Addressing Call Light Responsiveness

Managing workflows and patient expectations for better HCAHPS

As a key part of the patient experience and the focus of multiple HCAHPS questions, staff responsiveness can make or break the quality of a hospital stay. 

It is crucial for patient safety, too. A patient calling for help may be reporting the first signs of a crisis or needing help moving safely. Research confirms that hospitals with slower call light response times have higher rates of falls — a costly problem that causes patients harm.[1] On average, a fall without injury increases length of stay by eight days and costs the hospital over $6,000, with even greater costs if the patient is injured.[2] 

Yet, with short staffing, unprecedented turnover, and high burnout rates, many hospital units find themselves struggling with call light response times. Staff may be working at peak productivity and simply can’t work faster.

In this environment, how can healthcare organizations improve call light response times? Read on for tips and strategies to help raise your responsiveness scores.

Responsiveness and HCAHPS

Two HCAHPS survey questions address staff responsiveness:[3]

• During this hospital stay, after you pressed the call button, how often did you get help as soon as you wanted it?

• How often did you get help in getting to the bathroom or in using a bedpan as soon as you wanted?

Responsiveness could also influence answers on other questions, including:

• Would you recommend this hospital to your friends and family?

• Using any number from 0 to 10, where 0 is the worst hospital possible and 10 is the best hospital possible, what number would you use to rate this hospital during your stay?

Identify the Roots of the Problem

If you have lower staff-responsiveness scores on HCAHPS than your goal, start with a thorough audit of your hospital units to help identify the root causes and contributing factors. Get staff on board with the effort by communicating your intent to understand the challenges they face and your commitment to help. Adopt an attitude of discovery rather than blame.

Possible root causes include:

1. Inadequate staffing. Evaluate if you have adequate staff — both nursing and ancillary — to meet patient needs safely.

2. Unclear expectations. Examine your units’ expectations concerning timeliness and which staff members are responsible for answering call lights.

3. Inefficient workflows. Review daily workflows and identify any that seem overly complicated. Get feedback from staff by asking if they find themselves doing repetitive tasks, or tasks that seem unnecessary.

4. Cumbersome communication. Observe a day in your units. Does your staff spend time walking across the unit to deliver messages or ask each other questions? Does the same message get delivered in multiple ways?

5. Ineffective tools. Examine your tools, such as software and communication systems. Ask your staff if they are helpful. Tools intended to increase efficiency can sometimes fail to live up to the promise and instead add extra work for staff with frequent glitches or added procedural steps.

How to Move the Needle on Call Light Responsiveness

Identifying the root causes of your responsiveness issue may let you know how to remedy it. Here are some more strategies to help:

1. Empower more staff to answer call lights. This strategy helped New York Presbyterian improve its call light responsiveness HCAHPS scores by six points. The hospital set the expectation that everyone, from the C-suite to environmental services, answers call lights if they are near them.[4] Establish an easy method for these staff to communicate with the care team if they can’t meet the patient’s need after answering a call light. A digital messaging platform at the nurses’ station is a potential solution.

2. Use tools such as call lights that incorporate speakers to enable a conversation; or call lights that categorize requests such as those for pain medicine or help using the restroom. Ensure patients understand how to use these tools.

3. Speed communication with tools such as messaging systems or digital whiteboards.

4. Adopt a scheduled rounding practice so patient needs are met regularly, or evaluate if rounding is being used effectively. Teach patients about your rounding practice to set expectations and reduce anxiety.

5. Encourage staff to meet patient needs proactively by bundling care and anticipating possible issues before entering the room.

Addressing staffing 

Sometimes, the root cause may be as simple as inadequate staffing to meet patient needs quickly. Examine nurse-patient ratios. Consider minimum staffing standards established by professional organizations,[5],[6] regulatory agencies, and at the state level.[7] Also, note proposed federal guidelines[8] endorsed by the American Nurses Association. Stretching out nurse-patient ratios may result in short-term cost savings, but doesn’t pay in the long run. Instead, it leads to increased burnout and turnover, poor culture, more patient safety events, and low HCAHPS scores — all with costly ramifications.[9]

Securing staffing can prove challenging. Adequate ancillary staff can help maximize the effectiveness of your nursing staff, keeping nurses working at the top of their scope of practice as much as possible. Consider using different care delivery models, keeping in mind that what may work in one area will not necessarily work in another. Input from direct care nurses in each unit is vital to inform the correct decision.

Conclusion

Call light responsiveness is critical to both patient safety and HCAHPS. Solutions that increase responsiveness will be different for every unit but could include empowering more staff to answer call lights, using advanced communication systems, adopting proactive care practices, and maintaining adequate nurse-patient ratios. Hospital leaders who commit to understanding the challenges staff face and involve them in building solutions will increase care efficiency and gain better responsiveness scores.

References:

[1] Morello RT, Barker AL, Watts JJ, et al. The extra resource burden of in‐hospital falls: a cost of falls study. Medical journal of Australia. 2015;203(9):367-367. doi:https://doi.org/10.5694/mja15.00296

[2] Morello RT, Barker AL, Watts JJ, et al. The extra resource burden of in‐hospital falls: a cost of falls study. Medical journal of Australia. 2015;203(9):367-367. doi:https://doi.org/10.5694/mja15.00296

[3] HCAHPS Survey. https://hcahpsonline.org/globalassets/hcahps/quality-assurance/2023_survey-instruments_english_mail.pdf

[4] Laura Ramos Hegwer. How one hospital improved its call-bell responsiveness. HFMA. Published June 11, 2019. Accessed July 19, 2024. https://www.hfma.org/finance-and-business-strategy/patient-experience/how-one-hospital-improved-its-call-bell-responsiveness/

[5] AACN Standards for Appropriate Staffing in Adult Critical Care - AACN. Aacn.org. Published 2024. Accessed July 24, 2024. https://www.aacn.org/nursing-excellence/standards/aacn-standards-for-appropriate-staffing-in-adult-critical-care‌

[6] Silveira A. Staffing Standards - AWHONN. AWHONN. Published June 7, 2022. Accessed July 24, 2024. https://www.awhonn.org/education/staffing-standards/‌

[7] AFL-07-26. Ca.gov. Published 2024. Accessed July 24, 2024. https://www.cdph.ca.gov/Programs/CHCQ/LCP/Pages/AFL-07-26.aspx

[8] American Nurses Association Backs Staffing Ratios | NurseJournal.org. NurseJournal.org. Published 2023. Accessed July 24, 2024. https://nursejournal.org/articles/american-nurses-association-nurse-patient-staffing-ratios/

[9] Rich V. Nurse Staffing Ratios: The Crucible of Money, Policy, Research, and Patient Care. Nurse Staffing Ratios: The Crucible of Money, Policy, Research, and Patient Care. Published March 15, 2021. Accessed July 25, 2024. https://psnet.ahrq.gov/web-mm/nurse-staffing-ratios-crucible-money-policy-research-and-patient-care