To Improve HCAHPS, Achieve Alignment

All hospitals value patients and want to make them happy. However, when patient satisfaction is one of the drivers of hospital reimbursement — as with the Hospital Consumer Assessment of Healthcare Providers and Systems survey — the measure becomes doubly important. Indeed, keeping patients happy isn't an exact science, which makes the question of how improve HCAHPs scores and avoid financial penalties quite complex.

While there are many ways to improve metrics, Carol Geffner, PhD, president of healthcare consulting firm Newpoint Healthcare Advisors, says it goes deeper than that: "The goals established for HCAHPS ratings typically align with the overall strategic intent of the hospital," she says. "If achieving excellence is an overarching objective, it is likely that hospital leadership will set the measurement goals at the highest levels nationally. If a hospital wants improved scores, building a culture of improvement will be the framework for attaining the optimal patient experience."

Getting to a culture of improvement, or creating an organization in which quality is hard-wired, is potentially the most difficult hurdle to clear when improving HCAHPS scores. The transition to a culture of improvement requires complete organizational alignment with patient experience as a top priority. In fully aligned organizations, each staff member understands that patient care is his or her business. "It's not only about nurses or physicians improving care, it's about everyone in the system being looked upon as a caregiver, even if their job does not allow them to provide actual care," says Dr. Geffner. Complete alignment is not something that is achieved simply. Regardless, the culture is the foundation for all behavior. Being committed to establishing a culture of improvement is the imperative to achievement at the highest levels.

To achieve alignment, hospitals must construct a process through which a culture of improvement can be built over time. Part of that process is for employees to become data literate so they understand the metrics and implications and for data reporting to support accountability; patient satisfaction is a 100 percent participation activity.

According to Dr. Geffner, for hospitals trying to achieve complete alignment around patient satisfaction, there are a couple of necessary steps to take.

1. Get the CEO on board. "If it's a top priority personally on the CEO's agenda, and if it's built into strategic priorities of the hospital or the system, then the entire C-suite will come to understand the topic's importance as well as their role in leading the rest of the organization," says Dr. Geffner.

2. Ask the tough questions. Part of creating an improvement strategy involves a careful organizational analysis. C-suites should be clear about their organizational vision, the strategic priorities that will move them forward and kind of infrastructure and talent needed to implement change.

3. Select a doable number of initiatives. Change fatigue is a danger that is all too real. Tackling a realistic number of initiatives will reduce the risk that employees become disengaged because of feeling too busy, overworked or overwhelmed.

4. Get involvement from employees. At the same time, it is vital employees are part of the discussions about improvements and decision making. Frontline employees have important insights about what policies mean in practice and which behaviors must be changed to allow the initiatives to succeed. "Whatever you decide to do, it should involve engagement from top, midlevel and frontline employees," says Dr. Geffner.

5. Talk about it. Keeping the data transparent and discussing it regularly in the boardroom and in other management meetings is vital. These meetings are important venues for sharing patient stories, learning what can be improved and celebrating   successes.

Above all, Dr. Geffner says hospitals must acknowledge that improvement starts with clear and consistent support from leadership. "Improvement is not a project. It is a long-term strategic commitment that takes everyone's efforts, time and resources," she says.

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