Congenial nurses carry more weight than cutting-edge surgical technologies and fancy facilities when it comes to satisfying patients, according to a survey of healthcare consumers.

The survey's findings show that physicians and nurses account for half of outpatients' overall experience ratings. In addition, say researchers, poor staff service and attitude are common problems that drive down satisfaction scores. The satisfaction scores of patients cared for in outpatient settings reached 863 index points on a 1,000-point scale, notes the report, higher than scores gathered from inpatients and emergency department patients.

Solving problems with a genuine interest in patients' needs is linked to higher scores, according to the study. "This has become more important as hospital reimbursement is now linked to patient satisfaction," says Rick Millard, senior director of the healthcare practice at J.D. Power and Associates, the market research firm that produced the study.

While facilities might invest in makeovers aimed at creating the look and feel of a luxury hotel or buy new equipment in efforts to attract patients, finding and keeping gregarious staff members might be more worthwhile, say the report's authors.

"Having an appealing hospital facility matters, but an experienced and socially skilled staff has a greater impact on patient satisfaction," says Mr. Millard. "Personal interactions with the staff have a profound impact in both inpatient and outpatient settings."

Daniel Cook

A nationwide survey suggests that one of the chief obstacles in implementing evidence-based practices to improve patient care and outcomes is resistance from set-in-their-ways nurses.

"This was a distressing finding, and it's a huge problem," says study co-author Bernadette Melnyk, RN, PhD, CPNP, FAAN, dean of Ohio State University's College of Nursing and the school's chief wellness officer. "The average age of nurses is 47, and they were educated at a time when evidence-based practice was not well integrated into educational programs. As a result, many nurses are practicing the way they were taught or steeped in tradition of the health-care system in which they work.

"When new graduates who have learned to take an evidence-based approach to care are meeting these nurses in real-world settings, they encounter this prevalence of a 'this is the way we do it here' culture," says Dr. Melnyk.

The study, published in the September issue of the Journal of Nursing Administration surveyed 1,015 RNs aged 21 to 79 years about their use of and attitudes toward research in clinical practices. Slightly more than half reported that their organizations consistently used evidence-based practices, but only about one-third saw their colleagues consistently applying them.

Nurse managers' resistance to change was cited as a major roadblock to evidence-based methods' adoption, even when the goal was improved patient outcomes. While nurses with more education were more confident in implementing them, nurses with more experience were less likely to be interested in learning new and better ways of doing things.

Dr. Melnyk notes that these results signal a need for education processes and organizational cultures that value research findings and are routinely putting them to use in practice.

David Bernard

Risk assessment is the cornerstone of preventing patient falls in your facility, according to an analysis by the Pennsylvania Patient Safety Authority. Screening tools "accurately identify patients who will fall or those who are at high risk of falling with a sensitivity and specificity of greater than 70%" says the PPSA.

In 2011, the PPSA received more than 32,000 fall reports. Of the patients who fell, 64% had undergone fall-risk assessments, 60% had been identified as at risk for falling, and 65% had been subject to fall-prevention strategies. "While these statistics may reflect a lack of documentation, rather than a deficiency in practice, evaluation of compliance with best practices with respect to falls prevention is warranted, beginning with performance of a falls risk assessment for all patients," say the study's authors.

The analysis goes on to highlight fall risks, such as age, impaired mobility, and use of sedatives and benzodiazepines; provides a comparison of three fall-risk assessment tools; and outlines risk reduction strategies, such as such as screening all patients and measuring staff compliance with prevention efforts.

Finally, the authors remind that "risk assessment alone does not prevent falls," and stress that an effective fall-prevention program is "multifactorial, provided by a multidisciplinary team, targeted to common falls risk factors for all patients, and tailored to each patient's specific falls risk factors."

Stephanie Wasek

Managing a surgical facility is not for the faint of heart. It's a true pressure cooker of a job. What's the most stressful part of your job, however? An impending Medicare or accreditation survey? Dealing with surgeons? Managing your staff? Tell us in this week's InstaPoll.

Nearly half (49%) of the 371 respondents to last week's poll either flash-sterilized that day (27%) or within the past week (22%). On the other end of the flashing spectrum, more than one-third (34%) can hardly remember the last time that they flashed.

• Today: 27%
• Within the past week: 22%
• Within the past month: 17%
• Been so long I can't remember: 19%
• We have a no-flashing policy: 15%

Dan O'Connor