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Does Response Rate Impact HCAHPS Scores?

Posted By Hope Brown, Monday, August 27, 2018
Updated: Monday, August 27, 2018

Proactive hospitals always strive to improve patient experience, knowing that the best way to obtain this valuable feedback comes directly from patients, relying on surveys to create measurable results to continually improve hospital practices. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is one metric used to gain this valuable insight from patients. The key for this prized patient insight is to ensure that a reliable number of patients provide survey feedback. Response rate refers to the number of patients who responded to the survey, in relation to the total number of patients in the sample.

A quick review of HCAHPS publicly reported data shows the national average response rate has dropped since the initial program implementation. The average response rate in 2008 was 33%, compared to 28% in 2016. The decrease in response rate shows that today’s hospitals are receiving valuable feedback from a smaller percentage of their total population.

Why worry about response rate?

CMS stressed the importance of response rate to measure reliability in their April 2018 podcast highlighting ways to improve response rates. The Hospital Quality Institute (HQI), California HCAHPS Improvers Playbook identified a relationship between California hospitals’ response rates and HCAHPS scores. In addition, a nationwide in-depth analysis of the July 2016 - June 2017 publicly reported HCAHPS data found a correlation between all HCAHPS dimensions and response rate.

This table shares the correlations found in the nationwide analysis of Hospital Compare data. A correlation value is a number between -1 and 1. A positive relationship indicates that when one variable increases, the other measure is likely to increase as well. As you can see in this table, correlation values range from .310 - .506, exhibiting a moderate-positive relationship. As a practical application, for every in 1 point increase in response rate a hospital achieves, the hospital could expect to see an increase of .501 in their Overall Rating score. 


With the possibility of all HCAHPS dimension scores increasing in relation to response rate, this has the potential to impact Value-Based Purchasing (VBP) reimbursements as HCAHPS dimension scores are associated with VBP points and Medicare reimbursements. 

These values surprise even the most astute industry leaders; this relationship would be unlikely if feedback was received from a truly representative sample. Just as an increase in response rate is correlated with an increase in dimensions scores, the converse has been found—when response rate decreases, dimension scores tend to decline as well. This research suggests hospitals with low response rates may not be getting the best representation of their total population, negatively impacting their HCAHPS scores.

With recent research in mind, it’s critical that hospitals consider the importance of response rate to capture the true patient experience at their facility. Increasing and maintaining response rates allow a hospital to receive patient feedback on topics that matter most to patients, and allow for more accurate score in HCAHPS dimensions.

Since joining PRC in 2000, Hope has applied her expertise in statistical analysis, physician studies, and patient experience to help clients use data to improve customer service and achieve market leadership. She is recognized as a leading consultant to hospitals and health systems seeking to leverage best practice models to maximize Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores. Her skills in executive training and physician engagement, and her deep-seated knowledge of multiple product lines, round out a broad base of experience that has enabled her to contribute significantly in a number of key roles at PRC. Hope earned a Bachelor of Science degree in Biology from Trinity University in San Antonio, Texas.

Tags:  HCAHPS  response rate  survey  Value-Based Purchasing 

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Calculating and Understanding the Drivers of a Net Promoter Score in Health Care

Posted By Andrew S. Gallan, PhD, Monday, May 15, 2017
Updated: Thursday, May 11, 2017

In 2016, Advocate Health Care, the largest health system in the Chicagoland area, integrated into its performance measures a Net Promoter-like score, which they call a Patient Loyalty Score (PLS). Net Promoter Score (NPS) is a valuable metric, and it has been adopted by many companies in almost every industry. NPS is a simple, easy to use, and easily calculated metric that is intuitively associated with business health by assessing a respondent’s likelihood to recommend an organization to a friend or colleague.[1] Health care organizations are beginning to see its value, and are exploring how it is best calculated and used.

For Advocate Health Care, PLS is constructed using data from CAHPS and vendor surveys, and utilizes the likelihood to recommend question. Only a top-box score is defined as a promoter, and varying bottom scores are defined as representing a detractor. That is, for a five-point scale (ED vendor survey) the bottom three responses are categorized as detractors; for a four-point scale (HCAHPS) the bottom two are detractors; and, for a three point scale (CG-CAHPS) only the bottom score is a detractor.

Some issues with the measure include the referent (CG-CAHPS asks about likelihood to recommend the provider’s office, ED refers to the department, and HCAHPS asks about the hospital), and the limited scale width (the original NPS scale is 11 points). However, for me, having a patient-provided measure outweighs the issues, and I commend the organization for holding people accountable for patient perceptions of care. The strength of this metric is to create system-wide responsibility for a patient-provided measure, thereby ensuring that the patient’s voice is heard.

Like most organizations, Advocate Health Care is interested in earning increased rates of positive word-of-mouth recommendations. As a result, I recently engaged with Advocate as an Academic-in-Residence. In this role, championed by EVP & COO Bill Santulli, SVP & CNO Susan K. Campbell, and VP Information and Technology Innovation Tina Esposito, I performed analytics to identify drivers of PLS. The two important research questions that drove this project were:

  1. Which variables are the most important drivers of PLS?
  2. What can we learn from patient comments about potential drivers of PLS?

In order to investigate these questions, I was provided with almost two years of HCAHPS, CG-CAHPS, and ED survey data and patient comments. Top line results included the following:

Inpatient (HCAHPS): Nurses and personal issues (privacy, pain, and emotional issues) had by far the most impact on patients. Positive comments centered on comfort, communication, and care. Negative comments focused on food.

Outpatient (CG-CAHPS): The face-to-face interaction between a patient and physician is the “moment of truth,” and as such is what the patient apparently will use to evaluate the entire experience. Positive comments centered on comfort and communication. Negative comments focused on waiting and rude treatment. 

Emergency Department (Vendor Data): When patients are in the ED, taking care of personal issues will have the greatest impact on PLS. These issues include keeping patients informed about delays, caring about patients as people, pain control, and providing information about caring for yourself at home. Positive comments centered on comfort, communication, and care. Negative comments focused on feeling vulnerable and afraid in a busy and foreign environment.

As a result of this project, Advocate Health Care is now embarking on disseminating the results, integrating insights into daily practice, and evaluating additional questions that emerged from the analysis. I’d be interested in hearing more about what your organization thinks about NPS, how you use it, and what you have learned as a result!

[1] NPS was first proposed by Fredrick F. Reichheld, (2003), "The One Number You Need to Grow," Harvard Business Review, 81 (December), 46-54. For more on advantages and issues utilizing NPS in health care, see

Andrew S. Gallan PhD is an assistant professor at DePaul University in Chicago, a member of the Editorial Review Board of Patient Experience Journal, and principal of Dignity in Action, Inc., a PX analytics and advisory company ( Andrew can be contacted via email:

Tags:  CAHPS  CG-CAHPS  data  drivers  HCAHPS  net promoter score  NPS  patient loyalty  patient loyalty score  survey 

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The Patient Experience as the Ethos of Nursing

Posted By Susan E. Mazer, Ph.D., Tuesday, January 24, 2017

The key to the optimal patient experience is sustainably grounded in the ethos and practice of nursing.

From Florence Nightingale: “I use the word nursing for want of a better. It has been limited to signify little more than the administration of medicines and the application of poultices. It ought to signify the proper use of fresh air, light, warmth, cleanliness, quiet, and the proper selection and administration of diet -- all at the least expense of vital power to the patient.”

To nurse someone to health makes us think of specifics images of caring, as well as any number of tasks and responsibilities. The professional nurse, however, does so much more with skill, knowledge, and in-depth commitment. 

When Nightingale wrote this, she was writing a job description of one person. However, in current healthcare organizations many of these tasks wind up being handed to environmental services, housekeeping, and dietary services. Further, a nurse aid or CNA might also take over bathing patients and providing blankets.  

Yet, there is higher risk with the nurse not doing the bathing and not observing patients except at medication time. Nightingale often wrote about how a patient would perk up when the nurse walked into the room, but such a burst of energy was for performance or out of pride. A skilled and trained nurse would see past this to actually understand what was happening with the patient.

The result is that, for patients, many people are involved in their care, with the nurse administering medications and performing a variety of clinical tasks. What’s more, nurses do all the work of tending to medical needs according to what physicians request and, as well, what they see.  

For patients, each person that enters their room performing any of these roles carries the mantel of nursing. Because of this, it is common for patients or family members to ask whichever staff person is in the room about the next pain medication, meal, or any number of other things. 

If you ask patients who is the most important to their recovery, they will tell you it’s the physician and the nurse. They tolerate the system that sends in surrogates, but become frustrated with the inconsistency in quality and authority.

Where is Nursing Located in the Patient Experience?

Nurses have not yet been called to, called for, referenced, or sought out to lead us into a more humane model of care that has been codified in each nurse from the day they decided to go to nursing school. The patient experience is a nursing tradition of compassion and respect for the personhood of the patient. It is inseparable from what nursing is. 

Further, a subculture of nursing has formed without acknowledging its dilution of the patient experience/caregiver relationship. Patients now have one person to tend to taking their vital signs, another to respond to all their non-clinical needs, another to feed them, another to bathe them, and still another to get the “real” nurse. 

Each one of these individuals knows a piece of the patient only to the degree their position allows. The rigorous call to service that is the nurse, the attention to every detail that holds the clue to the patient’s pain and suffering is not part of this subculture. In fact, the tasks that a CNA or nurse aide performs are done with minimal understanding of what human caring is.  While they are considered non-professional assistants, to patients these individuals are in their room to care for them. And to do so with the highest regard for the patient and family.

In service to patients, the cohesive practice of caring should be consistent in all those who take on even a small piece of the total responsibility. Everyone, then, who enters into the domain of the patient is a nurse in the sense, as Nightingale expressed, that the health of the patient has been entrusted to them. Anything less is unsafe and inappropriate to the healing relationship and integrity of care.

Nightingale wrote that the task of the nurse is to make sure that her patient is cared for exactly as she would if she is not there, for any reason at all. 

She wrote, “Let whoever is in charge keep this simple question in her head (not, how can I always do this right thing myself, but) how can I provide for this right thing to be always done?” 

And Then Came HCAHPS

The HCAHPS survey makes visible what Nightingale acknowledged 150 years ago and is the mandate of Watson’s Theory of Human Caring. 

HCAHPS surveys begin with questions about physicians and nurses speaking to the patient with respect. Nightingale wrote this about how to speak to a patient:

“Always sit within the patient's view, so that when you speak to him he has not painfully to turn his head round in order to look at you. Everybody involuntarily looks at the person speaking. If you make this act a wearisome one on the part of the patient you are doing him harm. So also if by continuing to stand you make him continuously raise his eyes to see you. Be as motionless as possible, and never gesticulate in speaking to the sick.”

Respect has many meanings, each unique to the individual and the situation. However, holding the patient in the highest regard was a founding tenet for the Nightingale nurse. She wrote about how not to strain the patient, how to acknowledge by one’s actions that the patient’s comfort was primary to the conversation.  At that time, and even today, this is a demonstration of respect.

Many nurses have no idea what HCAHPS is other than memorandums coming from others.  They are removed from the other side of HCAHPS because the ethos of their practice disavows disrespect for the patient, for the family, and for each other. And, what HCAHPS measures is already within their professional mission and practice.

As we continue to move into greater depth of our understanding what the patient experience is for the patient, those who care at the bedside must be acknowledged and supported. The key to the optimal patient experience is, again, in the ethos and practice of nursing. It is in the mission of caring merged with skill and knowledge that is in the core of each nurse that we will find answers to how to respect and heal patients into wholeness.


Susan E. Mazer, Ph.D. is the President and CEO of Healing HealthCare Systems®, Inc., which produces The C.A.R.E. Channel. In her work in healthcare, she has authored and facilitated educational training for nurses and physicians. Dr. Mazer has published articles in numerous national publications and is a frequent speaker at healthcare industry conferences. She writes about the patient experience in her weekly blog and is also a contributing blogger to the Huffington Post’s "Power of Humanity" editorial platform, dedicated to infusing more compassion into healthcare and our daily lives.

Tags:  compassion  HCAHPS  healing  heart of healthcare  nurses  patient care  serve  tradition  wholeness 

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SPOUSE-CAHPS – For Better or for Worse (Happy Valentine’s Day)

Posted By Don Prisby, Tuesday, February 2, 2016
Updated: Monday, February 1, 2016

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,

"Let’s see:
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.

Tags:  HCAHPS  improvement  pay-for-performance  survey  value-based purchasing 

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Universal Children’s Day Reminds Us of Our Impact on Pediatric Patient Experience

Posted By Martie L. Moore, Sunday, November 1, 2015
Updated: Monday, November 2, 2015

"The one thing all children have in common is their rights. Every child has the right to survive and thrive, to be educated, to be free from violence and abuse, to participate and to be heard.”1 - Secretary-General Ban Ki-moon

As a former pediatric nurse and expert witness for child protection services, I’ve spent a lot of time caring for children in the hospital and home setting. I know one of the greatest things I’ve learned is that we as caregivers can empower children during difficult situations. The need to support the wellbeing of children extends beyond healthcare: It is a universal initiative.

Universal Children’s Day on Nov. 20—unlike the traditional Mother’s Day or Father’s Day recognized in the United States— was established by the United Nations General Assembly in 1954. All countries are encouraged to promote not only mutual exchange and understanding among children, but also to initiate action to benefit and uphold the wellbeing of children around the world.

Children in the U.S. may not always face the same frightening conditions as elsewhere in the world. But this day helps us to remember that we as clinicians still have a responsibility to create an atmosphere that supports the children under our care. We know that the less stress and anxiety a child has, the better their ability to cope in a stressful situation. Hospitalization is one of the stressful situations that we can do something about.

Improving patient experience is already a major target for hospitals, and hospitals are measured and paid based on HCAHPS surveys completed by adult patients. In October 2014, the Agency for Healthcare Research and Quality posted a pediatric version of the HCAHPS survey. This pediatric survey is under review this year as a possible benchmark on which to base hospitals’ Medicaid and Children’s Health Insurance Program reimbursements, leading to the expectation that this pediatric HCAHPS survey will ultimately factor into reimbursement as the adult equivalent does now for Medicare.2

Now is the time to be thinking about how to address this special population. The ways you care for children in your facility can go a long way toward producing a positive experience for both the patient and their loved ones.

Make the Hospital A Safe Place for Children

We all know hospitals can be a very scary place for anyone, let alone children. A child doesn’t know what to expect, and is constantly meeting new strangers. He or she may not understand what’s happening to them. They could be experiencing pain from their illness, the treatment, or both.

So how do we make the hospital a place where a child can feel safe, participate, and be heard? You can make a big impact with small changes: Start with what they’re wearing. Pajamas are a great source of comfort, and while the child’s personal pajamas may not be an option, your facility can still stock pediatric gowns that promote comfort and modesty, have kid-friendly prints, and feel soft like the pajamas they may wear at home. Consider pediatric gowns with MRI-safe plastic snaps that negate multiple gown changes.

While using pediatric gowns that evoke the comforts of home, also be sure that a child’s hospital bed is a safe place. Avoid performing any painful treatments while they are in their hospital beds so that it remains a haven that they can trust.

You can also help by communicating directly with your patients. Talk to them, not at or above them, so they understand what is happening. Speak at their level, both intellectually and physically, crouching or sitting down to look them in the eye.

You may even choose to draw pictures to help demonstrate what is going on inside their bodies or a treatment they are about to experience. Many children "play nurse or doctor” at home; offer to let them participate in their care by holding the stethoscope, counting with you for their pulse or heartbeat, or perhaps picking a favorite color for a bandage or cast. Your conversation may also help distract them from their pain. The fun prints on their gown featuring friendly animals or characters could be a conversation starter in itself. Ask them about pets, sports, movies, or their funniest joke. A good belly laugh does wonders for the soul!

Good communication involves good listening. Take the time to hear what a child says to you. You could learn that something as simple as a special toy or a quick trip outside for some fresh air could make him or her feel better.

Listening and observing may also help you uncover any signs of abuse. If you observe these signs, stay calm and report the suspected abuse immediately per your facility protocols.

You Make a Difference

Every day, clinicians make a big difference in the lives of the children they care for. Make yours a good difference. Delivering extraordinary care to our children can change lives, helping them grow up to be healthy and successful adults who can protect the next generation of youth around the world.

1. Universal Children’s Day. Available at: Accessed October 15, 2015.
2. CMS may use new child HCAHPS to adjust Medicaid hospital pay. Available at: Accessed October 15, 2015.

Martie L. Moore is chief nursing officer of Medline Industries, Inc. based in Mundelein, Ill, a leading provider of medical products and clinical solutions across the continuum of care. In this role, Moore provides nursing leadership for solution-driven clinical programs, delivers product development to enhance bedside practice and launches quality initiatives across the continuum of care. With what she learned during the nearly 30 years of clinical experience and extensive executive leadership, Moore now develops forward-thinking solutions and programs for those in the field today.

Tags:  HCAHPS  Hospital  patient experience  patient safety  pediatric 

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Patient Experience Builds Brand Equity

Posted By Jim Lahren, Monday, March 9, 2015
Updated: Monday, March 9, 2015

Healthcare in the US continues its radical transformation with the rollout and rapid adoption of high-deductible insurance plans. More than even value-based purchasing, this has the potential to reshape the healthcare landscape because it has awakened the healthcare consumer. In its 2014 Employer Health Benefits Survey, The Kaiser Family Foundation reported that 41% of all firms (32% of large employers, 61% of small firms) have rolled out high-deductible insurance plans.

With the patient now responsible for large deductibles at insurance company negotiated rates, households are forced to become smarter consumers of healthcare services. New businesses and services have been introduced to meet market needs. Witness the rapid expansion of urgent care facilities, the availability of vaccinations at pharmacies, and most recently, staffed clinics within retailers. These all serve one purpose: providing consumers more expedient, cost effective access to care on their terms.

This ever-increasing trend in consumer activism necessitates that healthcare providers start to view their patients as healthcare consumers. In a January 2015 article titled "Improve patient satisfaction from the eyes of the consumer,” this author advocated that providers improve patient satisfaction in order to build their brands. With a stronger brand, they can better compete, and be among the winners as the industry consolidates. Overwhelming feedback to the article questioned the appropriateness and relevancy of patient satisfaction as a stated goal. Instead, reviewers advocated that patient outcome should be the sole focus. Notably, the article’s premise: "How will hospitals compete given the structural changes facing their industry?” was not addressed.

Why did this happen? Simply, the phrase "Patient Satisfaction” has become polarizing. CMS measures hospital patient satisfaction and ties reimbursements through standardized patient surveys called HCAHPS. Many clinicians believe that the HCAHPS survey is misguided, inaccurate and leads to excessive costs in an effort to please the patient. And as one nurse said, "And you can’t make everyone happy!”

An expert on patient experience development and cultural transformation, Jake Poore of Integrated Loyalty Systems, says: "Many providers today feel like they are set up to fail. With the pressures of new requirements, tools and processes for documentation (EMRs) and having to see 10-30% more patients than last year just to make the same productivity or revenue, they feel like they are literally running ‘on the daily gerbil wheel.’ When you add the fact that most patient clinic appointments are in 15 minute windows, you have a perfect storm: The last thing on a provider’s mind is patient satisfaction or survey results.” What is the root cause? Poore suggests a misalignment of priorities between what healthcare organizations measure, reward and hold accountable and the priorities patients expect from their caregivers. When Poore and his team ask healthcare leaders, providers and staff to identify the top 4 most important operational priorities and prioritize them in order, they say: #1. productivity, #2. competency, #3. safety, and #4, courtesy.

On the other hand, when you ask patients (which Poore and his team have done with nearly all of their clients around the country) what they want most from the front desk to their physicians and nurses, patients rate their priorities as: #1. courtesy/compassion, #2. competency, #3. productivity, and #4. is safety. In explaining the patient priority order, Poore says that it rarely even occurs to patients that a hospital or the caregiver is not safe. As one patient said it, "safety only becomes my concern when safety has been jeopardized.” Overwhelmingly, what patients say they want FIRST is a care team member (clinical and non) who is "warm, welcoming and listens” and talks with them, not to them: "… as an individual, with dignity and respect. As patients, we assume you are smart and an expert of your trade, but we want you to start the conversation on the human side first, do your exam second.”

As consumers, we purchase products and services we like. We are most loyal to brands where we have an emotional connection and where the people behind those brands seem to share our priorities and values. But when managing our own healthcare, we have traditionally been the "Patient.” The patient has now become the consumer who expects the healthcare provider to treat them as such. But how should providers adapt to this new paradigm? They need to focus on their client, the patient, and improve the patient experience. More than ever before, healthcare consumers have many choices for their care. Providing a poor patient experience will damage an institution or provider’s brand, resulting in lost loyalty, lost patients, and above all, lost revenue. By improving the patient experience, providers will not only enhance their patients’ well being, they are better equipped to prevail in the new healthcare marketplace.

Jim Lahren is the Principal of Lahren Consulting. A former Chief Marketing Officer, he has worked in highly competitive consumer categories where he developed a comprehensive understanding of consumer behavior. His retail experience spans big box, department store, specialty, and online. He believes that patient experience will become the driver in building the institution's brand and is excited to attend The Beryl Institute’s Patient Experience Conference 2015.

Tags:  branding  HCAHPS  healthcare  patient experience  survey 

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Patient Experience: Above and Below the Surface

Posted By Don Prisby, Monday, March 2, 2015
Updated: Wednesday, February 25, 2015

Can listening to icebergs teach us something about listening to patients?

One morning last week, I was tuned in to National Public Radio (NPR). The feature story was about a gentleman who "listens to icebergs." Listens to icebergs? Really? In some way, I sensed a kindred connection with this Arctic audiologist of sorts. But I just couldn’t put my finger on it.

As the story unfolded, I learned that the majority of an iceberg’s structure is under water, beyond our field of vision. That which can be readily seen relays only partial information about the iceberg’s actual state. What was asserted in this radio interview is that each iceberg emits audio clues that, once aggregated into patterns, can be considered correlative indicators of that iceberg’s current state, be it melting or perhaps moving. The iceberg’s voice can also reveal what it’s about to do - either cascade into the deep, dark blue or worse, menacingly float into the shipping lanes.

Then it dawned on me why this story inspired me. Why is that, you ask?

Because you and I, in our various healthcare roles, are like the iceberg attendant. By listening to patients’ input about their care on a daily basis, we gain insight about conditions, behaviors and processes that impact the patients’ well-being. Additionally, similar to icebergs, most of what our patients are really experiencing is below the surface. When we listen to our patients intently, we are likely to avoid being caught unprepared for immediate concerns or finding ourselves on a "patient-care Titanic," about to hit an obstacle below the surface.

One of our missions as patient experience professionals is to track immediate and long-term trends based on patient feedback. We seek to hear, in real-time, insights from our patients, gleaned from attending deeply to their verbal, emotional, psychological and physical concerns - those that we can observe right away, and those that we understand only by actively listening.

But what does actively listening to the patient mean? Lagging data from 45-day-old survey responses is important - yet not enough. Actively listening on a daily basis requires the commitment to:

  • Hear in real-time the urgent concerns of our patients
  • Turn that input into insight · Share that insight with our front-line staff
  • Look for team members or practices that can be coached or improved right away
  • Discover trends that tell us more about our future success
  • Act on leading indicators
  • And listen. Again. And again. And again. Daily.

Leading hospitals I’ve worked with have realized dramatic increases in operational and clinical performance by actively listening, in real-time, to the patient. Then, they take active steps to improve behaviors often associated with improving HCAHPS scores. These same hospitals have also achieved other benefits such as engaging non-clinical staff in the mission of care and increasing staff loyalty through the daily sharing of input that has come directly from their own patients. An iceberg will not thank you for your concern, but a patient can - and often will.

With real-time insight and rapid-cycle improvement, we will gain new awareness. We will improve clinical and operational processes. We will assure a healthier and more effective care environment. And we will avoid the financial, reputation and patient-care disasters that might otherwise be lurking, unknown, unseen, unheard, under the surface and up ahead – for the next shift, or for the next patient.

For more insight about how some organizations are using leading insight to improve clinical, operational, staff engagement, safety and care improvement, The Beryl Institute has recently published this Case Study about the VA New Jersey Health Care system success using real-time insight for improvement.

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. Don is an avid reader and recently was a guest speaker at Concordia University’s (St. Paul, MN) MBA program presenting the topic "Intrinsic and Extrinsic Elements Influencing Culture Change.”

Tags:  HCAHPS  listen  patient engagement  Patient Experience  real-time 

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Improving Patient Experience: It’s Less Complicated than You Think

Posted By Joel High, Thursday, September 18, 2014

It’s on all of our minds. It keeps us up at night. HCAHPS scores are not improving (or at least not fast enough). Value Based Purchasing is becoming more and more established. The competitor across town just remodeled their patient rooms and are wooing our patients their way. Employee morale and engagement are stagnant or declining. To top it off, your board members and CEO are demanding action.

Is this a worst case scenario? Perhaps. However, improving patient experience tops the list of strategic priorities for many health care organizations around the country. Medical school, nursing school, nor business school has prepared today’s healthcare leaders to manage, much less improve, the patient experience. A common misconception is that improving patient experience is a huge and complex undertaking, but in reality, improving patient experience doesn’t have to be complicated. In fact, in many ways it’s simpler than you think.

During my years working across the continuum of healthcare including hospice, long-term, acute care and now as a Patient Experience Improvement Coach, I have seen some simple and inspiring ways that healthcare organizations have improved the experience for patients and their loved ones. I share two examples of easy to implement initiatives below.

Every Patient Is My Patient

At a community hospital where I served as the Patient Experience Lead, we implemented an innovative patient experience program called "Every Patient Is My Patient” in response to declining HCAHPS scores around staff responsiveness. The program hinged on the philosophy that every employee and volunteer has an impact on the patient experience. The ask: Employees and volunteers were expected to respond to call lights immediately if they noticed one illuminated. Although it was known that on occasion there would be needs that fell outside of the expertise of the responder, we believed that the impact of responding to the call light right away would be important to patients and would communicate that the organization cared about them.

What we found was that the "Every Patient Is My Patient” program reaped immediate and sustained improvement in the patient experience and an increased level of team member accountability. In less than 6 months, this simple initiative resulted in a 5% increase in HCAHPS scores around staff responsiveness.

Through The Voice of Our Veterans

By leveraging insights gleaned from real-time patient feedback and improvement coaching support, one of our Veterans Affairs partners found that Veterans were having a difficult time finding their way to their appointment, securing post-discharge assistance and basic post-visit transportation services. Faced with these issues impacting their patients, a Roaming Ambassador program was put into place. The Ambassadors main objective: seek out Veterans who appear to need assistance and offer to assist. This was contrary to the traditional approach of having Veterans looking for assistance. The Ambassadors assist Veterans through every aspect of the discharge process and ensure that the needs of each veteran are supported. Comprised of volunteers and work study students, the Roaming Ambassadors worked weekdays with a team of about 30 on rotating shifts. To make the Ambassadors more visible to Veterans and others visiting the facility, donated funds were used to purchase Navy blue vests which on the back read "The Price of Freedom is Visible Here.”

The result of the initiative paid off with Veterans raving about the great service of the Ambassadors. This simple approach has made a big difference in the patient experience at this medical center and has helped create a more warm and inviting atmosphere at the medical center.

Creating an exceptional Patient Experience in today’s healthcare marketplace is extremely important. Everyone within the organization should be focused and committed to delivering an exceptional patient experience. Similar to a rowing team, progress becomes easier when all of the team members are working together towards the same goal. It doesn’t have to be complicated. Quick wins that sustain are possible with focus and attention.

Joel High, MDiv, MBA is a Performance Improvement Coach with TruthPoint. Joel’s passion is in helping healthcare organizations to transform their culture and create patient centered processes and practices. Joel has been engaged in patient centered care and patient experience work at both locally and nationally for more than a decade.

Tags:  HCAHPS  Hospital  Patient Experience  veteran  voice 

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Understanding the Totality of the Patient Experience through Total Quality Encounters

Posted By Paul Roemer, Monday, January 27, 2014
Updated: Saturday, January 25, 2014

Point One. New College, Oxford, was founded in 1379, hundreds of years prior to the invention of the I-Beam. As a result, the roof of the main dining hall is supported by big oak beams, two feet square and forty-five feet long.

About 100 years ago, entomologists were studying the beams and noted that they were infested with beetles, a problem which had eroded the integrity of the roof. Unfortunately for the college it was believed that all of the large trees from the old-growth forests had long since fallen.

As luck would have it, the college owned a great deal of land and actually employed its own forester. When the college asked their Forester about whether he knew of any large trees, the Forester replied, "I was wondering when you’d come asking.” It was discovered that when the college was founded, a grove of oaks had been planted to replace the beams in the dining hall when they became beetle-infested. This information had been passed down from forester to forester for more than 500 years.

Long term planning: Planning that involved the exact solution, not a series of ad-hoc fixes year-in and year-out.

Point Two. Heliocentric versus geocentric. Heliocentric—the planets revolved around the sun. Geocentric—the earth was the center of the universe and everything revolved around it. Copernicus. Early astronomer, pretty smart guy—he got it right.

Point Three. Patient experience. The hospital is the center of the universe and the patients revolve around it. Where is Copernicus when we need him? What about a patient-centric model?

Four out of five hospitals do not have a patient experience strategy. Of those 20 percent that do, most, if not all of them, do not include anything outside of HCAHPS.

There are several fatal flaws with the hospital-centric model of patient experience. Improving HCAHPS scores is not the same thing as improving patient experience. One strategy involves improving a set of numbers, the other involves improving experiences.

Here are the flaws around what most hospitals are doing:

The experiences of outpatients are ignored—surveying them doesn’t count; we already established that with HCAHPS.
The experiences of all prospective patients - the largest group of stakeholders - are ignored. Definition of Prospective Patients—everyone who has ever been to your web site, called the hospital, parked in the garage, eaten in the cafeteria and driven past the billboard advertising the hospital’s urology practice.

The hospital-centric patient experience model requires hospitals to try to apply a fix for every patient experience, patient by patient, day after day. One hospital fixing thousands of patients’ experiences. Shampoo, rinse, repeat. Since the patient is no longer classified as a patient when the fix is applied, whose experience is the hospital attempting to fix?

The patient-centric model of patient experience centers around one patient, one person. It is designed, planned and thought through. A patient, like a customer, should be able to carry the hospital around on their iPad. That person should be able to accomplish everything they need to with the hospital, with the possible exception of a hip replacement, the same way they can accomplish everything they need to with Amazon.

The following graphic shows the lifecycle of someone’s experience with a hospital. The most noteworthy aspect of the graphic is that only the green circle represents a person’s time in the hospital. The blue circles represent all of the other interactions someone has with the hospital.

Patients only spend a small fraction of their time in the hospital. Hospitals only spend a fraction of their time understanding the totality of someone’s experience.

Since most hospitals do not have a working definition of patient experience, I like to use this definition: TQE—the Total Quality of a person’s Encounter with the hospital is equal to the sum of their HCAHPS scores plus all of the nonclinical patient touch points. This definition parallels The Beryl Institute’s definition of the patient experience – the sum of all interactions, shaped by an organization’s culture, that influence patient perceptions across the continuum of care. Using these definitions as guides in their own organizations enables healthcare leaders to truly keep the patient at the center of their universe.

A remarkable experience happens for every person, every time, on every device.

Paul Roemer
Vice President
Tower Strategies

Tags:  Customer Service  defining patient experience  HCAHPS  healthcare  Hospitals  Patient Experience  patients 

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Could A Simple “Fix” Exist For Influencing the Patient’s Perception of Care?

Posted By Marlena Jareaux, Tuesday, October 29, 2013
Updated: Sunday, October 27, 2013

HCAHPS, enacted by Federal policy makers in response to the uneven care among hospitals, seemingly attempts to even the playing field. The primary goal is to lower the skyrocketing medical costs in our country while simultaneously giving more weight to the actual patient experience. This, in and of itself, is timely, very much needed, and will benefit our society as a whole in the long run. The problem is, as is often the case when a decision is made that attempts sweeping changes that affect many people, the mandate to essentially "fix it or be penalized” has made hospitals scramble to find fixes to a problem that many have found not to be as simple as it sounds. Or is it?

Recently, while doing a search on the internet on the phrase, "medical decision-making preferences,” I was struck by the synopses found within the first four pages of results.

Are there cultural differences in patient’s shared decision-making preferences
(of course there are)
Variability in patient preferences for participating in medical decision-making
(I would assume so)
A theory of medical decision making under uncertainty
(Is there just one?)

My favorite is the lecture notes from a medical education course on medical decision making. The first sentence reads, "This week we enter the strange and fascinating world of preferences, utilities and feeling.”

NOW, we’re onto something!

Tempting as it is to hope that your task of increasing your patients’ perception of quality care can be accomplished by a one-size-fits-all approach that can be purchased and implemented, it just doesn’t exist. Preferences change (don’t yours?), people change (gosh, do we), and circumstances change (the only thing that is constant, IS change). Fortunately, one of the greatest tools that can be used to keep abreast and stay ahead of the "strange” and seemingly complex world of your patients’ perceptions and expectations, is already embedded into the roots of every single healthcare organization that exists into this country and the healthcare workers working in them. CARE enough to ask. If you are human, you can care enough to ask.

I’m sure that in our pay-for-performance and results world that we live in, people will say "we don’t have the time to ask.” I’ve seen versions of this for myself: the revolving-door environments where the patient can barely see the eyes of the doctor or nurse to be able to even recall the color of those eyes, much less to detect any compassion in them. Or the seemingly thriving practice that delivers results for their patients, but can’t figure out why their scores for "likely to recommend” aren’t moving upwards.

Bottom-line is this: previously, hospitals could always rely upon patients walking through their doors because, well, they needed care and the hospital was there. Patients had to accept the care that they got, and only the truly-bad encounters got reported by those who bothered to take the time to do so. That landscape has changed. Like it or not, HCAHPS is here to stay, your patients are having their perceptions elicited, and you are being graded and rewarded (or penalized) according to those grades (and thereby, perceptions). Not only are those grades being publicized on the largest billboard that exists (the Internet), but so are the neon signs telling your patients and prospective patients to view your grades and choose in accordance with them.

On page one of the Hospital Quality Initiative Overview, found on the CMS website, you will read, "This will encourage consumers and their physicians to discuss and make better decisions on how to get the best hospital care…”

One powerful "fix” then, for all of you looking for one, is as simple as this: ASK.
Marlena Jareaux

Tags:  HCAHPS  patient experience  pay-for-performance  perception  quality of care 

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