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Understanding the Nurse's Role in Improving the Patient Experience

July 2013

In the rapidly-evolving healthcare environment, it sometimes appears as if change is one of the few constants. Much of that change is driven by new research and technology that can help make smoother, more effective and pleasant care a reality for patients. According to the Robert Wood Johnson Foundation (RWJF), nurses are the largest group of healthcare industry workers with the most face-to-face interaction with patients. This presents an opportunity for nurses to take a lead role in shaping this change and improving the patient care experience.

In 2005, the RWJF launched its Interdisciplinary Nursing Quality Research Initiative (INQRI) to support academic studies that analyze how nurses can affect change for patients. Since its creation, many INQRI studies have produced positive results, showcasing ways that better nursing can lead to a better patient experience, and laying out methods of support for hospital administrators, policymakers and other important figures in healthcare to help nurses achieve better patient outcomes.

One such project was a nurse-generated and nurse-led innovation that tested the impact of a computer-based nurse communication training program on intensive care unit patient care outcomes. Another study analyzed the experience of children to determine which outcomes matter most from the perspective of young patients, and what pediatric nurses can do to help improve their experiences. While the long-term results of these and several other studies remain to be seen, more information can be found in a recent report released by the RWJF that discusses the role of nurses in improving the quality of patient care.

Many healthcare facilities across the nation are starting to adopt the methods discussed in these studies. One such facility is the Cleveland Clinic, whose Office of Patient Experience was the first of its kind to focus entirely on the patient experience. Nurses in this department help their team provide resources and establish best practices across the Cleveland Clinic health system, and their efforts have prompted several other facilities to launch similar programs of their own.

“If you look back around 90 years ago, you will see writings from our hospital’s founders that discuss the importance of focusing on patients,” said Mary Linda Rivera, RN, ND, Senior Director at the Cleveland Clinic’s Office of Patient Experience (OPE) in Cleveland, Ohio. “If it weren’t for patients, after all, then nurses would have nothing to do. By creating the Office of Patient Experience, we were really trying to go back to a philosophy of ‘patients first’ with a recognition that everyone in the hospital is responsible for providing care.”

According to Rivera, one of OPE’s most important findings is the importance of the healthcare facility’s culture. “Hospital processes and best practices are very important, but equally if not more important is making sure we have the right culture in place for our nurses,” said Rivera. “The right culture is one that focuses on service excellence and recognizing each member of the healthcare team as a caregiver. Establishing this culture and providing the skills and training necessary to follow through with service excellence are important keys to ensuring a better patient experience.”

In addition to focusing on the hospital’s culture, another process OPE emphasizes is called Purposeful Hourly Rounding. This process requires the hospital’s nursing staff to visit with patients during their assigned hour, “with an emphasis on ‘purposeful,’” said Rivera. “We find that having nurses not only visit, but actually talk to the patients – asking them very specific questions that relate to their experience and well-being – helps build a relationship between the patient and the caregiver and ensure we are doing enough to provide the best service possible.”

While OPE has taught Rivera and her team a lot about patient experience to date, the next big push is to ensure sustainability of the programs and processes that they put in place. “We need to avoid thinking of these new processes as initiatives that might go away in six months and focus on creating transformational change in the way we provide care,” said Rivera. And while there is still a lot of research needed to determine what these changes will be and how nurses will implement them, she believes that OPE has created a strong pathway for nurses who want to drive their workplace to a stronger focus on patient experience.

To learn more about the Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative, visit To learn more about the Cleveland Clinic Office of Patient Experience, visit

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