SPOUSE-CAHPS. What a great idea! Hilarious. Actually… when you really, really think about it, it’s a terrifying prospect. Imagine sitting on the couch together with your spouse or significant other, filling out THAT survey,
The rooms are clean.
You’re a good communicator.
It’s quiet at night.
And the food is good.”
Ninety days later, you tear open the snail-mail envelope that finally arrives. And the results: Congratulations you’re in the 95th percentile! "Whew, another good quarter!” As healthcare professionals, since it seems that we evaluate just about everything else, why not take a peek at our personal relationships? Well, maybe not.
H-CAHPS, CG-CAHPS, PEDS-CAHPS, ED-CAHPS... Now those can also be terrifying. With the move from fee-for-service compensation to outcomes-based quality, the full force of Value Based Purchasing and the oversight of the Centers of Medicare and Medicaid Services in place, it seems we’re all in for evaluation and scrutiny. Like a happy couple. Forever and ever and ever. These post-discharge scores are helpful as benchmarking tools to guide organizational change. Just like in a healthy relationship, how much improvement we make is dependent upon the approach and methodology we employ to transform our behaviors and impact change.
With the myriad approaches to performance improvement advocated by multiple authors in contemporary business literature, a wide array of styles can be observed. In addressing behavior change, insights like Quint Studer’s, "Hardwiring,” are quite prescriptive. Employing a different tone, Fred Lee’s, "If Disney Ran Your Hospital, 9-1/2 things You Would Do Differently,” is informative and insightful. In his New York Times best seller, "Unaccountable,” Atul Gawande is instructive, advocating the responsibility of healthcare providers to get "better” based on a commitment to "diligence, doing right and ingenuity.” Marty Markary, surgeon and professor of health policy at Johns Hopkins Hospital and School of Public Health, illustrates the dangers of unchecked health care service in his work, "Unaccountable.” For those who want a great weekend read, Sanjay Gupta’s, "Monday Mornings” is a revealing story about the trials of healthcare that is captivating throughout and concludes with a heartbreaking finale.
While there are a variety of perspectives available, organizations also have various approaches toward people and process change. Some are paralyzed in the face of poor or falling CAHPS scores. Others lack two precious commodities: time and budget. Some over-analyze and are locked in the metrics, unable to translate data to insight and actionable plans. And some are punitive, holding measurement over the heads of their offenders.
Reviewing some of the more successful healthcare systems in my day-to-day work, I find the following: One leading hospital is presenting a Kudos report of same-day patient satisfaction every afternoon championed by the care area leader. Others are escalating such reports to the executive level where upon administrative rounding, recognition can be provided to top performers. Another hospital is engaging all of their non-clinical office workers in assessing the patients’ experience, thus connecting all employees to the mission of the hospital. Still another is informing their providers with the previous day’s assessment of care reports right on their smart phones at 5:30 every morning.
There are as many models about patient experience improvement as there are wedding planners in May. The key combination for success, it seems, is using CAHPS data with a combination of real-time insight and leadership coaching to drive change. Looking forward, this writer sees organizations that are combining CAHPS benchmark and real-time input to create immediate and sustained change.
In closing, one could only hope never to be the subject of a SPOUSE-CAHPS survey. I’m not sure I’d want to see the wide swings or downward-turned trends on my relationship behavior. And I don’t know about you, but I cringe at the thought of how I would be rated for, "Willingness to Recommend.” However, it is exciting to be part of an industry that is getting more and more committed to the intrinsic value of providing extraordinary care. With an internal drive to "do no harm” and extrinsic assistance through benchmarking, real-time insight and rapid-cycle improvement, healthcare systems are transforming their cultures and developing gradual and sustained improvement.
So, SPOUSE-CAHPS? Um, not this guy. CAHPS data, complemented with real time point-of-care insight? It’s time to say "I do… for better or for worse, for richer or for poorer, in good times and in bad, in sickness and in health……care.”
Don Prisby is a business development executive with Minneapolis-based TruthPoint, a technology enabled performance improvement firm focused on delivering patient insight and performance improvement services to healthcare systems nationwide.