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Patient Experience Case Study - Beaumont Health
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Compassionate Caring Connections

What was the opportunity, issue or challenge you were trying to address and in what setting?

Beaumont Health HCAHPS patient satisfaction survey feedback for the inpatient settings identified low scores in the domains of Communication with Doctors and Nurses. Establishing compassionate connections with patients can improve outcomes and form trusting relationships which support patients feeling safe during their hospitalization.

Compassionate connections are a way to make a connection with a patient by sitting at the beside, being fully present and listening with compassion to learn more about the “person behind the patient”. During this encounter, which takes approximately one minute, the staff asks the patient “what are things they like to do if they were not in the hospital”. This begins to establish a trusting relationship, while helping the patient feel safer as we get to know the patient on a more personal level.

Patients want to feel valued and be an equal member of the team. Ways this can be accomplished are by interacting more effectively with patients to establish caring, empathetic, patient-centered relationships as the basis for care. Communication is quite evident and can happen effectively by listening carefully to the patient, treating patients with respect and courtesy, and explaining information in a way that is understandable.

What process did you use to develop a solution?

Beaumont Health conducted a test of change for communication with 9 units in the second quarter of 2017. Training of all staff occurred in Q1 2017. The focus was to create a compassionate connection with each patient. Forming relationships can often times be made in one minute or less by getting to know the person behind the patient. One way to engage staff was to sit with their patients during each shift in order to discover a “fun fact” about the patient and note it on the white board. Other staff entering the room could converse about this fun fact, further exhibiting compassion and interest in the person and enhancing the patient’s feeling of a trusting and safe work place. Outcomes measured were the Overall Rating, and Nurse and Doctor Communication composites on the Press Ganey survey.

Process: Getting to know the person behind the patient

1. Sit down with the patient

2. Ask the patient’s name and what they liked to be called

3. Ask an open-ended question like: “When you are not in the hospital, what do you like to do?” This should take less than one minute

4. Document what the patient shares in the EMR or on the white board –with patient permission (e.g. When I go home I will continue to prepare for a marathon I am running)

5. Refer back to this item and continue to develop this topic with each encounter

6. Daily:

  • Huddle debrief at end of each shift on what went well, did not go well, refinements
  • Leader Rounding: Use Point of Care (POC) survey tool to assess effectiveness of pilot connections; follow up on issues as soon as possible and provide patient with resolution

7. Monthly: Assess effectiveness overall by reviewing patient satisfaction scores each month and note trending

We based the design of the work on literature and once the pilot began, we enlisted feedback from our patients and families about this specific encounter. Feedback from our patients and families was very positive as they felt we got to know who they are and not just a clinical diagnosis. Since we wrote the patients “fun fact” (what they like to do when not in the hospital) on the white board, families enjoyed seeing what their loved one shared. Fun facts, such as liking a particular baseball team, being a WWII veteran, or having 8 children all connected this patient to a personal fact about themselves.

What outcomes were you looking to achieve?

Measures of success:

1. HCAHPS scores (baseline and monthly follow up) using the Press Ganey Calculator data as a gauge which is to increase from baseline by 2 percentile ranks in:

  • Communication with Nurses
  • Communication with Doctors
  • Overall

2. Assess effectiveness using the Point of Care Survey (POC) to ascertain daily the following answers:

  • Did you feel staff was actively listening to you?
  • Did a nurse ask you about any personal or special needs?
  • Did you feel the physician took the time to properly explain?

3. Sustainability- hardwired to become part of unit culture

What specific steps did you take to address the problem?

Q1 2017:

  • Created a 30-minute training curriculum and commitment pledge for the pilot units to use
  • Conducted train the trainer sessions which then fanned out to the training for all staff who have direct encounters with each patient on the 9 pilot units (e.g. nursing, physicians, environmental services, dietary support, rehab staff, pharmacy, etc.) At the conclusion of each training session, employees signed a commitment pledge acknowledging their support to this project work 
  • Established baseline data analytics and targets for the test of change project
  • Confirmed the Point of Care (POC) survey tool and questions to be used during daily leader rounding. The 9 units used iPads for tracking patient feedback responses electronically

Q2 2017:

  • Roll out of the compassion connection conversations on all 9 units
  • Monthly: monitored HCAHPS data and POC rounding feedback, and held meetings with the key stakeholders to understand concerns, barriers, accomplishments
  • 60-day unit visits:
    Objectives for the unit visits- 1. Observe and obtain direct feedback from pilot staff on what is working or not working; 2. Communicate to pilot staff Beaumont Health’s appreciation for their commitment to the pilot and improving the patient experience; 3. Obtain direct feedback from pilot unit managers on managing change processes; 4. Debrief with pilot site administrators on site visit discoveries.

Q3 2017: 

  • Continued to review HCAHPS scores analysis-provided updates to pilot units each month

What resources, if any, did you engage – either internally or externally – to address the problem?

  • Utilized the Press Ganey calculator to establish target score projections for the 3 months of pilot work. The calculator evaluates each service based on their starting percentile rank compared to the All Press Ganey Database. These numbers represent the levels of change (year over year) achieved by other facilities in the database that were within the same starting percentile rank range.
  • Applied the Press Ganey Point of Care survey tool using an iPad during leader rounding to track and trend feedback. Line charts noted in real time how well the compassionate connections were impacting the patients’ answers to the following questions:
    • Did you feel staff was actively listening to you?
    • Did a nurse ask you about any personal or special needs?
    • Did you feel the physician took the time to properly explain?

What measures did you establish to determine the success of this effort?

HCAHPS scores (baseline and monthly follow up) using the Press Ganey Calculator data as a gauge with a goal to increase by 2 percentile ranks in the following domains:

  • Communication with Nurses
  • Communication with Doctors
  • Overall

Baseline line period for scores were based on 1st Quarter 2017 by date of service by unit. Data was reported April 25 for baseline period.

Check period for scores based on 2nd Quarter of 2017 by date of service by unit. Data was reported July 25 for results period.

Data to be extracted from All Press Ganey Database 25 days post close of quarter to allow for responses to waive 1 and waive 2 of sampling by date of service.

Scores to be monitored were Overall Rating 9-10’s, Communication with Nurses Domain and Communication with Doctors domain.

Recommended score improvement during time period for Test of Change will be 2 Percentile Ranks in All Press Ganey database for all domains.

Controls charts were shared each month with the 9 units during the pilot as well as in quarters 3 and 4 for sustainment. Additionally, bar graphs also displayed progress. The example bar graph below displays one domain, Communication with Nurses, after one quarter of implementation against the baseline.

What was the ultimate outcome of your effort?

Three months after the pilot concluded, patient satisfaction scores demonstrated the following:

  • Communication with Nurses: three of the units noted positive special cause Oct 2017 as percentile rank was statistically significantly high (above upper control limit)
  • Communication with Doctors: two of the units noted positive special cause Jul 2017 and Oct 2017 also positive special cause as percentile rank was statistically significantly high (above upper control limit).
  • Rate Hospital Overall: one unit noted positive special cause in Jan 2017 and was maintained through Jun 2017 due to a string a successive month with percentile rank score greater than 1 sigma

We came to discover that communication with nurses and doctors improved, as evidence by the HCAHPS scores.  Units that were not fully engaged in the process did not have as significant of an improvement in scores.  As other staff members (e.g. Environmental Services, Dietary Aid, etc.) would enter the room they would also comment on the fun fact.  This supported more conversation with the patient about their likes, hobbies and interests.   

What lessons did you learn you would share with others as they consider addressing a similar issue?

The Test of Change for Communication afforded us many helpful insights and learnings. First, on the topic of training, it is most important to train the entire team including physicians. Physician training was inconsistent thus the outcomes measures varied because of that. Noting one “fun fact” on the white board became a repetitive topic over time thus the need to acquire a few fun facts proved to be more beneficial in having diverse conversations with the patient. Two units did not note the fun facts on the white board and instead noted them on the paper hand off sheet. Conversations were not as consistent with each patient and their outcome measures did not change over time.

Staff shared some discoveries as well. Barriers to success were routine interruptions, time constraints, staffing, chatty patients and/or disengaged patients, and not having a chair to sit on. Staff were very satisfied with management being very supportive and encouraging of this work. They also felt this promoted teamwork and patient engagement. An interesting observation they noted was that patients conveyed an increase in trust when a personal connection was made.

Innovations that surfaced while the project work was underway were in creating a special location on the white board with the term Fun Fact so staff, patients and their families could see this.

A specific pilot unit decided to focus on the discoveries they learned from their patients.  The staff created the “56 Second” board located in the center of the Nurses Station. Each week staff wrote various fun facts about their patients on a sticky note and placed them on the board.  These comments were shared in the daily Huddles. 

At the start of a new week, the manager cleared the board and new sticky notes were added to keep the board fresh and interesting.  As other staff members (e.g. Residents, physicians, consultants, etc.) came to the unit, they read the notes, commented on the board, and learned about the pilot. This board kept the focus on the patient’s interests and created an enjoyable way to validate how we were getting to know each patient as a person. 

During leader rounding, one manager would sit with each patient to role model this communication style with the patients. Another manager shared stories in Huddles that staff emailed or verbalized to her identifying how much this inspired them as clinicians and provided a great sense of satisfaction in their work. The entire staff at one hospital wore a “commit to sit” button as a way to embrace this effort.

A comment patients shared is that staff talked about that certain hobby (e.g. enjoy golfing) each time they were in the room.  Based on that feedback, we changed the “fun fact” after 24 hours and/or wrote a list of several “fun facts” so staff could choose what to talk about.  In this way, we would not continuously address only one item.  One of the hospitals did an inventory of chairs and ordered enough chairs to assure each room had chairs to accommodate. 

As of 2018, the plan is to roll this out system wide for both the inpatient units and the emergency departments.  

About Beaumont Health

Beaumont Health is a not-for-profit organization formed in September 2014 by Beaumont Health System, Botsford Health Care, and Oakwood Healthcare to provide patients with extraordinary, compassionate care, no matter where they live in southeast Michigan.

The organization has total net revenue of $4.4 billion (2017) and consists of eight hospitals with combined total of 3,429 beds, 187 outpatient sites, nearly 5,000 physicians, 38,000 employees, and 3,500 volunteers.

2017 service statistics totaled 175,688 inpatient discharges, 574,591 emergency visits and 17,789 births. The 187 outpatient sites are comprised of emergency and urgent care centers, medical centers, laboratory centers, pharmacies, rehabilitation centers, imaging centers, senior living and nursing homes, wellness and fitness centers, and home care and hospice.

Beaumont Health is committed to education and has affiliations with over 160 schools, institutes and universities as well as 3 medical schools:

  • Oakland University William Beaumont School of Medicine
  • Michigan State University College of Osteopathic Medicine
  • Wayne State University School of Medicine

Beaumont Health has established patient and family-centered care (PFCC) as its care delivery model. According to the IPFCC, patient and family-centered care is an approach to planning, delivery, and evaluation of health care built on mutually beneficial partnerships among patients, families, and providers shaped by patient preference. PFCC is about working with patients and families as partners in care rather than doing to and for them. Beaumont Health encourages all staff to embrace PFCC by engaging patients and families which will improve outcomes, as well as creating improvements for patients and families, their teams, and colleagues across the system.

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