The problem seemed simple enough to solve.
To improve the patient satisfaction scores that impact Medicare reimbursement, some hospitals decided they needed immediate feedback on patient complaints. Only then could physicians and nurses on the hospital floor address problems as soon as they arose.
Real-time monitoring of patient satisfaction would provide the crucial information needed to take action.
But as health systems like OSF HealthCare in Peoria, Ill., and Providence Health in the Pacific Northwest quickly discovered, sending administrators and nurse leaders into patient rooms to ask specific questions about their experiences created a frustrating chokepoint. Jotting down the responses with pen and paper, inputting the data manually into spreadsheets, and calling up other departments to fix patient problems simply added another layer of burdensome paperwork onto an already beleaguered staff.
That was the last thing they wanted. A study published by the Permanente Journal in 2008 found that nurses in medical-surgical units spent the majority of their working hours on documentation (35.3%) and care coordination (20.6%) rather than actual patient care (19.3%).
Seeing a major opportunity to give those systems a technology-driven solution, a number of medical technology companies and start-ups have begun developing software applications that seek to reduce the administrative burden by doing away with the middle man. Humm Systems, for instance, has created a real-time feedback system that allows patients to fill out a digital survey using a tablet given to them by a nurse during their hospital stay.
The application asks multiple-choice questions about room cleanliness, staff communication, and other aspects of their experience. Some health systems have put kiosks with Humm tablets in public areas such as the waiting room.
“People going room to room for rounding is a good personal touch but can be resource intensive,” said Dr. Marisha A. Burden, chief of hospital medicine at Denver Health. “I think the more people are getting familiar with smartphones and tablets, it becomes easier to have them just press a button on their own time.”
But others point out that hospital patients are generally an older population who may not feel comfortable with such technology. Also, having them fill out a digital survey in their room could lead to a sense of detachment for both staff and patients, as opposed to face-to-face rounding by trained medical personnel or administrators.
Three other companies—CipherHealth (Orchid) My Rounding Solutions (MyRounding), and the Advisory Board (iRound)—have created digital rounding software applications that combine the intimate human interaction of pen-and-paper rounding with the speed and automation of technology. These tools use a tablet, computer, or smartphone to assist hospital staff in collecting and analyzing survey data on patient satisfaction.
“Rounding is generally viewed as the clear place to start for measuring patient experience in real time because there is already a process in place,” said Timothy Schulte, director of provider solutions at Avia. “At this point, it’s really about how to collect the data in an efficient way.”
My Rounding Solutions, a Denver-based health technology company acquired by Huron Consulting Group earlier this year, creates and supports a digital rounding application for leadership, nursing, and staff. MyRounding allows for custom scripts or questionnaires and connects to a hospital’s information system to pull in patient data. It also aggregates data and produces reports across round types into one centralized dashboard.
Implementation of iRound, digital rounding software by the Advisory Board Co. of Washington, D.C., has boosted HCAHPS rankings of member organizations by as much as 80%. The application offers executives web-based access to organization-wide performance indicators and monitors unit-level metrics against actionable service goals.
Like MyRounding, CipherHealth’s Orchid digital rounding tool allows for custom questions to be inserted as a specialized script for each hospital or division. Those responses can then be analyzed for longitudinal trends.
Certain responses can result in an automated message sent to another department as an action item. For instance, if a nurse taps “yes” on a question about whether the room was dirty, the software will send an immediate request to the environmental services department.
“I think the key is not just in the rounding technology itself but really being able to identify service issues, track those, and ensure they get completed,” said Bates. “If I ask for real-time feedback but then don’t act on it, this can actually create a worse experience for the consumer.”
Such technology has the potential to make the lives of nurses and others doing patient rounding easier and the hospital stays of patients more comfortable. But without a proven track record, it’s difficult for hospital officials to know which of these startups and new technologies will work best.