Running Head: QUALITY IMPROVEMENT

Quality Improvement on Patient Experiences

Gil Anthony Rubia
Bon Secours Memorial College of Nursing
Professional Role Development: Servant Leadership- NUR 4144
Dr. Ellcessor
October 24, 2016

Running Head: QUALITY IMPROVEMENT

Quality Improvement on Patient Experiences

In the emergency department, a surge of patients come in and out of the doors, all
experiencing different levels of care. From a lacerated finger to septic shock, these people are
being stabilized and are either admitted or discharged. During my time in the emergency
department, it has been noted multiple times that we need to improve our patient satisfaction.
From my experience, I have met patients who were truly appreciative of the care given to them,
and those who were unsatisfied with the care. From each nightly huddle, it is reported that we
need to improve our patient satisfaction. These patient experiences are extracted by the charge
nurse using the Press Gainey Scores, a survey that measures a patients experiences quality, and
these are reported to the nurse manager. The nurse manager then translated the information to
impact the Emergency Department Patient Experiences with Care (EDPEC). The EDPEC are
surveys about the experience of patients eighteen years old and older that are admitted and
discharged from the emergency room (Centers for Medicare & Medicaid Services, 2016).
Actions have been taken to improve these statistics, however, survey shows that there has not
been much improvement. Utilizing Lead Like Jesus heart, head, hands and habits, as well as
being a servant leader, I have developed a plan as a nursing manager to increase patient
satisfaction (Blanchard 2005).
Servant Leader
To begin the improvement of patient experiences, the staff itself must understand what it
means to become a servant leader. A servant leader focuses on servicing others. Focusing on
others instead of self can is the beginning of becoming a servant leader. They also have a holistic
approach to work. Instead of just focusing on tasks and orders, the nurses must view the patient
holistically and tend to their physical, emotional, and spiritual needs. Servant leaders must also

Running Head: QUALITY IMPROVEMENT

work together and promote a sense of community. Having a close knit team who can work
together will aid in caring for the patients. This teamwork can make the workplace more efficient
which can directly affect patient satisfaction. Being able to collaborate with a multidisciplinary
team and sharing power in decision making regarding the patient care also benefits the patient,
creating better patient outcomes. Servant leaders lead from the heart, which determines their
motivation and intent. The mind defines how they seek role their roles and their relationships to
those they wish to influence. To transmit, what is in the servant leaders heart and head, the
leader uses their hands to plan, coach, and evaluate those around them. The servant leader also
has habits similar to Jesus, with the habits embodying the leaders character (Neill & Saunders,
2008).
Leadership Styles
Leadership creates teamwork, motivation, inspiration, leadership, vision and innovation.
There are many leadership styles, such as autocratic, bureaucratic, democratic, and laizssez-faire
leadership. There are also multiple types of leadership theories such as contingency, quantum,
servant and transformational leadership theory. A transformational leader has self-confidence
and self-direction. This type of leader is honest, loyal, committed and has the ability to develop
and implement a vision. An exemplary leader models the way, creating a standard of excellence.
They also inspire a shared vision, enlisting their colleagues in their dreams to see a beneficial
future. The leader also keeps the teams morale high, encouraging the heart, and rewarding the
team members efforts. Through collaboration, the leader creates trust and respect this
strengthening others, and enabling others to act. Following the rules, the leader also constantly
looks for improvement or innovations. They challenge the process by accepting failure, and
using these failures as learning opportunities.

Running Head: QUALITY IMPROVEMENT

By giving power to the staff through shared governance, the transformational leader is
able to gain more power. According to Kutnee-lee, hospitals that provide nurses with the
greatest opportunities to be engaged in shared governance are more likely to provide better
patient experiences and superior quality of care and have more favorable nurse job outcomes
compared with hospitals where nurses are not engaged in institutional decision making (Kutneylee, Hatfield, & Kelly, 2016). The transformational leader, combined with the ideals of a
servant leader, is the optimal choice of a leadership style.
Heart
Initially, the intent or the heart to care for the patients entering the emergency
department needs to be reestablished. The nurse manager needs to analyze the reports given by
the charge nurse and find solutions to the negative reports. To do so, a meeting with the staff
regarding the complaints mentioned by the patients is necessary to figure out why the complaints
were mentioned. The nurse manager also needs to find out what they can do to remind those who
are misguided about their purpose in taking care of these patients so that they can correct the
problem. In a phenomenological study by Brigitte S. Cypress, three themes were described by
the patients and their families. These themes were critical thinking, communication, and
sensitivity and caring by the nurse (Cypress, 2013). The results show that the importance of
these three themes are essential for patients to have a good experience. There has been cases
where patients feel as if they were wasting the nurses time. They felt this way because the nurse
has belittled their complaint, stating It really shouldn't hurt that bad, and Why are you even
here? People visit the emergency department for different reasons in varying acuities, however,
it is bad practice to assume that they are there unnecessarily. The nurses need to refresh on

Running Head: QUALITY IMPROVEMENT

therapeutic communication so that the clients will have a better experience. This in turn affects
how our patient report their experience.
Head
To guide those under the leader, the nurse manager needs to clarify his or her belief
system and his or her perspective on the role of the leader. Using the head. the nurse
managers role is to receive the charge nurses information, and carry out tasks from there. In the
Emergency Department, the nurse manager has a flow sheet of patient reports created from the
nurse managers qualitative survey of the patients experiences. From these reports, he or she is
able to follow trends and see which areas need improvement. The manager can either call
patients and have a clarification on their experience or talk to the patients before discharge.
Depending on the results, the manager either talks to the staff as a whole or talk to the staff one
on one. The nurse manager can use this information to uphold respect, quality, justice,
compassion, stewardship, integrity, growth, and innovation.
Hands
Using the hand, the nurse manager can integrate performance planning, day-to-day
coaching, and use performance evaluation to help increase patient satisfaction. Performance
planning will provide direction and set goals. An example would be hourly rounds. These have
been implemented to ensure interaction between nurse and patient during their stay. It is easy to
disregard a patient if a nurse is occupied with a higher acuity patient. Hourly rounds have been
shown to increase satisfaction by making the patient aware of the nurses presence. During these
hourly rounds, the patients are also able to express their needs (Mitchell et al. 2014). If
documentation and patient reports show positive results, the nurse manager can show
appreciation to the nurse by making the unit aware of the nurses performance. If the nurse is

Running Head: QUALITY IMPROVEMENT

unable to comply with hourly rounding, the nurse manager can help the nurse to accomplish his
or her goal by reminding, or helping with hourly rounds. This day to day coaching will redirect
the focus to patient satisfaction and the nurse can achieve his or her goal. After everything is
done, a performance evaluation or appraisal can be initiated so that the efforts of the nurse is sure
to be acknowledged.
Habits
It is difficult to change ones habit. According to Lead like Jesus, the five habits consists
of solitude, prayer, study and application of scripture, accepting and responding to Gods
unconditional love, and involvement in supportive relationships (Blanchard, 2005). In the
emergency departments environment, it is almost impossible to follow these five habits, but it is
ideal to keep those habits in mind. The habits formed in this unit are usually the habits regarding
patient interaction. In this department, the purpose is to help those in need, which is why it is
important to make sure that the patients that come through are given proper care. The emergency
department has placed small stools in each room, a place for physicians, but also anyone to sit
down and talk to the patient at eye level. A study by Marcus Dawn, patients report better
satisfaction in that having the physicians sit down creates an illusion that they stay in the room
longer. It makes it seem like that they are not in a hurry (Dawn, 2012). A physician in the unit
has shared his own mindset and habit when taking care of patients. He states that he treats his
patients like his own beloved mother. This way, any disrespectful or non-therapeutic comments
are not even considered in the conversation. As the charge nurse, spreading this type of habit
across the whole staff will help both the staff and the patients achieve a healthy experience.
By integrating the heart, head, hands and habits, the population being cared for will be
able to have a better patient experience. With this patient experience, the patient outcome will

Running Head: QUALITY IMPROVEMENT

hopefully be better as well. In some cases, even if the patient outcome is not optimal, such as a
death, hopefully the team will be able to provide proper care for the family involved. The
emergency department unit will benefit in this quality improvement by having desirable EDPEC
scores, as well as a desirable patient outcome.

Running Head: QUALITY IMPROVEMENT

References
Blanchard, K. H., & Hodges, P. (2005). Lead like Jesus: Lessons for everyone from the greatest
leadership role model of all time. Nashville, TN: Thomas Nelson.
Centers for Medicare & Medicaid Services (2016). Emergency department patient experiences
with care (EDPEC). Retrieved October 24, 2016, from http://www.cms.gov/ResearchStatistics-Data-andSystems/Research/CAHPS/ed.html
Cypress, B. S. (2013). Using the synergy model of patient care in understanding the lived
emergency department experiences of patients, family members and their nurses during
critical illness a phenomenological study, 32(6).
http://doi.org/10.1097/DCC.0000000000000005
Dawn, Marcus A. (2012). Make eye contact, sit down, and touch your Patient. Southern Medical
Journal. 105(9):491, September 2012. doi: 10.1097/SMJ.0b013e3182641620
Kutney-lee, A., Hatfield, L., & Kelly, S. (2016). Nurse engagement in shared governance and
patient and nurse outcomes, 0(0), 18. http://doi.org/10.1097/NNA.0000000000000412
Mitchell, M. D., Lavenberg, J. G., Trotta, R. L., & Umscheid, C. A. (2014). Hourly rounding to
improve nursing responsiveness. Journal Of Nursing Administration, 44(9), 462-472.
doi:10.1097/NNA.0000000000000101
Neill, M. W., & Saunders, N. S. (2008). Servant leadership enhancing quality of care and staff
satisfaction, 38(9), 395400.

Running Head: QUALITY IMPROVEMENT