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Appraise economical aspects that influence healthcare delivery systems.
Scenario Your hospital received $4,000,000 in revenue this past year. Medicare withholds 2.6% of this amount ($) until the value-based purchasing scores are in. If the scores are good this year, the hospital will earn back this money. If scores are below the national average, the hospital can lose this money. Twenty-five percent (25%) of this score is based upon the Community Engagement patient satisfaction score (HCAHPS). Last year’s patient satisfaction scores (HCAHPS) in the following areas were below the national average, which cost your hospital $398,000 in revenue. The hospital director of Quality Improvement has asked you to participate in developing a nursing action plan for your facility.
Prepare a nursing action plan in poster format for improving one of the following key areas that: • Selects one key area of focus: • Communication with nurses • Communication with physicians • Responsiveness of hospital staff • Communication about medications • Cleanliness and quietness • Discharge information • Care transition • Examines nursing actions to achieve optimal scores to contribute to the hospital’s financial success. • Provides a list of recommended nursing actions to improve the selected key area. • Appraises references/resources for best practices to increase score and enhance reimbursement. • Communicates the rationale for the nursing actions listed in the action plan. • Provides stated ideas with professional language and attribution for credible sources with correct APA citation, spelling, and grammar in the action plan poster.
Sample Answer
Value-Based Purchasing (VBP) ACTION PLAN:
Elevating Patient Experience through Rapid Staff Responsiveness
Focus Area: Responsiveness of Hospital Staff
1. The Financial Imperative: Connecting Quality to Capital
The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey results constitute a significant portion (25%) of the Total Performance Score (TPS) used in the Medicare Value-Based Purchasing (VBP) Program (CMS, n.d.).
The HCAHPS Responsiveness of Hospital Staff domain directly measures two critical safety and satisfaction indicators:
How often you got help as soon as you wanted when you pressed the call light.
How often you got assistance getting to the bathroom.
Prompt responsiveness reduces patient anxiety, prevents safety events (e.g., falls when trying to ambulate unassisted), and increases patient trust and willingness to recommend the hospital (Always Culture, 2024).
2. Evidence-Based Nursing Action Plan: The R³ Bundle
The following bundle of three interdisciplinary interventions is proven to improve patient perception of staff responsiveness by managing expectations and ensuring proactive, timely intervention.
Recommended Nursing Action
Rationale and Impact on Score
A1. Implement Structured, Proactive Hourly Rounding (The 4 P’s)
Rationale: Prevents the need for call lights by anticipating patient needs before they are expressed. This shifts care from reactive to proactive, improving patient perception of staff attentiveness (Wolters Kluwer, n.d.).
Protocol: Every RN/CNA performs intentional rounding hourly, addressing the "4 P's": Pain, Position (comfort), Potty (toileting needs), and Proximity (call light, water, phone within reach).
A2. Establish and Enforce a "No-Pass Zone" Policy
Rationale: Improves call light response time by mandating that every staff member (clinical and non-clinical) who passes an illuminated call light must acknowledge the patient, manage the immediate non-clinical need (if applicable), or immediately summon the appropriate help (Always Culture, 2024).
Protocol: All staff are trained that there are "No Pass Zones" on the unit. Non-clinical staff utilize a defined script (e.g., "I see your light is on, let me immediately notify your nurse/CNA to ensure you get help right away").