Strategic Leadership and Future Delivery Models C163

Healthcare organizations today are facing various challenges especially the increasing difficulty to satisfy more aware and demanding patients. To help solve this problem, strategic leadership is required to guide institutions towards improving quality, making workflow cost-effective, and ensuring facilities are on a sustainable trajectory. One of the strategies used to improve quality in healthcare is the periodic analysis of performance using quality improvement tools. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is a tool recognized to guide quality improvement in many hospitals in the US. The HCAHPS scores present an opportunity for leaders and managers to plan for improvement in aspects that do not meet the required organizational standards. This discussion analyzes the HCAHPS scores at Providence St Peter Hospital and develops a strategic plan to improve low-scoring areas.

1. HCAHPS Scores: Providence St Peter Hospital

The current HCAHPS scores for the institution are as follows:

	Survey Response Rate
Patients who reported that their nurses “Always” communicated well	79%
Patients who reported that their doctors “Always” communicated well	80%
Patients who reported that they “Always” received help as soon as they wanted	64%
Patients who reported that staff “Always” explained about medicines before giving it to them	61%
Patients who reported that their room and bathroom were “Always” clean	67%
Patients who reported that the area around their room was “Always” quiet at night	49%
Patients who reported that YES, they were given information about what to do during their recovery at home	87%
Patients who “Strongly Agree” they understood their care when they left the hospital	50%
Patients who gave their hospital a rating of 9 or 10 on a scale from 0 (lowest) to 10 (highest)	73%
Patients who reported YES, they would definitely recommend the hospital	75%

 B1. State and National Averages

The table below highlights the HCAHPS scores for Providence St Peter Hospital and how they compare to the state and national averages.

	Survey Response Rate(Providence St Peter Hospital)	State Average (Washington)	National Average
Patients who reported that their nurses “Always” communicated well	79%	80%	81%
Patients who reported that their doctors “Always” communicated well	80%	81%	82%
Patients who reported that they “Always” received help as soon as they wanted	64%	69%	70%
Patients who reported that staff “Always” explained about medicines before giving it to them	61%	66%	66%
Patients who reported that their room and bathroom were “Always” clean	67%	76%	76%
Patients who reported that the area around their room was “Always” quiet at night	49%	56%	62%
Patients who reported that YES, they were given information about what to do during their recovery at home	87%	88%	87%
Patients who “Strongly Agree” they understood their care when they left the hospital	50%	53%	54%
Patients who gave their hospital a rating of 9 or 10 on a scale from 0 (lowest) to 10 (highest)	73%	72%	73%
Patients who reported YES, they would definitely recommend the hospital	75%	73%	72%

Located in Olympia, Washington, Providence St Peter Hospital is the leading healthcare facility in the southwest region providing an array of services to different communities. The HCAHPS scores for the institution compare differently to the state and national averages providing room for improvement. The first aspect that compares closely with the state and the national average is communication with nurses. The institution has an average of 79% compared to 80% and 81% of the state and national averages respectively (U.S. Centers for Medicare and Medicaid Services, n.d.-a). The same can be said about doctor’s communication with patients that has a score of 80% compared to the state average of 81% and the national average of 82%. One aspect that demonstrates a wide range is the responsiveness of hospital staff. The institution has a score of 64% compared to 70% and 69% of the national and state averages respectively.

The HCAHPS survey analyzes the aspect of explaining medication to patients before administration. Providence St Peter Hospital demonstrates low scores in this area (61%) compared to 66% of the state and national average. Regarding the cleanliness of patient’s rooms, the state and national averages are 76% compared to 67% of St Peter Hospital (U.S. Centers for Medicare and Medicaid Services, n.d.-a). Another area that requires great improvement is the maintenance of quietness at night in the facility. St Peter Hospital has a score of 49% compared to 56% and 62% of the state and national average respectively. The area that seems to perform better and closer to the state and national averages is the provision of discharge information to patients. A score of 87% for the hospital equals the national average and is only one percent below the Washington state average.

The third low-scoring area for St Peter Hospital is on patients who strongly agreed their understood their care when they left the facility. The institution has a score of 50% compared to 53% of the state and 54% of the national average. To gauge the quality of services provided, the HCAHPS survey allows patients to rate hospitals on a scale of zero to ten. According to the survey results, the institution has a score of 73% that equals the national average and one percent above the state average (U.S. Centers for Medicare and Medicaid Services, n.d.-a). The last aspect that demonstrates the organization has a good reputation for the population served is on the recommendation of the hospital. The facility has a score of 75% compared to 72% of the state and 73% of the national average.

B2. Comparison to Other Hospitals

The table below provides HCAHPS scores of St Peter Hospital and how they compare to Providence St Mary Medical Center and Providence St Joseph Hospital.

	Providence St Peter Hospital)	Providence St Mary Medical Center	Providence St Joseph Hospital
Patients who reported that their nurses “Always” communicated well	79%	82%	82%
Patients who reported that their doctors “Always” communicated well	80%	83%	82%
Patients who reported that they “Always” received help as soon as they wanted	64%	64%	81%
Patients who reported that staff “Always” explained about medicines before giving it to them	61%	65%	74%
Patients who reported that their room and bathroom were “Always” clean	67%	79%	94%
Patients who reported that the area around their room was “Always” quiet at night	49%	55%	61%
Patients who reported that YES, they were given information about what to do during their recovery at home	87%	89%	82%
Patients who “Strongly Agree” they understood their care when they left the hospital	50%	51%	57%
Patients who gave their hospital a rating of 9 or 10 on a scale from 0 (lowest) to 10 (highest)	73%	71%	86%
Patients who reported YES, they would definitely recommend the hospital	75%	75%	83%

Providence St Peter Hospital compares closely with neighboring healthcare facilities in various aspects of the HCAHPS survey aspects. Of all the three institutions, St Peter Hospital has the lowest score regarding communication of nurses. The hospital has a score of 79% compared to 82% of St Mary and St Joseph hospitals. The same results can be observed in the communication of doctors whereby St Peter has a score of 80% compared to 83% of St Mary and 82% of St Joseph hospitals. Regarding the aspect of receiving help for patients as soon as they need it, both St Peter and St Mary have a score of 64% while St Joseph demonstrates a better performance of 81%. (U.S. Centers for Medicare and Medicaid Services, n.d.-b).

The three institutions display different scores on the area of explaining medication before administration. Providence St Peter has a score of 61% while St Mary and St Joseph have 65% and 74% respectively. The same can be said on the area of cleanliness for the patient rooms where a wide margin is observed. St Peter Hospital has the lowest score (67%) followed by St Mary with 79% and St Joseph with a remarkable performance of 94% (U.S. Centers for Medicare and Medicaid Services, n.d.-b). One area that seems to be evenly performed across the three institutions is on maintenance of quietness at night. St Peter has a score of 49% followed by St Mary with 55% while St Joseph has the highest score of 61%. Much higher scores are observed in the aspect of information given during discharge across the three institutions. St Peter has a score of 87% and St Mary has 89% while St Joseph has a slightly lower score of 82%.

Understanding of care upon leaving the hospital is an area that commonly displays low HCAHPS scores with a national average of 54%. When comparing the three institutions, St Joseph has a score of 57% and is the highest followed by St Mary with 51% and lastly St Peter with 50%. When comparing the scores for rating the healthcare organizations on a scale of zero to ten, St Peter has a score of 73% compared to 71% and 86% of St Mary and St Joseph respectively (U.S. Centers for Medicare and Medicaid Services, n.d.-b). The last aspect of comparison is on the recommendation of the hospital by patients whereby St Peter and St Mary have an equal score of 75%. St Joseph Hospital has a score of 83% making it the most recommended amongst the three hospitals. Generally, St Peter has the lowest HCAHPS scores in many areas compared to St Mary and St Joseph Hospitals. St Joseph Hospital is the most outstanding institution of all the three.

B3. Survey Response Rates

Hospital	Number of completed surveys	Survey response rate
Providence St Peter Hospital	859	25%
Providence St Mary Medical Center	1116	28%
Providence St Joseph Hospital	54	29%

The survey response rates for the three hospitals compare closely despite the differences in the number of completed surveys. Providence St Peter Hospital has completed 859 surveys and recorded a survey response rate of 25% (U.S. Centers for Medicare and Medicaid Services, n.d.-a). This score is the lowest amongst the three hospitals. Providence St Mary Medical Center has the highest number of completed surveys, 1116, and demonstrates a survey response rate of 28%. Providence St Joseph Hospital has the highest survey response rate of 29% with only 54 completed surveys.

B4. Demographics and Services Provided

Providence St Peter Hospital is located in southwest Washington and provides services to the communities in Thurston, Lewis, Mason, Grays, harbor, and Pacific counties. Demographically, Olympia is home to a population of 50.8k people from which 95.7% are citizens (DATA USA, n.d.). The community of Olympia is made up of people from different races and ethnicity. According to the 2018 statistics, the largest community is made up of Non-Hispanic Whites followed by Asian and Hispanic Whites. The Non-Hispanic Whites account for 38.9k people while Non-Hispanic Asians and Hispanic Whites account for 3.69k and 3.02k people respectively (DATA USA, n.d.). The Black or African American people account for 2.78% of the total population while the native Hawaiians are the least populated accounting for 0.4%.

Economically, the median household income in Olympia is $58,606. However, the level of income varies between regions whereby Census Tract 120 has the highest median household income followed by CT 104 and 107 respectively. The economic stability varies according to sex with the males having an average income that is 1.36 times the income of females (DATA USA, n.d.). Comparing the income level of Olympia with the national statistics, the annual income level is below average. However, the income level of the region has grown by 5.52% since 2017 indicating positive economic growth. Racially, the Asian population earns more followed by the Whites. Regarding the poverty level, 16.7% of the people live below the poverty line, a number that is higher than the national average of 13.1% (DATA USA, n.d.). Educationally, most students graduating from universities are Whites with 61.9% followed by Hispanic or Latino with 10.3%. The most common degrees awarded include liberal arts and sciences, general business, and physical sciences. Using averages in Olympia, the mean commute time is 19.5 minutes compared to the national average of 25.3 minutes.

Providence St Peter Hospital is a 390-bed not-for-profit regional teaching hospital offering comprehensive medical, surgical, and behavioral health services to the population served. Based on the core values of compassion, dignity, justice, excellence, and integrity, the institution provides various health services according to the age and condition of the patent (Providence, n.d.). Among the services offered include diagnostic imaging, cardiac surgery, emergency care, family birth care, neurosurgery, orthopedic care, palliative care, psychiatry, cardiovascular services, cancer care, and anti-coagulation services at the anti-coagulation clinic (Providence, n.d.). Additionally, the institution has special clinics like Providence sleep medicine and chemical dependency center to offer specialized care to patients.

B5a. Cultural Dynamics

Culture is a pattern of ideas, customs, and behaviors shared by a particular group of people and can affect health. Culture affects the perceptions of health, death, disease, and approaches to health promotion. For example, individuals who are not native English speakers might find it difficult to understand the care received in the hospital. The result is low scores on the aspect of the patient’s understanding of care upon leaving the facility. Secondly, areas of communication with nurses and doctors can receive low scores due to communication problems. Additionally, some cultures have stoicism as a norm whereby aspects like pain are perceived differently. The individuals might fail to seek help as soon as they need it making it difficult to be satisfied with the type of care received.

B5b. Educational Dynamics

The level of education can positively or negatively influence HCAHPS survey scores. The key areas affected by the level of education are communication and understanding of instructions, especially during discharge. The people of Olympia are well-educated with the majority having degrees. This level of education will ensure improvement in HCAHPS scores in the aspect of communication with nurses and doctors and understanding of care upon leaving the facility. The level of education can also hinder the observed HCAHPS scores due to the high expectation of care from the patients. Educated individuals always have high expectations of care including immediate response to their problems and the nature of the environment they are served. The high expectations might lead to low response on questions like maintenance of quiet environment at night and responsiveness of staff when called upon.

B5c. Socioeconomic Dynamics

The socioeconomic status of individuals is mainly determined by employment status and the level of income earned. The demographic data indicates that Olympians’ medium household income is below the national average indicating a struggling community. During patient care, challenges may be observed in adhering to discharge instructions leading to readmissions and poor prognosis upon leaving the institution. The result is poor satisfaction scores especially on the recommendation of the facility. The self-esteem of the individuals might also affect the aspect of communication with nurses and doctors leading to low scores in these areas.

B6. Financial Impacts

The HCAHPS scores present an opportunity for healthcare organizations to improve financial stability. On a short-term basis, good HCAHPS scores will lead to more reimbursements from the CMS that can help in sustaining projects and improving staffing. Good HCAHPS scores will lead to more census that can help generate more income for the institution. On the contrary, poor HCAHPS scores can affect areas of staffing, maintenance of technology and lead to delays in service delivery. The long-term effects of improved HCAHPS surveys will include more capital for the development of infrastructure, installation of technology, and strengthening of performance through improved staffing levels. On the contrary, poor HCAHPS scores will cause problems with sustainability, decrease census, bankruptcy, and potential closure of the institution.

B6a. Impact on Quality

In today’s value-based care delivery model, the only true measures of quality are the outcomes that matter to patients. Common quality outcome measures in healthcare include mortality rates, the safety of care, hospital readmissions, patient falls, and timely patient care. HCAHPS scores can influence these measures through the implementation of change to address observed barriers. For example, poor satisfaction scores on communication with nurses can lead to the implementation of change that can reduce medication errors and improve response time during care delivery. Secondly, the HCAHPS scores can lead to improvement in staffing levels to address areas like a timely response to patient needs and cleanliness of patient rooms. Through these steps, the organization will increase quality through increased patient safety.

1. Causes of Low Scores

Providence St Peter Hospital has three areas that have low HCAHPS scores. The first part is on the response of healthcare providers to patient needs that has a score of 64% compared to 69% and 70% of the state and national averages respectively. The second aspect with low scores is the maintenance of a quiet environment at night with 49% compared to the state average of 56% and the national average of 62%. The last part is on patients who understood their care when they left the facility with 50% compared to 53% and 54% of the state and national averages respectively. The potential causes of these scores can be due to patient factors, faulty systems, or as a result of healthcare provider issues as discussed below.

Low scoring HCAHPS Question	Potential Causes
Patients who reported that they “Always” received help as soon as they wanted.	·         Lack of adequate staff to respond to the immediate needs of the patients. ·         Poor communication between healthcare providers and patients leading to delayed response to their needs. ·         Location of nursing station far from the patient rooms hindering information exchange. ·         Faulty alert and alarm systems that prompt providers to respond to the patient needs.
Patients who reported that the area around their room was “Always” quiet at night	·         Location of patient rooms close to the nursing station where a lot of noise is experienced. ·         Overhead intercommunication system utilized at night that disturbs patients while they are asleep. ·         Alarms, monitors, and other alerts from equipment that make it difficult to maintain silence. ·         Busy nights, especially admissions that make it difficult to maintain silence. ·         Presence of relatives that make it difficult to maintain silence in the halls and patient rooms.
Patients who “Strongly Agree” they understood their care when they left the hospital	·         Poor communication skills by staff that hinder passing of information during discharge. ·         Language barriers, especially for non-native English speakers that hinder communication and information exchange. ·         Failed discharge planning protocol ·         Lack of resources for discharge planning and follow-up services. ·         High patient expectations regarding the services provided at the facility leading to low satisfaction.

 

D1. Organizational Change

The first area that can benefit from organizational change is the responsiveness of staff to patient needs. The proposed change is to improve staffing levels to ensure adequate nurses, physicians, and other providers are available to immediately respond to patients. Research establishes that lack of adequate staffing, especially for the nurses hinders care delivery by delaying response to patient needs and establishment of relationships (Bridges et al., 2019). The result is poor quality service delivery and low satisfaction that affects HCAHPS scores and other patient outcomes. Through the improvement of staffing level, the institution is likely to achieve high scores in the question of staff responsiveness to the patient needs when called upon.

The second area that requires organizational change is the maintenance of a quiet environment at night in the areas around the patient rooms. The proposed solution is to implement an alternative mobile phone technology that can be used for communication instead of overhead paging. The new technology will allow for direct communication to nurses and physicians regarding patient care instead of making announcements that disturb patients (Hughes Driscoll et al., 2020). Through the use of messages, alerts on their phones, and direct phone calls, overhead paging at night can be eliminated to promote sleep. Addressing this area will improve the HCAHPS score on maintenance of a quiet environment around patient rooms at night.

The third aspect that requires organizational change is the transition of care during the discharge of patients. The majority of them are reported to have problems with understanding the reasons for hospitalization including failure to identify their diagnosis, medications given, and what to do while at home to promote their health. The proposed solution is to implement the use of written health information given to patients right from the point of admission rather than waiting for the day of discharge (Flink & Ekstedt, 2017). The use of these documents will standardize patient education across the hospital and promote continuity of care upon leaving the facility. This intervention will improve the HCAHPS score on the aspect of care transition.

D2. Structure, Process, and Outcomes

Structure	Process	Outcome
Improve the responsiveness of hospital staff	Ø  Literature search for evidence-based practice to improve healthcare worker responsiveness to patient needs. Ø  Collaborate with the human resource department to plan for improvement of staffing levels. Ø  Hire new staff, especially nurses to improve staffing levels across all hospital departments. Ø  Offer education and training about timely response to patient needs and its impact on organizational performance. Ø  Implement and evaluate the new strategy and make necessary changes.	Improved HCAHPS scores on the question “ Patients who reported that they ‘Always’ received help as soon as they wanted”

 

Structure	Process	Outcome
Ensure maintenance of a quiet environment around patient rooms at night.	Ø  The first step will involve literature search for best practice to reduce noise at night. Ø  Work with the information technology (IT) and finance departments to implement mobile phone technology. The technology will replace overhead paging system. Ø  Educate and train staff on the use of the new technology. Ø  Implement, evaluate, and make changes to the new strategy to ensure sustainability.	Improved HCAHPS score on the question of “Patients who reported that the area around their room was ‘Always’ quiet at night.”

 

Structure	Process	Outcome
Improve transition of patient care upon leaving the hospital.	Ø  Search for evidence-based practices to improve care transition upon patient discharge. Ø  Engage the nurses and physicians in implementing the use of written health information for patients right from admission through discharge. Ø  Educate staff and patients on how to improve and promote care delivery using health education activities. Ø  Engage the clinical nurse educator and charge nurses to ensure printed material is available to patients throughout their stay. Ø  Implement and evaluate the strategy while making necessary changes.	Improved HCAHPS scores on the question “Patients who ‘Strongly Agree’ they understood their care when they left the hospital.”

D3. Improving Organizational Quality

The strategy to improve organizational quality will involve the use of evidence-based practices and shared governance approaches. Evidence-based practice (EBP) involves the utilization of research and practice guidelines to improve safety, quality, and patient outcomes. During the implementation phase, a literature search for EBP to improve the selected HCAHPS scores will be done. For example, the improvement of staffing and installation of new technology to minimize noise at night is supported by evidence to lead to better patient outcomes. Shared governance is a strategy that involves teamwork and accountability while working together to solve problems that affect practice and patient care. To ensure shared governance is utilized, healthcare providers will have an opportunity to recommend practice changes that can improve the selected HCAHPS scores. Secondly, the implementation of the new strategies will involve members from diverse teams including nurses, physicians, administrators, educators, the IT team, and the research department to ensure the most appropriate decision is made.

D4. Shared Accountability

The first group to be involved in shared accountability are the patients. To ensure patients are accountable for their actions during survey response, I will organize for health education to enlighten the patients on the importance of honesty when filing the survey questions. Secondly, using a negotiation approach, a discussion about noise reduction at night will be made to incorporate other measures that patients might find crucial to improving the HCAHPS score area.

The second group that will play part in shared accountability is the medical providers. The use of education and training will form the first step towards promoting accountability. These sessions will ensure the providers convey the right information to patients especially concerning the area of care transition. Timely provision of feedback and the use of disciplinary measures will ensure the medical providers are accountable for their actions.

The third group that will be accountable for their actions is the payers. The initial strategy is to engage the payers in providing timely feedback on the HCAHPS scores and financial reimbursements to the institution. With help from the financial department, the payers will provide regular bills to their patients throughout their hospital stay to improve understanding of their care upon discharge. Additionally, the provision of monthly and quarterly reports on healthcare expenditure will inform the organization on areas for improvement.

The last group that will play part in shared accountability are the personnel that includes case managers, registered nurses, security, housekeeping, and many others. The first strategy will involve the use of meetings to discuss their roles in ensuring HCAHPS scores like maintenance of quietness are improved. Another strategy will involve the timely provision of feedback and incorporation of their proposals to the strategic plan of improving quality in the organization.

D5. Technology Trends

Digital technology has become an integral part of healthcare and is all set to revolutionize the practice of medicine. To ensure the utilization of technology in the strategic plan, I will involve the IT team to design a new method to replace the overhead paging system. The use of mobile phone technology will serve as a replacement for the overhead paging system that contributes to noise at night. Additionally, the use of the organizational website to communicate results, the financial status of the organization, and HCAHPS scores will demonstrate the use of technology in improving quality.

D6. Improve Care Delivery System

The first aspect that will be incorporated during the improvement of the care delivery system is quality. To improve quality, the strategic plan will involve the use of evidence-based practices. For example, improvement of staffing ratios and timely discharge planning for patients evidently improve quality in healthcare. Other methods to improve quality will include education and training of staff during the implementation of new changes across all departments.

The second aspect that will be considered during the improvement of the care delivery system is cost. The implementation of changes like improving staffing and the use of discharge planning will have a huge impact on healthcare costs. Patients will be able to receive help as soon as they need it using the staffing approach and this will help in reducing hospital stay time. The other method that addresses the issue of cost is the timely provision of feedback from the payers to help design new strategies to cut healthcare expenditure.

The third topic in improving the care delivery system is access that entails the ability to receive health care when needed. Using the evidence-based practice approach, I will ensure that adequate staff is available to respond to the patient’s needs as soon as they are needed. Another strategy is the timely provision of written materials to educate patients on their care. These strategies will ensure improvement of HCAHPS scores on the response of staff and care transition upon leaving the hospital.

The last topic in improving the facility’s care delivery system is patient-centered care that entails the incorporation of patient’s preferences in health care delivery. The first method will entail involving the patients and families in coming up with solutions to address the identified low HCAHPS scoring areas. For example, the patients will propose the perceived changes that can help reduce noise at night. Another strategy is to provide timely feedback using an array of communication channels including hospital notice boards and organizational websites.

D7. Improve Financial Stability

Financial stability in healthcare is determined by the quality of services provided and good governance by the managers. The first method to improve financial stability is the use of evidence-based practices to improve identified HCAHPS score areas. Improvement of these scores will lead to more reimbursements from the Medicare and Medicaid Services. The second method will include involving patients and healthcare providers in decision making. The engagement of staff and patients will have positive impacts on patient-centered care and will lead to motivated staff that will be more productive. Research establishes that about 25% to 30% of operational efficiency can be lost if hospital staff are unhappy (Bridges et al., 2019). Additional strategies to improve financial stability will include education, training, and monthly audits to align expenditure with the income generated.

E1. Stakeholder Roles and Responsibilities

Stakeholders	Roles and Responsibilities
Hospital Administration	·         Review low-scoring HCAHPS areas to determine need for change. ·         Accept the proposed changes and allocate finance to manage the change. ·         Communicate changes to staff and coordinate implementation of the new changes. ·         Provide feedback to project managers and staff.
Clinical Nurse Educator	·         Guide the managers and project implementation team in addressing the low HCAHPS score areas. ·         Conduct literature review and recommend best EBPs to solve identified problems. ·         Organize education and training for staff during change implementation.
IT Department	·         Look for a technology to replace overhead paging system. ·         Install the mobile phone technology and ascertain workability of the new plan. ·         Educate and train staff on the use of the new technology. ·         Provide feedback to project managers and the administration.
Nursing team	l  Attend education and training sessions during implementation of the new changes. l  Educate patients/families the importance of the new changes and their role in improving the low-scoring areas. l  Implement identified strategies to improve responsiveness to patient needs, reduce noise at night, and improve care transition. l  Provide feedback to the project managers and the administration.

E2. Stakeholder Accountability and Involvement

The first method of ensuring stakeholder accountability is through the maintenance of transparency. Each stakeholder will be informed on their roles during change implementation and given a timeline to achieve desired outcomes. For example, the administration will ensure staff is hired to address the issue of responsiveness t patient needs. The second method will involve setting goals for each stakeholder and evaluation of the goals to ascertain alignment with the set timeline. For example, the clinical nurse educator’s goal will be to identify the most appropriate strategy to solve the low-performing HCAHPS score areas and to educate staff. Another method to ensure stakeholder accountability will involve periodic evaluation of goals and patient outcomes upon implementation of the new strategies. Each stakeholder will be involved in explaining aspects that will not improve in relation to their roles and responsibilities. Lastly, the use of deadlines for implementation of change and disciplinary action will ensure all stakeholders are involved in quality improvement.

E3. Training

The first implementation change will involve improving staffing levels to solve the issue of staff responsiveness to patient needs. During the implementation of this strategy, staff will be trained on responding to alarm systems that prompt providers the need to check on the patients. Additionally, training on hourly rounding will help to improve staff responsiveness to the patient’s needs. The second implementation change will involve implementation of the mobile phone technology to help reduce noise at night. The healthcare team, especially the nurses will be trained on how to use the new system and turning off the overhead paging system until the quiet hours are over. The third approach that will require training of employees is the use of written health information to improve the patient’s understanding of their care. Training on printing of the material, the use of EHRs to communicate data, and interpretation of the information to patients will be required especially for the new staff.

E4. Plan Implementation

HCAHPS Question	Months 0-4	Months 5-8	Months 9-12
Low score- Patients who reported that they ‘Always’ received help as soon as they wanted	l  Consult with the administration to identify low scoring areas. l  Conduct literature review to identify most appropriate EBP for change management. l  Decide the organizational change strategy to use.	l Communicate to staff about the new strategy through meetings. l Collaborate with the HR department to advertise new positions for employees. l Adjust the financial expenditure to meet the demands of the new staffing levels.	l  Hire new employees. l  Train employees on responding to patient needs. l  Monitor the progress of the new strategy. l  Evaluate results and make necessary changes to the initial plan.
Low score- Patients who reported that the area around their room was ‘Always’ quiet at night	l  Review HCAHPS scores on the identified area of weakness. l  Conduct a literature review to identify EBPs. l  Decide the strategy to be used improving quietness at night. l  Allocate funds for purchasing the new technology.	l  Conduct meetings to inform staff about the new change. l  Work with the IT department to purchase and install the new technology. l  Provide education and training of staff about the new technology use.	l  Evaluate the outcome of training. l  Implement the mobile phone technology and monitor progress. l  Evaluate results and provide feedback to staff.
Low score- Patients who “Strongly Agree” they understood their care when they left the hospital	l  Review current HCAHPS scores and start discussing required changes. l  Literature review for strategies to promote care transition. l  Convene shared governance meeting and decide strategy to use.	l  Communicate the new strategy to staff and patients. l  Allocate resources to facilitate availability of written material to patients. l  Involve patients and families in discussions during bedside reports and routine rounding.	l  Training of staff about the new strategy. l  Monitoring of progress and provision of feedback.

1. Evaluate the Strategic Plan’s Success

The success of the strategic plan will be evaluated at the end of the year using the HCAHPS surveys. Periodic evaluation will be done during the second quarter after training of staff to ensure their readiness for implementation of the new changes. For example, evaluation of hiring of new staff will be done to ensure the area of staff responsiveness is addressed. To analyze the success of the plan, attendance sheets for education and training will be used to ascertain employee involvement. Secondly, the HCAHPS scores will be compared with the previous scores to determine improvement in the three areas.

F1. Involvement of Stakeholders

The first strategy to involve stakeholders in the evaluation process will involve the provision of feedback about the plan’s success. The nurses, It team, administrators, and the nurse educator will provide feedback on how the implemented changes addressed the low-scoring areas. Secondly, the delegation method will be used to ensure unit champions collect data from staff to evaluate the effectiveness of the new changes. Participation of the stakeholders in meetings and benchmarks will give them an opportunity to discuss the new HCAHPS scores that will determine the success of the strategic plan.

F2. Communication of Results

The evaluation results will be communicated internally and externally using different strategies. Internal communication will be done using staff meetings, internal memos, emails, and using the hospital newspaper. External communication of the results will be done using the hospital compare website that will post the new HCAHPS scores. Additionally, media platforms like Facebook and LinkedIn will be used to communicate the success of the new changes in the organization.

References

Bridges, J., Griffiths, P., Oliver, E., & Pickering, R. M. (2019). Hospital nurse staffing and staff–patient interactions: An observational study. BMJ Quality & Safety, 28(9), 706-713. http://dx.doi.org/10.1136/bmjqs-2018-008948

DATA USA. (n.d.). Olympia, WA: Census place. https://datausa.io/profile/geo/olympia-wa

Flink, M., & Ekstedt, M. (2017). Planning for the discharge, not for patient self-management at home – An observational and interview study of hospital discharge. International Journal of Integrated Care, 17(6), 1. https://doi.org/10.5334/ijic.3003

Hughes Driscoll, C. A., Cleveland, M., Gurmu, S., Crimmins, S., & El-Metwally, D. (2020). Replacing overhead paging with smartphones to reduce hospital noise. Biomedical Instrumentation & Technology, 54(4), 251-257. https://doi.org/10.2345/0899-8205-54.4.251

Providence. (n.d.). St. Peter Hospital: Services. https://www.providence.org/locations/wa/st-peter-hospital/departments

U.S. Centers for Medicare and Medicaid Services. (n.d.-a). Providence St Peter Hospital: Patient survey rating. Medicare.gov. https://www.medicare.gov/care-compare/details/hospital/500024?id=b9b0d859-9eda-4b8f-bf44-5f7bb98aee5f&city=Olympia&state=WA

U.S. Centers for Medicare and Medicaid Services. (n.d.-b). Hospitals: Overview. Medicare.gov. https://www.medicare.gov/care-compare/compare?providerType=Hospital&providerIds=500024,500002,501309&state=WA