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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
An Evidence-Based Nursing Action Plan to improve the HCAHPS Responsiveness of Hospital Staff domain should include a third critical, interdisciplinary intervention focused on managing patient expectations and promoting team accountability.
💡 Recommended Nursing Action: Implement Interdisciplinary Staff Huddles and Real-Time Communication 🗣️
Recommended Nursing Action
Rationale and Impact on Score
Protocol
A3. Establish Real-Time Accountability and Communication (The R³ Bundle - Rounding, Reporting, Responsibility)
Rationale: Closes the loop between a patient's need, the staff member who addresses it, and the care team. This addresses the "perception" gap by ensuring staff know the unit's current responsiveness performance and are motivated to collectively improve. It also highlights toileting needs as a safety priority for all staff.
Daily/Shift Huddle Protocol: The Nursing and CNA lead begins each shift huddle with a brief review of the unit’s previous day's call light response time and fall rate. They reiterate the A1 (Hourly Rounding) and A2 (No-Pass Zone) protocols, specifically emphasizing the toileting needs (Potty) component as a fall prevention strategy. Real-Time Protocol: Utilize a centralized communication system (e.g., smart phones/voicera) to immediately send call light alerts to the closest available staff member, ensuring a response within a target time (e.g., 90 seconds), and track response times as a quality metric.
Summary of the R³ Bundle for Responsiveness
This complete R³ Bundle of interventions is designed to directly target the HCAHPS staff responsiveness questions ("How often you got help as soon as you wanted when you pressed the call light" and "How often you got assistance getting to the bathroom").
Action
Primary Focus
Mechanism
Impact on HCAHPS
A1. Structured Hourly Rounding (The 4 P's)
Proactive care and Fall Prevention (Potty)
Anticipates needs to prevent call light use.
Improves perception of getting assistance as soon as wanted by reducing the need to call.
A2. "No-Pass Zone" Policy
Timely Response and Interdisciplinary Accountability
Mandates any staff member to stop and help or immediately seek help.
Dramatically improves call light response time and patient trust.
A3. Real-Time Accountability & Communication
Expectation Management and Performance Improvement
Ensures all staff are aware of performance and prioritizes toileting safety in huddles.
Reinforces proactive, quick response behaviors, especially for toileting/bedpan needs.
This multi-faceted approach shifts the culture from reactive care (waiting for the call light) to proactive, interdisciplinary responsibility, which is key to sustaining high HCAHPS Responsiveness scores.