Courtesy and Respect: Impacting Patient Experience in the Ambulatory Care Setting

As defined by the Beryl Institute, patient experience is “the sum of all interactions, shaped by an organization’s culture, that influence patient perceptions across the continuum of care.” A review of literature suggests that evidence-based best practices can positively impact the patient experience. Practices common in service industries known to improve customer experience include AIDET (acknowledge, introduce, duration, explanation, thank), HEAT (hear, empathize, apologize, take action),and teach-back. One healthcare organization includes almost 200 ambulatory care practices in four states. The organization identified a strategic goal to implement an evidence-based best practice bundle within the ambulatory care setting to improve patient experience scores and survey comments. A collaborative team inclusive of nurse leaders, a patient experience program manager, and a patient education specialist spearheaded bundle implementation across all patient-facing roles with advisement from a patient experience subcommittee that included ambulatory care operational and clinical leadership stakeholders. The bundle was initially implemented in the women and children’s service line and the cancer service line and subsequently in the remaining practices. The goal was to increase patient experience survey metrics for courtesy and respect, teach-back, and likelihood to recommend practice for ambulatory care practices by two percentile rank points by the end of the fiscal year.
The bundle components selected to improve patient experience metrics were AIDET, HEAT, and teach-back. The implementation plan included providing resources on bundle components to practice clinical and operational leaders, education for all staff who interact with patients, and an observation mechanism. Staff was assigned online learning for each bundle component, and leaders observed staff, provided real-time feedback, and documented rounding in the organization’s tool.
Key outcome measures were patient survey metrics for courtesy and respect, teach-back and likelihood to recommend practice, and comments related to these themes. Comparison of quantitative data demonstrated that the targeted improvement was exceeded for several metrics in both service lines in the initial launch. Comparison of qualitative data showed a decrease in the percentage of negative comments in multiple areas for both service lines. Process measures evaluated were bundle online learning completion rates and number of observations documented within the tool.
The goal of improving several patient experience survey metrics through the implementation of an evidence-based intervention bundle was achieved. A structure for observations was created, real-time feedback and coaching at the local level occurred, and a culture of accountability was cultivated around the bundle within each service line.
Lessons learned include the value of engaging stakeholders through collaboration with the patient experience subcommittee and the need for a streamlined mechanism for provider outreach, engagement, and education. Next steps include ongoing data collection to evaluate impact across all service lines, development of a job aid for tracking practice-level metrics, quarterly reminders to practice leaders, and inclusion of the bundle components in orientation for new leaders and caregivers.
Following this presentation, conference attendees will be able to describe how ambulatory care nurses can promote change and influence outcomes by implementing interventions to improve patient experience in collaboration with clinical and operational leadership.