Nurse Leadership Matters in Patient Experience Performance

By Jason A. Wolf Ph.D.

As shared by the Robert Wood Johnson Foundation and known by many in practice, nurses represent the single largest group of health professionals who deliver hospital care. This represents a broad range of caregivers from the senior ranks of CEOs or CNOs, to the bedside, from managing triage in emergency departments to conducting post discharge follow-up calls.

With this expansive reach, nurses and in particular nurse leaders, have a significant opportunity to impact the experiences of patients and families. I say this reinforcing the strong point found in the definition of patient experience that experience is created in every interaction – meaning by everyone that plays a role in the healthcare system and at all points in the continuum of care, from well before to well after a clinical encounter. With that we would be short sighted to miss the fact that the experience most patients and family members relate to, reflect on and remember is the one they had with their nurses.

In a Hospital Impact blog last year, I wrote about my own experience of quickly leaving at the close of Patient Experience Conference to become a family member at the bedside for the birth of our son. I spoke of Kristen, our L&D nurse, who was responsive and took every opportunity to not only set appropriate expectations, but also answer our questions. She served as a guide through one of life’s most important and incredible moments.

In inquiring why she and other nurses in the unit were so positive and engaged (and not revealing my profession), I was told about how their leaders take time to support the nurse team not simply as individuals there to work, but as professionals, people and partners in care delivery.

In thinking back on this moment I had the chance to share some thoughts with the nurse leaders at my most recent On the Roadsite – Presbyterian Health Services. My realization in the conversations reminded me of how as a family member I had clear expectations about clinical excellence, quality and responsiveness from my nurse team. It was the things they did beyond that though that drove my experience.

As we talked at Presbyterian, it became clear in the dialogue that in the fast-paced world of healthcare, specifically in the nursing realm, nurse leaders have a critical role to play. They set the stage for behavior, they reinforce actions and responses, and they coach, guide, cajole and celebrate with their teams. In the end these nurse leaders, whether aware of it or not, are indirectly driving the experience for so many in their care.

This observation and discussion was supported by the data revealed in the 2013 State of Patient Experience Benchmarking Study. In both the 2011 and 2013 research “clinical managers who visibly support patient experience efforts” was the second greatest driver of experience success after visible support from the top. Here again leadership was reinforced as critical, and more so the clinical managers, those guiding the largest part of the healthcare workforce and with the greatest contact with those served, were identified as central to patient experience performance.

What does all this mean in action. Based on what I have experienced and learned from the many nurse leaders I have had the fortune to work with, the ideas are simple in concept, but sometimes require great effort to execute. Nurse leaders must:

• Nurture and develop their teams beyond core clinical skills to the behaviors they see as critical to the total delivery of care.
• Model expectations at all times in their own actions and hold themselves and everyone else accountable when these expectations are broken.
• Listen and create a space for the words of all team members to be heard. Sometimes the greatest of ideas come from the unlikeliest of sources.
• Reinforce and create a sense of ownership in staff at all levels that they are leaders in every moment. As every experience happens in the interaction between one human being and another, every individual has the power to choose how they lead in every moment.

In a world where nurse leadership faces continued and growing pressures to perform, these, what some might call, “softer”, non-clinical aspects of leadership and action can easily be pushed aside. But it continues to be the strongest and most successful leaders I see that find the space and time to consider and act on these aspects of the total experience.

It is simple. In whatever way fits their style or the organization in which they provide care, nurse leaders matter in patient experience performance. Of that there is truly no question.

Jason. A. Wolf, Ph.D.
President
The Beryl Institute