Nursing communication challenges are an under-appreciated, often overlooked contributor to higher cost, lower quality care and patient dissatisfaction. With ever-increasing demands for improved quality and efficiency in hospitals, improving communications should be an executive-level imperative.
The digital world opens new doors to diagnose and address the causes of poor communication in hospitals—and, in the process, damage the hospital bottom line. A recent study by Accenture provides insights to common and frequent communication challenges that can hinder hospital performance.
The cost of communication breakdowns
Communication challenges have always carried a cost in terms of lost productivity, insufficient time with patients and longer lengths of stay. U.S. hospitals “waste” approximately $12 billion annually due to poor communication among care providers. The loss, as percentage of hospital revenues, is about 2 percent. A typical 500-bed, acute-care hospital could experience an annual economic burden of about $4 million due to wasted physician and nurse communication time and potentially increase in length of stay.1
New reimbursement models also tie nursing communication to the bottom line as new measures factor in patient satisfaction. For example, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey for discharged patients includes questions related to communication with doctors, communication with nurses and responsiveness of hospital staff. Hospitals risk losing 1 percent of their Medicare reimbursement this year if they don't meet expected patient satisfaction levels. That will jump to 2 percent by fiscal 2017.
The bottom-line impact is enough to move this issue to the front burner of hospital C-suite imperatives, yet communication challenges continue to be an untapped area of opportunity.
1 Agarwal, R., Sands, D.Z., and Diaz-Schneider, J., "Quantifying the Economic Impact of Communication Inefficiencies in US Hospitals," CHIDS Research Briefing (3:1B) Center for Health Information and Decision Systems, Robert H. Smith School of Business, University of Maryland, Winter 2008, pp 1-4.
Accenture conducted an observational study that examines nursing communications challenges within acute care hospitals across multiple departments and multiple shifts. The observation and analysis revealed four primary impact areas: interruptions, patient transitions between units, communication between nursing staff and patient/family, and communication between nurses and physicians.
Accenture set out to observe and measure communication inefficiencies to identify tangible ways where improvements could result in time and economic savings, better patient care and safety.
Accenture researchers found that while the challenges are immense, it is possible to address the nursing communication issue and aim to alleviate its potentially detrimental impact on finances, patient satisfaction and quality. As part of its research, Accenture identified actionable ways in which the C-suite (chief nursing officer, chief information officer and chief executive officer) can lead the way along the journey to improvement.
For real change to happen, hospital leadership must work together to champion and advocate for improved nursing communication. Each member of the C-suite must think outside of traditional silos and pursue a holistic strategy that addresses people, process and technology.
Accenture’s study revealed common communication challenges. For executives, these ubiquitous examples are the starting point for process and culture transformation enabled with technologies. There is no magic pill to provide a cure for hospitals struggling with communication challenges. However, the right mix of technologies and process change can help nurses to communicate more efficiently and effectively, allowing them more time to focus on providing outstanding patient care.
Solutions to communications challenges include:
Unified communications. Unified communications can help by establishing controls for both the sender and receiver. People using a variety of network-enabled devices and media can more easily interact and collaborate. Unified communications technologies help people find those they need to interact with, know if others are available and through which medium, and provide choices for information sharing and interactions. For example, a message
can be available through both voice mail and email with unified messaging.
Location/presence technologies. Presence technologies will indicate the nurse’s physical location and his or her “status” (whether they are with a patient or available, for example). The system can alert the sending nurse when the other nurse is free. Therefore the calling nurse is able to move on to other tasks, confident that communication would follow at the earliest opportunity.
Mobile orchestration platforms. Mobile orchestration helps nurses to enter information in real time at the bedside, speeding the process for some interactions that require a doctor. For example, if a nurse needs an order from a physician, the platform will send a text to the attending physician’s computerized order entry system so he or she can submit the order.