Nurse-provider rounding pilot boosts communication and NPS at UCI Health

UCI Health is composed of nationally regarded physicians, nurses, researchers, clinicians, educators, and students dedicated to discovering new medical frontiers, teaching future healers, and delivering the finest evidence-based care. As the only academic health system in Orange County, California, the organization is advancing toward becoming the friendliest, most accessible academic health system in the nation. To achieve this, they focus on creating a welcoming and healing environment, providing whole-person care, embracing Human Understanding to treat each person as unique, and supporting the next steps for any care they provide.

UCI Health is expanding its footprint into Irvine, South Orange County and South Los Angeles and has acquired hospitals in Fountain Valley, Los Alamitos, Lakewood, Placentia, and Yorba Linda, which allows them to serve more diverse communities.

Bringing in leaders in oncology, orthopedics, and cardiology, UCI Health’s associations with the School of Medicine and School of Nursing support the education and training of the healthcare leaders of the future.

UCI Health also boasts the UCI Susan Samueli Integrative Health Institute, whose vision is to be the preeminent national and international academic institute for pioneering multidisciplinary research, education, and healthcare practices for whole-person care. 

As part of their effort to become the friendliest, most accessible academic health system in the nation, UCI Health leaders have recognized that effective communication between care teams is important for patient-centered care and overall hospital performance.

UCI Health built a four-month pilot program incorporating NRC Health’s patient feedback platform, to address communication gaps in specific units that need improvement and to build cohesive care teams. To validate the data, they established a four-month pause of the pilot as well.

After COVID, leaders at UCI Health recognized the value of getting back to basics and looking at how they could impact employee retention and increase meaningful employment to avoid burnout.

“Something I think we lost during COVID was direct communication with our patients, sitting at the bedside, making sure to connect with the family members, spending the time needed to answer questions and not trying to rush during the patient encounter,” says Brad Giafaglione, MBA, Director of UCI Experience and Operations. “What our team has since been focusing on is more of a programmatic focus that encompasses quality, safety, patient experience, throughput, and combining those to make sure that we’re making changes that are sustainable but also impactful to help us improve, because that’s extremely important for our success and where we’re headed as an organization.”

Giafaglione says that if you have lower performance for employee engagement and provider engagement, there is a direct correlation with lower patient experience. He adds that, with respect to those connections, “UCI Health’s leaders wanted further evaluation around inpatient key drivers to overall patient experience, which led us to focus on our good ‘communication between physicians and nursing’ metric for our Medical Surgical areas.”

The Tower Medical Surgical units are located in the oldest part of the hospital, with double-occupancy rooms where patients go for longer-term stays with challenging care issues. UCI Health experience team leaders decided to start within the Tower units and initiated conversations with the Chair of Hospitalist Medicine, Medical Surgical Nursing Director, frontline nursing, and physician teams about various frustrations encountered regarding the patient experience.

The fundamental issue identified by team members was the lack of timely communication of care plans, which was impacting their ability to update patients and their family members. This in turn was negatively affecting their rounding compliance and team communication scores.

“Our CMO and CNE had a shared goal of improving physician-nurse rounding,” says Justin Wang, MS, Manager of UCI Experience and Operations. “Healthcare issues are based on communication breakdowns, so if we can improve something around that, it’s a win for all.”

“Healthcare issues are based on communication breakdowns, so if we can improve something around that, it’s a win for all.”

—Justin Wang, MS, Manager of UCI Experience and Operations

UCI Health Experience team leaders identified the communication gap and met with key stakeholders. Next, they formed a Hospitalist Medicine and Medical Surgical steering committee to brainstorm solutions, which resulted in a pilot rounding workflow agreed upon by providers and nursing teams.

Team leaders communicated expectations, and as their frontline team implemented these changes, they were accompanied by a team of nurse and physician champions on each floor. Leaders outlined these champions’ roles and responsibilities, which included monthly feedback to ensure the pilot’s strategies were successfully implemented.

“I think that’s where the improvement in the team communication from the patient’s perspective came through,” says Giafaglione. “But really, if we had surveyed our providers and nurses at the same time, I think we would’ve seen a significant improvement in their overall engagement as well.”

From a qualitative standpoint, the feedback from nursing teams to providers recounted more engagement and collaboration than ever. And the data comparison from before the pilot to after the pilot showed impressive results in just four months.

In turn, this enhanced communication strategy had a significant impact on Net Promoter Score (NPS)* for the pilot units. For UCI Health, the interconnectedness between healthcare professionals directly influenced patients’ likelihood to recommend.

To flush out the data another way, UCI Health put the pilot on pause for four months, and those numbers verified the research in a different but profound way.

UCI Health Experience team leaders admit that it’s crucial to have the right executive sponsorship and stakeholders involved throughout an improvement pilot like this. “You have to understand that team communication is not an overnight or year-long journey, but a culture change,” Giafaglione says. “And I think that’s what really is central to the experience piece too, which is that this will take time, so be ready to work through some of those frustrations.”

“You have to understand that team communication is not an overnight or year-long journey, but a culture change.”

—Brad Giafaglione, MBA, Director of UCI Experience and Operations

Leaders at UCI Health recognize the importance the partnership plays in their successes, noting NRC Health’s platform empowers their initiatives.

“Using NRC Health’s real-time data allows us to make actionable changes within a few days,” Giafaglione says. “Looking at data a month later doesn’t help. So now we’re able to get the data within 72 hours for our inpatient areas, and we’re able to see that what we’re implementing with this work is helping improve our processes.”

“Using NRC Health’s real-time data allows us to make actionable changes within a few days.”

—Brad Giafaglione, MBA, Director of UCI Experience and Operations

“What we’ve done is to make an improvement that you can see, which gets people more motivated because they can get behind it and be more willing to engage further,” he adds. “We started to see improvement in the rounding numbers from a compliance perspective, but from the NRC Health side, all communication performance went up, and overall Net Promoter Score for the units also increased. So, to watch that and be able to present it back to those team members—it’s just a huge motivator.”

“NRC Health has been our partner throughout this, and I don’t know if we would’ve been able to make these types of improvements without the data they provided.”

—Justin Wang, MS, Manager of UCI Experience and Operations

“The support from NRC Health has been tremendous—their ability to jump in with whatever we need, whether it’s additional support or education,” Wang says. “NRC Health has been our partner throughout this, and I don’t know if we would’ve been able to make these types of improvements without the data they provided. The key drivers are nice reports to show teams, and the real-time trends are great. They tell a story, and NRC does a really good job with its platform to do that.”

Additional information on this pilot project has been published in the Cureus Journal of Medical Science.