What a mouthful: the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey.
To hospital administrators, who are obliged to think (and worry?) about it often, it is simply "H-caps."
This government-mandated, 27-question survey elevates patients to a higher status as healthcare consumers. Instituted by CMS in 2007, HCAHPS has ushered in a new era of respect for what patients think and feel about the quality of care they receive.
Soon, under Medicare's new value-based purchasing methodology, hospitals scoring poorly on the HCAHPS survey could suffer cuts in reimbursement.
Small wonder administrators are hiring people like Steve Whitehurst.
"It's not atypical for a patient to go in for a procedure, see 11 providers from 11 different departments, and if one of those encounters is negative, view the whole experience as negative," said Whitehurst, a man paid to know such things.
He's chief customer officer for BerylHealth, a firm that helps hospitals and health systems take steps to improve the patient experience.
We asked Whitehurst for some free advice on how hospitals can, to paraphrase Dale Carnegie, win friends and influence patients.
ADVANCE: Why is it more important than ever for hospitals to make the patient experience as positive as possible?
SW: For the first time, hospitals are being graded on customer satisfaction. Every other industry is measured through customer service. Hospitals are now in that category.
Also, patients are more computer-savvy today. If you don't keep them satisfied, you will have a 'leakage' of patients who seek care in other settings. In today's world, patients are the first to know about someone's bad hospital experience because it will be blogged about on social media. Patients put their dissatisfaction out there. The community-at-large thinks, 'Wow, they don't care about their patients.'
ADVANCE: What is your opinion of the HCAPHS survey?
SW: It's important to have, but I'm a bit of a skeptic. I call it teaching to the test. If you know the questions on the survey, you teach your nurses and other employees to teach to the test. Right now it's the only way to track satisfaction, but there are many other ways.
ADVANCE: Such as?
SW: Most hospitals do post-discharge calls. Within 24 to 72 hours after you leave the hospital, someone will call and ask how you are feeling. It's very important to do these calls but hospitals have to take that data and do something with it.
When we make post-discharge calls for hospitals, we ask patients, 'What do you want to tell us about your experience?' At one of our client hospitals, we learned through calling that 60 percent of patients didn't understand their discharge medication instructions. Now pharmacists at that hospital have begun doing rounds with patients and that percentage is going down.
If someone calls you immediately after discharge, you are more likely to provide details if, for example, a nurse didn't seem to care about you or kept you waiting if you needed to use the bathroom. We give this information to a nurse manager. We have a CNO call that patient and say, 'I got this information about Nurse Smith, I'm sorry, we are taking action. We feel badly about it.' Patients feel better after a hospital administrator has called them and heard them out.
ADVANCE: Once problems are identified and causes found, how can a hospital institute a permanent fix?
SW: Some hospitals start by hiring an executive in the patient satisfaction area, a vice president of patient experience. Second, hospitals must look at their processes. If they can't do certain things well, they must outsource them.
Lastly, they must commit to implementing change. Most hospitals, once they start discharge calls, see an immediate uptick. But within ninety days, improvements level out - and may start to slide again. They need system-wide change. They need to show their employees they will invest in the patient satisfaction area and bring in someone to implement it.
If improvements are made just to avoid the financial penalty, it may improve a little but if the hospital staff and leadership don't believe in it, it will fizzle. It has to be a culture shift.
ADVANCE: Are you concerned that CMS officials are giving too much importance to patients' opinions?
SW: You will always have some patients who complain. That won't be a problem if a hospital is performing well or above average across the board. But if you are below the line in patient satisfaction, you can't point to those patients as anomalies.
ADVANCE: Any final advice?
SW: Remember the family. It is very important that the family gets the same amount of satisfaction the actual patient gets. I'm involved in my own parents' health care. They have seven or eight care teams between them. I can tell you, I wouldn't go to certain doctors or certain clinics because of some experiences I've seen through them.
Embrace the surrogate caregivers. Call the son or daughter or husband. Make sure you touch all parts of that family.
Michael Gibbons is a former editor at ADVANCE.