As part of healthcare reform through the Affordable Care Act of 2010, hospitals across the United States are being held accountable for providing a positive patient experience and will lose up to 2% of their reimbursement by 2017 if they fail to reach targeted scores. The purpose of this quality improvement project was to review the process used by a Georgia hospital to educate newly-hired nurses about customer service expectations and to provide recommendations for process improvement. Theoretical foundations supporting customer service included the caring philosophy of Mayeroff; the caring theories of Watson, Leininger, Boykin, and Nyberg; and Roy's adaptation theory. Using the plan-do-study-act model, the project began with a literature review to discover evidence-based customer service strategies. A qualitative evaluation was then conducted of the organizational documents (job description, annual review form, orientation checklists, clinical orientation record, the Standards of Behavior Form) and the educational slide presentations to determine how customer service was presented to new employees. The customer service strategies introduced during orientation and reinforced by the organization in employee evaluations were compared with evidence-based strategies. Improvement recommendations were developed and presented to the 13 nursing leaders of the organization. Materials developed to improve customer service included a poster for display, a tool for examining customer service strategies in hourly rounding, and a performance competency tool to assess nurses' customer service delivery. The project promotes social change by enhancing nurse-patient interactions, improving patients' perceptions of care, and increasing trust between the patients and the healthcare team to improve patient outcomes.

The value-based purchase requirement of the Patient Protection and Affordable Care Act puts pressure on hospital leaders to control cost while improving quality of care. The resource dependency theory was the theoretical framework for this correlational study. Archival data from the Centers for Medicare and Medicaid Services collected from 166 acute care urban hospitals for the Fiscal Year 2016. Multiple linear regression analysis was used to determine the relationship between nursing salaries per patient day, cost of uncompensated care as a percentage of net patient revenue, percentage of net income from patient services, and overall patient satisfaction for quality of care received. The multiple regression analysis results indicated the model as a whole to significantly predict overall patient satisfaction for quality of care for the Fiscal Year 2016, F (3,162) = 13.788, p = .000, and R2 = .203. In the final model, all 3 independent variables significantly predicted overall patient satisfaction for quality of care. Nursing salaries per patient day and percentage of net income from patient services were significant positive predictors of overall patient satisfaction for quality of care. Nursing salaries per patient day (� = .366, t = 5.120, p = .000) accounted for a higher contribution to the model than percentage of net income from patient services (� = .169, t = 2.374, p = .019). The cost of uncompensated care as a percentage of net patient revenue displayed a significant negative relationship with overall patient satisfaction for quality of care (� = .176, t = €2.458, p = .015). The implications of this study for positive social change include the potential to enhance the quality of care for patients while maintaining local hospitals' financial viability.

There is a lack of quality communication among health care professionals and patients in the hospital setting, which can negatively impact patient satisfaction and increase hospital readmission rates. Interdisciplinary bedside rounding (IBR) is a method of rounding that uses direct communication and discussion of the patient at the bedside, and the use of IRB may improve the quality communication among health care professionals and patients. The purpose of this program outcomes evaluation project was to evaluate whether IBR increased patient satisfaction with nursing communication and if IBR decreased hospital readmission rates. The Iowa model of evidence-based practice provided a framework that was used for this project. This program outcomes evaluation used a retrospective pre-post design to collect data 3 months prior to and 3 months following IBR on 1 medical surgical hospital unit. A convenience sample of 42 IBR patient participants was used. HCAHPS scores were used to evaluate patient satisfaction with nursing communication, with a percent of change comparison evaluated. Thirty day readmission rates were evaluated using a hospital based data set and a direct comparison of data was performed. Findings revealed that IBR did not improve patient satisfaction with nursing communication overall. In regards to hospital readmissions, 1% of the hospital readmissions were from the IRB group versus 10% hospital wide. Those who experienced IBR were less likely to return within 30 days. The use of the IBR program and resultant reduced readmission rates show promise for positive social change by improved patient outcomes and decreased health care costs for all.

The clinical practice problems addressed by the DNP project were the low patient satisfaction scores and the high number of falls on a hospital neurological step-down unit. The purpose of this project was to improve the Hospital Consumer Assessment of Healthcare Providers and Systems score on one patient satisfaction question and decrease the number of patient falls by implementing hourly rounding, using a script related to patient comfort and toileting needs. The scripted questions were expected to increase the satisfaction of patients and decrease unassisted falls due to increased attention to patient pain and positioning and timely help with toileting and retrieving personal items. The project was guided by Rosswurm and Larrabee's change model and facilitated by the plan, do, study, act model for rapid change. The satisfaction scores on the survey question 'I received help as soon as wanted' and the number of falls were compared before and after hourly rounding with scripting was introduced. During the 3 months of the project, the average monthly number of falls increased from 3 to 3.6 and changes in the patient satisfaction score were within upper and lower control limits indicating normal variation in the process. These findings indicated that barriers to the change on the unit need to be examined further and another short-term, rapid change cycle initiated to meet or exceed the national benchmarks for patient satisfaction and falls incidence. The project may inform quality improvement efforts at other hospitals and assist in social change by increasing scripted communication between nursing staff and patients to ensure that patients' needs (pain, positioning, pottying, and proximity of personal items) are addressed during each hourly rounding encounter.

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The purpose of this project was to evaluate the effects of relationship-based care (RBC) on patient satisfaction. RBC is a caring model that promotes a caring and healing environment by establishing and maintaining therapeutic relationships between patient, self, and coworker. The Centers for Medicare & Medicaid Services links Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores with reimbursement to hospitals. It is essential to not only achieve high patient satisfaction scores in order to ensure full financial reimbursement, but also to ensure high quality, patient-centered care. The current project assessed samples from 2 medical surgical groups, one system-wide and the other only patients from a single inpatient unit with sample sizes approximately 2,900 and 250 respectively. Data were collected retrospectively 3 times using the Press Ganey webpage at pre implementation, 6 months, and 12 months post RBC training. Results from an ANOVA indicated only a slight increase in post intervention HCAHPS scores with no statistical significant improvement. However, this increase indicates a positive trend, suggesting that the implementation of RBC may have assisted in improving patient responses. This evaluation has implications for the continued implementation for the enhancement of patient-centered care. These findings suggest that a nursing care model provides a collective belief to define a specific attitude to deliver care, facilitate professional development, and improve outcomes. By following RBC, nurses share a similar philosophy toward a caring environment.

Many U.S. hospitals have historically failed to recognize nursing as essential to quality of care. Given the relationship between the patients' experiences, measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), and government reimbursement, stakeholders now value the role of nurses in the care experience. Some hospitals have pursued Magnet designation, which is a rigorous and costly process, in order to promote patient satisfaction through nurse autonomy and retention. The purpose of this study was to understand whether non-Magnet hospitals received similar HCAHPS scores. Expectancy disconfirmation theory provides a framework to understand the components of patient satisfaction within the context of organizational structures and norms addressed by the Bourdieu theory of cultural health capital. A quantitative study was conducted using secondary data from a stratified random sample of 317 non-Magnet hospitals and a purposive sample of 317 Magnet hospitals. Chi-square tests of independence were performed; Magnet designation was significantly related to nurse communication, pain management, timely responsiveness of care, explanation of medication, and willingness to recommend. Magnet designation consistently had a higher proportion of 3-star and 4-star ratings compared to the tendency of non-Magnet hospitals to be more normally distributed across all five ratings. Study results, combined with the climate of patient consumerism, provide the social impetus for healthcare improvement specialists to promote social change through Magnet-like culture and protocols using an evidence-based practice outcome approach to champion better care experiences through empowerment of both patients and nurses to match expected care with delivered care.

Recent changes in the Centers for Medicare and Medicaid Services (CMS) reimbursement programs resulted in $1 billion in payments to hospitals based on Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores. Approximately 50% of the 3,000 hospitals currently receiving Medicare supplements may receive increases in reimbursement payments while 50% will receive decreases in payments. This case study explored how one hospital team in North Texas achieved high HCAHPS scores. The primary provider theory, Deming's model of plan-do-study-act (PDSA), and disruptive innovation theory framed the study. The data collection process included administrator interviews (n = 7), hospital document analysis (n = 13), and observations of staff conducting care (n = 8). Through method triangulation, themes emerged on the constructs required to achieve high HCAHPS scores. Themes included caregiver-patient interactions, hospital services, hospital environment, hospital technology, and hospital governance. Although this was a single case study, other healthcare leaders may explore the findings to determine how the information contained within might transfer to other healthcare organizations. Improved patient outcomes resulting from education, communication, and technology in the continuum of care might enhance the patient experience and patients' overall health and wellness.

As the U.S. population continues to diversify, hospitals need to understand and care for patients of diverse backgrounds and provide quality service for positive patient satisfaction scores. The purpose of this nonexperimental quantitative retrospective survey design was to determine what relationship exists between cultural competence initiatives (CCI) and patient satisfaction scores as reported by the Hospital Consumer Assessment of Health Care Providers and Systems (HCAHPS) survey in U.S. hospitals. The theoretical framework for this study was based upon CCI and patient satisfaction through the lens of service quality. The research questions were created to understand the relationship between CCI and patient satisfaction scores and weigh the cultural competence components relative to each other and their effect on patient satisfaction. The study's data was gathered from secondary sources: the HCAHPS and Diversity and Disparities: A Benchmark Study of U.S. Hospitals in 2013 (DDBS). Through a multiple linear regression analysis, the findings were CCI does have a significant but weak relationship with patient satisfaction. Leadership, a component of CCI, also resulted in a significant but weak relationship with patient satisfaction. The social change implications of this study are that by understanding the diverse cultural needs of its customers, health care organizations will be able to improve patient satisfaction scores. Understanding the relationship between CCI and patient satisfaction scores will aid health care organizations in determining if these initiatives are worth an investment of resources. A broader look at the significance to practice with improved patient satisfaction scores is an increased bottom line, marketing ability, and consumer attraction for hospitals.