocket for healthcare services due to higher deductibles, they are expecting more for their money. Healthcare providers and organizations that are able to offer patients value in terms of convenience and a superior experience will ultimately be most successful in gaining patients loyalty. In today’s digital age this can mean simply making it easy for consumers to schedule their appointments through online scheduling, and online bill pay. Providing more information regarding the cost of care has become increasingly important.
  • Patients will pay more for services they value – More than half of the healthcare consumers surveyed, said they would pay more for experiences they considered valuable such as weekend or after-hours appointments, or additional time spent with the doctor. Others expressed an interest in paying more to see a provider virtually and paying more to be notified for a follow-up visit.

Those who are able to offer patients quick access, convenience, cost of care transparency, and personalized quality of care will be best positioned for success in this highly competitive ever-changing marketplace. Providing a better patient experience will not only help increase patient loyalty it also benefits a practice financially. Most importantly these providers and healthcare facilities will build long-lasting relationships with patients, which is the foundation of every medical practices success.

Jerry Stone is the co-founder of MedicalGPS, which provides real-time patient experience tools that help foster patient loyalty and reduce medical malpractice risks.

[PODCAST] 2 Key Measurements for the HCAHPS Survey Responsiveness Score

The HCAHPS survey asks about the measure of responsiveness in a very specific way. It doesn’t ask about responsiveness as it relates to how food trays are delivered, how medications are handled or how transportation is provided throughout the hospital. The HCAHPS survey asks about responsiveness in two specific areas…

Listen to the podcast to learn what those are and for steps on improving your Responsiveness Score or checkout the full video and article: 2 Tactics for Improving HCAHPS Scores AND Overall Patient Experience

5 Areas of Focus for HCAHPS eBook

2 Key Measurements for the HCAHPS Survey Responsiveness Score

The HCAHPS survey asks about the measure of responsiveness in a very specific way. It doesn’t ask about responsiveness as it relates to how food trays are delivered, how medications are handled or how transportation is provided throughout the hospital. The HCAHPS survey asks about responsiveness in two specific areas:

How responsive you were to call lights, and how responsive you were to toileting needs.

It’s important to remember that the HCAHPS survey asks for answers on a range from “never” or “always.” That means consistency: every patient, every time.


Call lights are one of the most ubiquitous and common experiences of any patient. Every patient has a button in their room that is not only a way that they can ask a question, but sometimes it’s their only link to help. It’s the only way that they can reach outside their room, especially if they must stay in bed. Problems arise when there is a disconnect between how important the call light is to a patient, as opposed to how important it is to staff. A survey recently showed that half of nurses believe that call lights are not related to patient safety, and another half of nurses believe that call lights just get in the way and are a distraction. That’s a big disconnect between how important those call lights are to patients and how important they are to staff. There are some specific tactics that can be used to address the issue and improve the patient experience.

hcahps survey



    The five-foot rule basically says that if a call light goes off in a nurses’ station, anyone within five feet of the call center is required to answer. If you want to take it to the next level, go into that patient’s room and have a personal interaction with them.


    A no pass-zone means that any staff member-any transporter, any environmental services staff, any facilities employee, anyone walking by a room when that call light is going off-cannot pass the room. They have to stop and at least ask the question, “Can I get your nurse? Do you need anything right now?” Let the patient know that you are responding to their needs.


    The keyword here is regular. If patients can rely on staff members to round on patients at predetermined intervals, you will begin to foster a trusting relationship. If a patient knows that they don’t have to get up to ask a question or to get something that’s in their room because in the next 30 minutes you’re going to be there anyway, you’ve created trust and a safer environment.


Like the issue of call lights, toileting is something that every patient experiences. Being in a hospital bed ties toileting to many other issues and concerns. One of the biggest concerns is safety. Eighty percent of falls happen in a patient’s room, and over half of those falls are toileting related. To address these concerns, some of the same tactics used with call lights, such as the five-foot rule and no pass zones, can be implemented. With toileting, there are a couple of areas where extra emphasis can also be used to make a difference.


    When the bedside shift report happens between an oncoming nurse and off going nurse, try to avoid asking yes or no questions regarding toileting. A real conversation needs to occur regarding the toileting process, and if the patient needs any extra help.


    Once again, establish regular rounding times so the patient expects staff to arrive at set intervals. This will build confidence for the patient to wait for staff to arrive, rather than trying to do it on their own. Call lights can still be used for more emergent needs, but if the patient trusts you to come in regularly then you will have created a safe toileting environment.

If you implement one tactic to improve responsiveness scores for HCAHPS it should be to make regular rounding a skill. Determine intervals that are good for your staff and patient population. Whether you choose to round every hour or every 90 minutes, the key is to keep it consistent where the patient trusts you to come in at that regular time.

5 Areas of Focus for HCAHPS eBook