Give me an A-I-D-E-T! What's that spell? If all goes as planned, it will spell improved patient satisfaction at Torrance Memorial Medical Center.
AIDET, an acronym for Acknowledge, Introduce, Duration, Explain, Thank You, is a communication tool designed for improving staff/patient interaction. The concept was invented by Quint Studer, a former teacher who entered the health care industry as a community relations representative and eventually became president of Baptist Memorial Hospital. Under his leadership, the hospital's patient satisfaction rate grew from 40 to 99 percent, leading many hospitals to contact him to learn about his methods. He decided to teach his concepts for achieving, sustaining and accelerating exceptional outcomes to other health care organizations by launching the Studer Group in 2000.
Today more than 800 hospitals have implemented the Studer Group's best practices leading them to join the nation's top performing hospitals. The group's own data touts that partner organizations outperform peers by an average of 20 percentile points across HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) measures and outpace them in improvements nearly 40 percent faster than the rest of the nation.
The Patient Satisfaction Benchmark
Patient satisfaction has become an increasingly important benchmark for hospitals in recent years not only from a public perception standpoint, but also from an economic one, as Medicare reimbursements are based on HCAHPS scores under health care reform. The elusive, but ever-present challenge, according to Maricarmen Luhrsen, RN, MSN, director of Magnet/Patient Experience at Torrance Memorial, is not only raising scores, but in keeping them consistently high.
"It's important to keep the focus away from chasing numbers and instead create an environment where the outcomes become automatic," says Luhrsen. "How to accomplish that is the million dollar question. Juan Caluya, RN, MSN/ED, PCCN, of Progressive Care Unit 7 (PCU7), was already familiar with the concept of AIDET back in 2011 when his unit, the worst HCAHPS-scoring unit of all eight hospital units, began examining ways to improve the patient experience.
He suggested AIDET to PCU7 Nurse Manager Tom Fox, RN, MSN, believing it might be just the ticket to attaining better and more consistent outcomes. Intrigued by some of Caluya's ideas, in late 2011, Fox appointed Caluya, Reiko Ota, RN, BSN, PCCN, Rose Lee, RN, BSN, PCCN, Angie Malit, RN, BSN, PCCN, Marina Coelho, RN, BSN, PCCN, Suman Lata, RN, PCCN, and Dona Lovin, RN, PCCN, to serve on a Patient Experience Work Group and more closely study AIDET and other best practices for improving the patient experience and maintaining high scores.
After six weeks, the group narrowed its focus to adoption of two initial practices: training the unit to use AIDET, and integrating it into purposeful hourly patient rounding by nurses. Fox also took on the role of patient rounding—not a common practice among managers at the time. With budgets tight, Fox approved the unit's utilization of time allotted for two scheduled staff meetings in February 2012 for training sessions. The training included AIDET, plus an overview of the HCAHPS scoring process and its role in the new pay-for-performance structure mandated by health care reform.
"We decided to implement AIDET first because it's evidence-based and also so easy to follow," Caluya says. "The key words are so appealing to patients. It's about respect and courtesy. We get so busy, we forget respect. With AIDET, we communicate to our patients that 'we're here to provide you with excellent care.' This immediately reduces the anxiety level and sets expectations not only for the patient, but for ourselves to maintain. It instills accountability and hardwires our focus on service to patients, physicians and employees."
On March 1, 2012, PCU7 put these two new systems into practice. Slowly scores began to improve, and by the end of 2012, PCU7's HCAHPS scores had climbed 6 percentage points, making it the third-best performing unit hospital wide.
"You could tell there was something very different happening on the floor," Fox says. "It was very powerful and you knew it was working."
Caluya also began to notice a shift in staff morale and productivity.
"Call lights decreased. That means nurses are gaining time." Caluya says.
He continues, "Previously it was not in our culture to say, 'hi' or 'hello' to each other. It has really improved the relationships among our nursing staff. Now there are no more grumpy faces here."
Hospital Wide Integration
Luhrsen also took note of the unit's rising scores and asked Fox to reveal the secret sauce. After learning about the team's new methods, she asked Caluya to speak about AIDET at a Management Committee Meeting, where he enthusiastically greeted attendees as if they were patients using the AIDET communication tools. He roused the room to applause.
After evaluating the evidence supporting AIDET, Luhrsen and a steering group, which included Elaine McRae, director, Torrance Memorial University, as well as Andrew Nguyen and Jeremiah Hargrave, managers, Process Excellence, presented a business plan to the Operations Committee that recommended house-wide adoption.
With Operation's approval, AIDET training began in January 2013 for all staff who interact with patients and families, including physicians, bedside nurses, housekeeping, security and volunteers.
The steering group then selected an "AIDET All-Star Team," who would train teams of representatives from each hospital unit or department to teach AIDET to their respective units. Instructive kits that included progress evaluation tools were also created and provided to each department.
"The primary objective of trainers is to help staff keep the message consistent and make sure the key points are delivered to patients correctly," says Luhrsen.
According to Caluya, a key indicator of whether staff is using AIDET is the frequency at which patients are using their call lights—an increase indicates it may be falling by the wayside.
According to Luhrsen, an increase in positive patient feedback is a key sign AIDET is being used and that it's working.
"Recently a patient asked Tom Fox if the hospital was under new ownership," Luhrsen said. "He replied, 'It is under new ownership—staff ownership!'
Another key sign for Caluya is a December 2012 DAISY Award submission from a patient praising PCU7's nurse Alex Castillo, citing his use of key AIDET principles.
The Power of AIDET
According to Fox, the power of AIDET lies in its "back to basics" approach of taking care of the whole patient.
"We are not only taking into account the person's physical needs, but also his or her mental needs," Fox says. "When you enter the hospital, we take your clothes; you can't eat what you want to; you feel a tremendous loss of power. The least we can do is keep you informed and say 'thank you.' It's very simple."
While AIDET is just one piece of the puzzle in the goal of sustaining long-term HCAHPS success, Luhrsen and Fox are optimistic it will be a key ingredient toward building a culture of service excellence.
"It gives us the tools to communicate to our patients our excellence and instill confidence that Torrance Memorial is the only hospital where they would want to be," Luhrsen says.