Background: The impact of hospitalists on the patient experience has gained attention with the advent of the HCAHPS survey. Hospitalists face multiple challenges in establishing quick rapport with new, acutely ill patients, possibly amplified in the academic setting where trainees are also involved in patient care. These challenges can potentially adversely affect patient reports of satisfaction if patient-physician communication is not optimized.
Purpose: Over the past decade, we have introduced multiple initiatives at our institution to improve patient-physician communication and create a culture where the patient experience is prioritized. These efforts have been validated by a substantial rise in HCAHPS scores for physicians in our Division of Hospital Medicine.
Description: We worked on several different projects to address the fundamental hospitalist challenge of providing coordinated, consistent,and clear communication with all patients. These initiatives include standardizing protocols around use of face cards and white boards in patients’ room and monitoring their use. We also standardized use of ‘afternoon rounds’ in addition to morning rounds to increase time with patients and improve the flow of information. In addition, we provided feedback to hospitalists on communication style (via HCAHPS results, role playing with simulated patients, observations of physician-patient interaction at bedside, and bedside patient interviews), and on-boarded all new attendings via observation/feedback from a behavioral scientist. We also created training videos by our faculty with high communication scores, collected data from other academic hospitalist programs to create a hospitalist specific HCAHPS database, and implemented a resident education plan on the importance of clear, empathetic communication.
HCAHPS data speak to the success of these initiatives. HCAHPS ‘doctor communication’ scores for hospitalists demonstrated a 400% improvement (from the 10th to 50thnational CMS percentile) since 2009. This score continues to rise, and the rate of improvement surpasses that of non-hospitalist physicians at our institution (figure 1). Improvements over time have also been seen in the overall rating of the hospital (from 75% of patients who would ‘rate hospital a 9/10’ in 2013 to 80% in 2014). Our institution has also begun to reach out to other academic hospitalist programs to share data on physician communication performance and preliminary data indicate that comparatively, our program is a strong performer.
Conclusions: Our hospitalist program has evolved over a decade to become more patient centered. We have seen great improvement in these measures of the patient experience through a variety of initiatives, all of which have combined to create a culture where patient communication is of high priority. Future directions for this project include standardizing utilization of patient educational resources to improve communication of complicated medical issues and continuing to expand the hospitalist specific HCAHPS database to create a robust benchmarking tool.