4 Strategies to Boost Hospitals' HCAHPS Scores

Hospitals' scores on the Hospital Consumer Assessment of Healthcare Providers and Systems survey are becoming increasingly important for hospitals to maintain market share and avoid losing reimbursement. Under the value-based purchasing program, hospitals could be financially penalized for low HCAHPS scores. In addition, hospitals' increased transparency and patients' greater involvement in choosing their hospital will force hospitals to provide a positive experience to attract patients. Here are four strategies hospitals can use to increase HCAHPS scores.

1. Communicate clearly and often.
One of the foundations of a positive patient experience is communication — both between providers and patients and among providers. Several questions on the HCAHPS survey address communication. For example, the survey asks patients:

•    How often nurses and physicians listened carefully to them.
•    How often nurses and physicians explained things in a way they could understand.
•    If hospital staff told them what their medicine was for.
•    If hospital staff described possible side effects of their medicine.
•    If physicians, nurses or other staff discussed whether they would have the help they need after leaving the hospital.
•    If they received information in writing about symptoms or health problems to look out for after leaving the hospital.

In a blog post titled "Simultaneously Enhance HCAHPS Scores and Patient Flow," Darin Vercillo, MD, a co-founder and CEO of patient flow software firm Central Logic, wrote, "In medicine, good communication is the action most highly praised by patients and families. 'My nurse explained to me…' and, 'the doctor sat and talked to us…' are phrases associated with high HCAHPS scores. You never see a comment card saying, 'my nurse ran that infusion so well,' or 'my doctor picked the perfect antibiotic.'" In today's healthcare environment, safe, quality care is expected from hospitals; the experience at the hospital may be what differentiates one hospital from another for patients.

Communication tools
There are many tools and tactics hospitals can use to improve their communication with patients. Hospitals should use multiple modes of communication to emphasize important information and help patients remember key instructions. "To reinforce important information to patients, staff should both write instructions and repeat them verbally, giving patients time to respond with questions," says Elizabeth Chabner Thompson, MD, MPH, a patient advocate and founder and CEO of Best Friends for Life Co., which makes products for patients recovering from various conditions.

At South Nassau Communities Hospital in Oceanside, N.Y., each patient's room has whiteboards to help physicians, nurses and staff communicate with patients, according to Ruth Ragusa, RN, vice president of organizational effectiveness and performance improvement at the hospital.

Another tool hospitals can use to ensure effective communication is interpretation services. Providing interpreters for patients who do not speak or understand English is crucial for communicating information about medication and discharge instructions.

Follow-up calls
Hospitals are also conducting follow-up calls to patients after discharge to answer any questions, ensure discharge instructions are followed and solicit feedback on their experience. Zach Silverzweig, a co-founder of healthcare solutions company CipherHealth, says one of the benefits of asking patients about their experience post-discharge is that patients feel the hospital is really listening to and cares about the patient.

2. Collect and act on data.
As in most improvement initiatives, lasting improvement in HCAHPS scores requires hospitals to collect, analyze and act on data about the patient experience. At the basic level, hospitals can examine HCAHPS surveys to identify trends and problem areas. However, one of the weaknesses of the HCAHPS survey is its low response rate, according to Mr. Silverzweig.

"You get a lot of squeaky wheels. People who are very satisfied and people who are very unsatisfied want to tell you about their experience." Mr. Silverzweig says hospitals can avoid this issue by communicating with every patient about their experience. A larger response rate will ensure hospitals receive data about universal problems in the patient experience. "You need to get a consensus view of how patients feel," he says. "Understand what changes are important for all patients, because that's what drives the most valuable improvement."

Target specific drivers of satisfaction
Data, whether from HCAHPS surveys, follow-up calls or other tools, can help hospitals determine what is most important for patients experience and then create projects to target these areas. "People think about patient satisfaction as this big, amorphous problem, but if you can think of a few key small micro-projects, you will be able to move the needle," Mr. Silverzweig says.

For example, he says one hospital found through follow-up calls that some patients were complaining that the beds were uncomfortable. As the hospital had recently brought in new beds, it determined staff were not adequately trained on using the beds. After additional staff training, complaints on the comfort of the beds dropped off, according to Mr. Silverzweig.  

3. Educate patients.

Another key strategy in improving HCAHPS scores is to educate patients throughout their hospital stay. "Start teaching and educating people from the day they come in, making sure they are prepared to take care of themselves at home," Ms. Ragusa says. In addition to speaking with patients one-on-one, Ms. Ragusa says hospitals can educate patients through videos at the bedside and written instructions.

Every interaction with patients is an opportunity to educate patients — about their condition, medication, post-discharge plans and follow-up plans. Patients that understand more about their condition and their care will feel more involved in their care process and less detached.

Educating patients during transitions of care, such as from the hospital to a long-term care facility or to home, is especially important for the patient experience because understanding what to do post-discharge eases patients' anxiety. "A 'cold' discharge process can leave a patient feeling like a number," Dr. Chabner Thompson says. "Empowering the patient with pertinent information and support tools makes a huge difference."

4. Make a positive patient experience part of the culture.

Significant, long-term improvement of HCAHPS will depend on the culture of the hospital. Hospitals where leaders emphasize the importance of patient satisfaction and where staff are trained in patient satisfaction strategies will be more successful in projects to improve HCAHPS scores.


Developing a strong culture that values the patient experience begins with leadership. "The single most important contributory factor in our success is that the hospital's senior [leaders] embrace and drive service excellence for the organization," says Michael Wiechart, COO of Franklin, Tenn.-based Capella Healthcare. "They must develop and drive a mature model of accountability that permeates the culture. That culture of service excellence must be continuously nurtured in order to consistently achieve the strong HCAHPS scores and provide the best care for our patients and communities."

To create a culture that values the patient experience, Ms. Ragusa suggests hospital leaders interact often with the patients. "A key function of leadership is to be accessible to patients and families so that you have first-hand feedback from patients and families directly," she says. "We have all of our management staff making rounds, talking with patients, talking with families, so they're close to what the patients are experiencing."

Training staff to adopt a patient-centric approach to patient care can also help hospitals emphasize the importance of patient satisfaction. "The perspective we always try to take is approach each patient as you would like your family member treated, understanding that [the hospital] may be a common place for us as professionals, but it is a unique situation for patients and families," Ms. Ragusa says. In addition, hospitals should acknowledge that treating patients goes beyond one individual, as treatment also affects the patient's family, according to Ms. Ragusa.

Small changes have big effects

Even small changes in physicians' and staff members' behavior can influence patient satisfaction. For example, Ms. Ragusa says sitting to talk to patients and families instead of standing can give a more positive impression. "Everyone [in the hospital] has so many things to accomplish, and it's easy for patients to feel that they're rushed," she says. "Even something simple like when you go in to speak to a patient, sit down as opposed to standing. It might take the same amount of time, but the impression is not rushed. The impression is that you might have spent more time when really you haven't."

More Articles on HCAHPS:

Top 62 Hospitals Where Staff Always Explain Meds Before Giving Them to Patients
50 Hospitals With Highest Percentage of Patients Receiving Help as Soon as They Want

61 Hospitals With the Best Nurse Communication

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