Enhancing the Patient Experience

Currently, there is national interest in improving the “patient experience” – a factor that typically is reflected in10 items on HCAHPS patient satisfaction instruments. The quality of the “patient experience,” as rated by patients after a hospital stay, determines placement on national “report cards”, and often, choices by insurance companies for future coverage of their hospital enrollees. Some items that are part of the “patient experience” are said to be nursing-sensitive and include:

  • communication by nurses and doctors
  • responsiveness (quick help) of hospital staff
  • pain control
  • explanation about medications
  • cleanliness
  • night time quiet
  • discharge planning

Comfort Theory states that, if nurses demonstrate simple comforting techniques (which includes management of discomfort and effective communication and “connection”), patients will respond favorably to most “patient experience” questions. Thus, a movement to a Framework of Patient Comfort seems a logical way to articulate and enhance a culture of comfort. This movement will eventually include objective ratings of patients’ comfort, assessing those ratings, intervening to increase comfort, and documenting patients’ comfort in the official patient record. Patient rounding will facilitate this process.

Principles of Comfort Theory that are relevant to the patient experience are:

  • each interaction involves therapeutic use of self and caring
  • nursing staff assess for holistic comfort needs of patients and family members, and design their interaction to meet those needs
  • nursing staff approach each patient and family member with the intent to comfort and to make a personal, culturally relevant connection
  • nursing staff regularly reassess comfort of patients and family members
  • nursing staff document comfort levels routinely. Utilizing this approach facilitates individualized and efficient care and a more positive patient experience

An alternate approach (not advocated by Comfort Theory) is to enhance the “patient experience” by implementing scripting, whereby members of the health care team utilize specific pre- written statements to use during common patient encounters. An example is a standard script to be delivered upon first introducing oneself to the patient such as, “Hello, I am Nurse Thomas and I will be in charge of your care for today. If you need anything at all, please let me know.” Scripting has been identified as a tool to help care providers approach patients consistently. However, the scripted statements need to be accompanied by a welcoming tone of voice and a smile, a positive attitude, and sincerity. And often, patients recognize scripted statements after just a few encounters. Moreover, I believe that providing comforting care equates to a more individualized, efficient, and satisfying method of care delivery, rather than being “one more thing to do.”

My definition of clinical excellence, which was crafted by nurse leaders from The Mount Sinai Medical Center and me, is: Best practices that involve knowledge and technical skills with a comforting delivery, ability to make critical decisions and utilize judgment, an ethical and moral foundation, and therapeutic communication.

This is what patients want and need in stressful health care situations, and the focus of my consultative visits is to bring this perspective to every day practice.