Barnes Jewish Hospital is a successful healthcare establishment with standards of high quality. The benchmark evaluation has identified that only three metrics in the hospital require serious attention – patient satisfaction, readmission rates, and standardized infection ratio. The three metrics require improvement as the Affordable Care Act (ACA) has set a goal on “expanding coverage versus reducing costs; targeting tax credits effectively versus incentivizing work” (“The future of U.S. healthcare”, n.d., para 43).
Thus, Barnes Jewish Hospital has to change its performance to be able to correspond with those goals. The policy proposal offers an improvement of team communication and interpersonal skills of the staff. Additionally, it provides a method for improving the standard infection ratio. The purpose of this paper is to highlight the importance of enhancing the benchmarks and to provide a policy that can be implemented by the hospital to perform the improvement.
How to Implement Changes
It is essential that the stakeholders who are part of the hospital are involved in further development of the policy. Institute for Healthcare Improvement recommends the Plan-Do-Study-Act (PDSA) model as it enchases the outcomes of policy alterations (“How to improve”, n.d.). The proposed guideline should help the stakeholders understand the importance of the needed change as it includes the underperformance score and justification for improvement. Additionally, the recommendations are based on scholarly literature, they are credible and are a valid option for the hospital. Thus, the policy proposal is developed following the PDSA method which should convince the stakeholders to follow the plan.
Considering the importance of the benchmarks, the stakeholder that needs to be involved is the medical staff. It is crucial to engage them in the process as they are the determining factors that influence the evaluation scores. The doctors, nurses, and other employees are in contact with the patients, which affects the patient satisfaction scores. How the personnel performs their duties influences the readmission rates and standardized infection ratio. The proposed change implementation is realistic for Barnes Jewish as other benchmark scores indicate the high professionalism and passion for work that the medical staff has (“Patients safety & quality annual report”, n.d.). Engaging them in the process of policy implementation is essential, as it should ensure the successful outcomes.
Patient satisfaction ratio is among the most important benchmarks for a hospital. Currently, the score is 72,4 %, and recommended target for improvement is 77% (“Patients safety & quality annual report”, n.d.). Thus, the numeric score of underperformance in this metric is 4,6%. The underperformance of this benchmark is affecting the quality of the provided care as the metric is a direct representation of how patients perceive the hospital’s operations.
Al-Abri and Al-Balushi (2014) describe the metric as “meaningful and essential sources of information for identifying gaps and developing an effective action plan for quality improvement in healthcare organizations” (p. 3). Patient’s view of the hospital is essential and can be improved in various ways. The repercussion of not implementing changes in this metric can result in fewer patients who chose Barnes Jewish, as well as possible lowering of standards of work.
Interpersonal communication of staff members particularly that of nurses can influence the levels of patient satisfaction. According to Al-Abri and Al-Balushi (2014), “health status of patients is an important predictor of a patient’s overall satisfaction” (p. 4).
Although the factor is important, it can not be altered as the patients are admitted with certain health status. However, among the other factors, there are “careful listening and easy access to care” in regards to nursing care (Al-Abri & Al-Balushi, 2014, p.4). Additionally, respect and courtesy are essential determinants of the satisfaction levels. Most of the indicators were researched in a setting of nurses communicating with patients. Therefore, improving the interpersonal skills of the nursing staff is critical to ensure that the benchmark is met.
Readmission rates affect the financial state of the hospital and can be improved by better communication between teams. The current underperformance in this metric is 1,96% (9,36% of readmissions in 2016 with a target of 7,4%) (“Patients safety & quality annual report”, n.d.). The low score is affecting the patients as it indicates that they have to be admitted after they were discharged, meaning that their health state does not improve.
Thus, the metric is an indicator of the quality of care provided in the hospital, and it is essential to improve it. The repercussions of not implementing change are financial losses, as according to LaPointe (2018) the metric directly influences the financial spending of a hospital. Therefore, the metric can be an indicator of the better quality of care and is associated with financial savings.
Communication between different teams in the hospital is an essential aspect of improving the benchmark. Nguyen et al. (2018) found that “improved communication between the emergency department and inpatient cardiology services” is improving the readmission rates for patients with chest pains (p. 97). The study indicated that most readmissions were associated with complication after previous admissions. Therefore, improving communication between the emergency team and other medical staff can help Barnes Jewish reduce readmission rates.
Standardized Infection Ratio
Standardized infection ratio is a benchmark that evaluates the incidents of infection occurring in a particular setting. Barnes Jewish Hospital underperforms in this metric by 0,32 (current parameter is 1,14, and the target for improvement is 0,82) (“Patients safety & quality annual report”, n.d.). The benchmark underperformance of this metric is affecting the quality of care that the hospital provides as it indicates the safety of patients and staff in the facility.
The nationally standardized infection ratio for central line-associated bloodstream infections in 2015 was 0,6 (“National 2015 standardized infection ratios”, 2015). If the hospital does not improve the score, the number of people infected can increase. Furthermore, according to the Center for Disease Control and Prevention (2015), in cases when the score for the incidents is more than one, the number of infections observed has been larger than predicted. Therefore, the data indicates that Barnes Jewish has to implement changes in its operation to improve standardized infection ratio and ensure the safety of both patients and medical staff.
Reevaluating the various metrics that standardized infection ratio consists of can help develop a plan for improvement. Kralovic, Evans, Simbartl, and Roselle, (2015) state that “the model demonstrates the importance of accounting for variables which can influence rates and can help to determine additional strategies” (p. 1). Therefore, researching the variables can help improve the benchmark evaluation. Based on the research the medical staff can offer a solution for how to reduce the number of infections.
Environmental Factors and Conclusions
The proposed changes are developed under the Affordable Care act as they help the Barnes Jewish Hospital become a better place for patients, by improving quality and reducing costs. In light of the environmental factors, the described policies are realistic. The organizational resource that can influence the policy implementation is staffing. The recommendations consist of improving internal and interpersonal communication between the members of the hospital and with patients. The standardized infection ratio metric requires additional research from the medical staff. Thus, financial resources should be considered as the implementation may require specific courses on communication skills for employees. However, the improvements in the benchmark scores should be significant.
Al-Abri, R., & Al-Balushi, A. (2014). Patient satisfaction survey as a tool towards quality improvement. Oman Medical Journal, 29(1), 3-7. Web.
How to improve. (n.d.). Web.
Kralovic, S., Evans, M., Simbartl, L., Roselle, G. (2015). Use of a standardized infection ratio (SIR) model to monitor a nationwide healthcare-associated Clostridium difficile: Prevention initiative within the US Department of Veterans Affairs (VA) healthcare system. Open Forum Infectious Diseases, 2(1), 1. Web.
LaPointe, J. (2018). 3 strategies to reduce hospital readmission rates, costs. Web.
Nguyen, J. T., Vakil, K., Adabag, S., Westanmo, A., Madlon-Kay, R., Ishani, A., … McFalls, E. O. (2018). Hospital readmission rates following AMI: Potential interventions to improve efficiency. Southern Medical Journal, 111(2), 93-97. Web.
Patients safety & quality annual report. (n.d.). Web.