Background: Health systems nationwide are grappling with creating innovative strategies to enhance the patient experience. HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) is a national survey that provides a standardized approach to valuing the patients’ perspective. Unfortunately, as HCAHPS data is delayed and challenging to link to individual patient interactions, physicians infrequently receive timely, transparent, and specific feedback on their patient communication.
Purpose: The NYU Division of Hospital Medicine partnered with our patient experience team to create a longitudinal curriculum with the primary objective of improving HCAHPS scores. We present VOICCE (Valuing an Observational Initiative in Communicating the Clinical Experience), a two-phase program that enhances feedback through direct observation of real-time and simulated clinical encounters. This novel curriculum for hospitalists includes direct feedback on the wards reinforced with OSCEs (Objective Structured Clinical Examination Experiences) to target the three fundamental domains of patient communication, effective care transitions, and delivery of discharge information.
Description: In Phase 1 of the program curriculum (Dec. 2022 – May 2023), 31 hospitalists were directly observed during work rounds by a member of the patient experience team. Immediately after rounds, each hospitalist received 10 minutes of feedback from this direct observer using a 14-item behavior-based rubric. Each behavior was assessed on a 3-point Likert scale (not done/ partially done/ well done) and inputted into Qualtrics. In Phase 2 (Oct. – Nov. 2023), these hospitalists subsequently participated in two patient OSCEs incorporating standardized patient actors. These 15-minute cases (one admission and one discharge case) included situations which challenge the patient-physician relationship to help hospitalists address patient concerns. The hospitalist then received 10 minutes of feedback from the standardized patient based on a more detailed 25+ item behavior-based rubric. These behaviors were assessed using the Likert scale and inputted into B-line software. The discharge case was complemented with verbal faculty feedback. Written feedback was distributed to the individual hospitalists in phase I and 2. Using statistical analysis, aggregate HCAHPS scores of the participating hospitalists will be directly compared before and following the intervention to trend growth in the three targeted domains.
Conclusions: VOICCE is an innovative program to help reinforce key behaviors impacting the patient experience that may be practically implemented at any institution. In addition to providing hospitalists with timely and specific feedback, phase I highlighted opportunity areas, including a need to expand on medication side effects and follow-up plans. Phase 2 is ongoing but preliminarily identifies growth areas scoring < 80% on aggregate analysis, notably the need to better address patient support systems, assess patient understanding, and clearly explain what health problems to look out for after discharge. Participants view this intervention as valuable in strengthening essential behaviors and minimally obtrusive in workflow. Future studies include expanding our curriculum to include trainees and advanced practice providers.