Responsiveness in healthcare is a critical determinant of patient outcomes as well as the quality of care that patients receive. A responsive healthcare system can meet the legitimate needs of the patients and their families through interaction with the healthcare providers (Mitchell et al., 2014). Healthcare workers that are aware of the responsiveness time are better placed to provide services that protect against adverse events and also focus on improving patient satisfaction. In contrast, delays in responding to the needs of patients negatively impact staff scores leading to poor patient outcomes. Measuring responsive time is part of the process improvement in healthcare since it provides relevant data to drive positive change. Patient-centered care aims at improving responsiveness time by delivering care according to the patients’ clinical needs and their preferences. Current efforts to reduce responsiveness time in healthcare are partly effective in driving positive outcomes and patient satisfaction, although there is room for further improvement beyond the 90 percentile benchmark. This paper, therefore, explores the background of the responsiveness time problem in healthcare and suggests a change for the organization based on existing theory and leadership roles.
The Problem
Patient response time receives great attention in healthcare organizations due to its critical role in determining patient satisfaction and outcomes. As such, delays in responding to patient negatively impacts the quality of care delivery, often leading to low levels of patient satisfaction. Attaining fast response time is, therefore, essential for process improvement that the organization uses to ensure excellent care delivery. Further, maximization of patient outcomes also relies on patient satisfaction; hence response time plays a crucial role in the care delivery. The problem of slow or delayed response can, therefore, have serious implications for healthcare organizations. Delays typically cause patient unhappiness with the kind of care provided and can also undermine patient safety in healthcare settings.
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Notably, delayed response is a problem that has existed for years in healthcare delivery. In the case of the organization, delays in refills, even with patients’ alerts, is a challenge that caused patient unhappiness leading to reported low levels of patient satisfaction. Besides, the time that patients waited in the clinic before seeing a physician was also a major complaint in the organization. These challenges were a result of compounded factors such as understaffing in the organization, ineffective leadership, and staff complacency. The clinic was severely affected by the challenge of understaffing, which forced staff members to work long shifts attending to a considerably high number of patients. Fatigue and burnout were a common problem leading to inefficiency. These problems negatively impacted on the patient attitudes and levels of satisfaction, causing low staff scores in various sections.
Patients' complaints eventually reached the management who came up with several measures to overcome the problem. The management theorized that tracking the amount of time that patients took to move through the entire visit would provide viable information on response times at the clinic. The organization’s front check-in staff were tasked with recording these visit times. While the response was partially effective in reducing the time spent by patients on a single visit, it ignored several factors relating to the quality of patient interaction. Responsiveness in healthcare takes into account the quality of care that patients receive and, eventually, the outcomes. Tracking time while ignoring the patients’ clinical needs and their preferences undermine the whole purpose of the improvement process. The impetus for change in this case to improve response time to increase patient satisfaction through experiences and outcomes. The proposed change aims to surpass the 90 percentile score of patient responsiveness times in the organization. As such, levels of patient satisfaction as well as satisfaction scores will move in a positive direction.
Background
Literature Review
Several studies on the role of patient responsiveness times on patient satisfaction highlight the need for patient-oriented structures in improving care delivery (Kashkoli et al., 2017; Tarrant et al., 2014). Kashkoli et al. (2017) outlined the patient-oriented structures as prompt attention to the needs of the patient, developing networks in delivering care, and the proper choice of the care provider. Meeting patient's expectations is part of the overall psychological aspect of patient satisfaction in the evaluation of clinical outcomes. Patients generally feel dissatisfied if they receive services that are against their expectations. Prompt attention features prominently among factors that patients considered critical in the evaluation of the quality of services they received (Kashkoli et al., 2017). The responsiveness of service providers, therefore, has a direct effect on the levels of patient satisfaction. Tarrant et al. (2014) noted that patients responded well to appointments and services that suited their needs. Flexibility by the service provider is also a critical consideration given that patients may sometimes require their services without booked appointments. The ability of the service providers to attend to the patient under such situations or to refer them to another available care provider without unnecessary delays contributed to the levels of patient satisfaction (Tarrant et al., 2014).
Mitchell et al. (2014) introduced the idea of hourly rounding to meet patient expectations. Patients' needs, including repositions and elimination, are among the most common request that nursing caregivers receive in healthcare settings. The responsiveness of caregivers to these request determine perceptions about the quality of services. Hourly rounds are, therefore, an effective method in reducing patient falls and improving patient scores (Mitchell et al. 2014). The findings on the effectiveness of hourly rounds are supported by assertions by Kashkoli et al. (2017) that the promptness of their caregiver is an indicator of the quality of healthcare that the patient receives. Reducing wait times thus emerged as an effective method of improving patient satisfaction by avoiding adverse outcomes such as injuries from falls and developing positive attitudes on the patient about the quality of services.
Organization Culture and Leadership Style
Notably, the culture of change is apparent in the way of doing things in the healthcare organization. The organizations' leadership emphasizes the need for adapting care delivery to suit the needs of the patient. A change culture is often characterized by staff willingness to react to new processes within the organization positively. The absence of rigidity on the part of the management and the staff ensures the continuous improvement of various care delivery processes. The management of the organization adopted a transformational leadership style to drive the change process within the organization. The leaders identify areas that require change and work with various teams in the clinic by providing inspiration and driving team members committed to the change process (Hustead, 2018). The leadership style ensures continuous improvement and staff commitment to the adoption of new processes in care delivery.
The change process is, however, undermined by the constantly changing leadership. Leadership change often overshadows the gains achieved by previous leaders. New leadership often comes with new ideas or projects for improving care delivery while little effort is made in the making follow-ups on the previous processes. Inadequate training of staff also hinders their ability to adapt to process improvement. The organization focuses on reducing costs; hence limited funds are channeled towards staff training. Proper training can, however, overcome the challenge of slow adaptation of the new processes. High staff turnover leads to inconsistencies in delivering care. Newly hired employees have to quickly learn about the processes in the organization, which often compromises the quality of care delivered.
Change Process
Instituting change at the clinic is imperative to the reduction of patient responsive time above the 90 percentile benchmark. The change process will adapt the PCDA (plan, do, check, and act) theory to guide the planning and implementation of the necessary processes.
Plan
The ‘plan’ stage involves the identification of problems facing the organization. In this case, the problem is slow patient responsiveness times, which negatives impact on patient satisfaction level and outcomes of clinical processes. These problems are precipitated by delayed or missed patient refills and long wait times at the clinic.
Do
The organization will establish a team to oversee and measure the change process that will improve responsiveness times. The leader of the team will be the medical director with four other members drawn from the nursing administration and care providers. The team will draft a manual for necessary changes that will reduce patient responsive times. The team is also responsible for assessing progress and tracking changes. Changes will include the use of alert devices to call caregivers and staff education on the need for quick response.
Check
After the systematic implementation of the change processes, the change process team will assess the progress of the project. The check process will include confirmation of the level of employee buy-in to the change process. Necessary measures to ensure complete staff engages will include further staff training and provision of incentives for increased response.
Act
The complete rollout of the project will begin providing mobile alert devices to staff and on the patient’s bed. Patients will also provide scores according to their level of satisfaction with the services offered at the clinic. Patients will also provide feedback on their wait times and perspectives about the quality of care delivered. Considering PCDA as a continuous process, checks and improvements at various changes will persist until the target is achieved.
Measuring Change and Benefits
Measuring change for the patient responsiveness times project will rely on data gathered through the mobile response software and patient feedback. A plot of the response time in minutes against the staff in each department will provide the percentile values for the desired response. Process improvement will apply until the benchmark of the 90th percentile or higher is achieved and maintained. The same will apply for the patient satisfaction score, which will be plotted on a line graph against the number of staff achieving the desired scores. The benefits of the change process will be achieved through reduced time for patient refills and time spent on visits. Response for refills will be monitored through attendance to alerts and mobile calls. Front office staff will also record the time spent on visits and scores provided by the patient.
Leadership Role
Leadership style plays a critical role in instituting change within a healthcare organization. The transformational leadership style adopted in the organization is appropriate in driving the change process. Hustead (2018) highlighted the importance of transformational leadership in healthcare through its team approach, which allows collaboration and exchange of ideas. As such, the medical director has to exercise transformational leadership in implementing change within the organization. The leader should create a shared vision for change to ensure all employees within the organization are involved in improving the quality of service delivery. The leader should also foster team collaboration in the organization to ensure idea exchange within teams contributes to the improvement process.
The inclusion of all stakeholders in the change process is essential for the success of the project. Direct and precise communication to the stakeholders on the purpose of the change process and its intended outcome will be communicated. The constitution of the team to oversee the response improvement process will also foster inclusion such that the leader of the team will be the medical director with four other members drawn from the nursing administration and care providers.
The plan for ongoing monitoring of the change process will rely on data from patient feedbacks and alert software for mobile devices. A plot for response time in minutes against the responses will follow the pattern shown in figure 1. The graph illustrates that 90 percent of responses were below 72. 5 minutes
Fig 1: A plot of responses against minutes
Responses (y)
Time (x)
A line graph of the responsiveness times will follow the pattern below in figure 2. The x axis will plot the cumulative time for response while the y axis will represent the staff percentage.
Fig2: A plot of cumulative time for response against staff percentage.
Once the level of progress for the change is determined from the analysis of the collected data, the project leader will interpret it to all nurse managers. The nurse managers will then communicate the progress to their respective staff. As such, the staff will understand the relevance of various improvement measures and the impact of their actions on the overall change process.
Results
Comprehensive data analysis will provide the results that will inform decision making on the project progress. Patient responsiveness times measured through the times for refills, mobile alerts, and waiting times provide valuable data for assessing progress. Although considering that the project is only 50% complete at the moment, considerable effort is required to surpass the 90th percentile benchmark. This effort will include overcoming existing barriers related to rigidity to change. Since the project is on track measured by the reduction in responsiveness times, it is more prudent to continue applying the current techniques without making significant changes. Furthermore, providing incentives such as rewards for the best performing teams can enhance the change process.
Conclusion
Delays in responding to the needs of the patients adversely impacts on levels of satisfaction on the part of the patient. Patients usually have expectations about the quality of services they will receive, hence failure to meet their expectations leads to negative perspectives and dissatisfaction with the care delivery process. The leadership at the clinic identified delays or misses in patient refills and long waiting times during clinic visits as the leading causes of low patient satisfaction. The management initially theorized that tracking the amount of time that patients took to move through the entire visit would provide viable information on response times at the clinic. The organization’s front check-in staff were tasked with the role of recording these visit times. These measures were, however, ineffective, prompting a more comprehensive approach will reduce patient responsiveness times and improve satisfaction levels. Instituting change at the clinic was imperative to the reduction of patient responsive time above the 90 percentile benchmark. The change process adapted the PCDA (plan, do, check, act) theory to guide the planning and implementation of the necessary processes. The change processes leveraged the transformational leadership style and the change culture within the organization. Bringing together all stakeholders ensures that the change process was rolled out with the knowledge of all staff members hence creating a shared vision. Future implications for this project relate to the application of theory in solving current healthcare problems. The success of the project using the PCDA approach highlights the importance of applying theoretical knowledge in creating organizational change in healthcare.
References
Black, N. (2013). Patient reported outcome measures could help transform healthcare. BMJ , 346 , p167. https://ohiostate.pressbooks.pub/pubhhmp6615/chapter/transformation/
Currie, J., MacLeod, W. B., & Van Parys, J. (2016). Provider practice style and patient health outcomes: the case of heart attacks. Journal of Health Economics , 47 , 64-80.
Hustead, E. (2018). Team science and transformational leadership in the healthcare field. Leadership in Healthcare and Public Health . https://ohiostate.pressbooks.pub/pubhhmp6615/chapter/transformation/
Kashkoli, S. A., Zarei, E., Daneshkohan, A., & Khodakarim, S. (2017). Hospital responsiveness and its effect on overall patient satisfaction. International Journal of Health Care Quality Assurance, 30 (8), 728-736.
Mitchell, M. D., Lavenberg, J. G., Trotta, R., & Umscheid, C. A. (2014). Hourly rounding to improve nursing responsiveness: a systematic review. The Journal of Nursing Administration , 44 (9):462-72. doi: 10.1097/NNA.0000000000000101
Tarrant, C., Angell, E., Baker, R., Boulton, M., Freeman, G., Wilkie, P. ... & Ketley, D. (2014). Chapter 5: Understanding patients’ experiences of responsiveness. In Responsiveness of primary care services: development of a patient-report measure–qualitative study and initial quantitative pilot testing . NIHR Journals Library
