Megan Brooks

April 30, 2013

WASHINGTON, DC — An intervention designed to improve communication and the responsiveness of hospital staff to patient requests has proven successful.

The secretaries on the inpatient units played a key role in developing and carrying out the intervention, Lauren McCaulley, BSN, RN, OCN, assistant nurse manager for the women's surgical oncology unit at the University Hospitals Seidman Cancer Center in Cleveland, Ohio, told Medscape Medical News. It was basically a workflow change, with secretaries really "holding staff accountable," McCaulley explained.

Lauren McCaulley

She reported the results of the pilot project here at the Oncology Nursing Society 38th Annual Congress.

Prior to the interventions, she explained, the center's Hospital Consumer Assessment of Healthcare Providers and Systems scores for responsiveness of hospital staff were below the institutional benchmark of the 55th percentile.

We had been focusing on nursing and support staff to try to boost scores, "and that wasn't working," McCaulley acknowledged. "We decided to move the focus to the secretaries.... We got their input and buy-in, instead of having management tell them they had to do something new or different. The secretaries were the ones who really defined this role and how they wanted to implement this project," she explained.

The intervention had several components. A new call-light response protocol was instituted, which included a callback by the secretary to ensure that the patient's issues had been addressed. Secretaries tracked patient requests on a log, categorized by type of call and shift. Monthly staff-education interventions focused on themes identified in weekly data collection to improve response time.

The role of the secretary was expanded to include introduction to newly admitted patients, informing patients and families of healthcare team roles, and commitment to call-light responsiveness. A division-specific bookmark and journal were provided to patients to reinforce the roles of team members.

Over the span of 4 months, the leadership team developed, implemented, and evaluated the effects of the intervention.

McCaulley reported that the effort has led to a "steady increase" in responsiveness of hospital staff scores. At baseline, in July 2012, scores were in 10th percentile. Four months after the implementation of the pilot project, they had increased to the 21st percentile, and they continued to climb to the 27th percentile by the end of the year. "We have continued to improve our scores and are currently at the 57th percentile," McCaulley reported.

Overall, scores improved in 7 of 8 categories, including overall satisfaction, relationship with nurses, and pain management.

"Because of the success of the pilot project in our division, this process was implemented in all inpatient divisions," McCaulley said, although there were a few bumps in the road.

To sustain the project, "constant reinforcement" is required, McCaulley said. Pairing a "management champion" with a secretary to reinforce the initiative with staff and provide positive reinforcement is critical. Having a "secretary champion" from each division who is engaged in the project is also important, as is getting staff on board to ensure that the interventions are sustained, she said.

"Timely responses are scored on patient-satisfaction surveys, so we take them all pretty seriously for various concerns, especially surrounding trust. This poster demonstrated that they were able to raise their scores, Linda Person, MSN, RN, AOCN, oncology clinical nurse specialist at the Keck Medical Center, University of Southern California in Los Angeles, who was not involved in the research, told Medscape Medical News.

This research received no funding. The authors have disclosed no relevant financial relationships.

Oncology Nursing Society (ONS) 38th Annual Congress: Poster 132640. Presented April 26, 2013.