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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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The Return on Improvement

Posted By Paul Westbrook, Wednesday, June 24, 2015

In this final article in our three-part series about the three-year patient experience transformation at Inova Health System, we present and examine the results of our efforts. In article one, "A Thin Line, The Nature of Care,” we spoke of adopting a "hospes” approach in healthcare, based on warmth, welcome and hospitality. In "Of Heads, Hearts and Hands,” we illustrated the transition from strategies to action, specifically by inculcating hospitality principles through five key work streams. Today, we must ask: What did we accomplish? What were the measureable results? How did we improve? What was the ROI, the Return… On Improvement?

Since objective and demonstrated numbers are visible evidence of improvement, let’s go there first. At Inova, while we established the foundations for change in the first 18 months of our effort, the latter part of the three-year period started yielding significant improvements across all of the HCAHPS domains. President/COO Mark Stauder reported, "In almost all of the significant areas, scores improved markedly. However there was more than metrics advancing. We were in, and continue to experience, a cultural transformation.” Domains such as, "Overall Rating of the Hospital,” "Nurse Communication,” "Doctor Communication” and "Responsiveness of Staff " scores each rose an average of 42 percentile points. The hospitality principles applied resulted in percentile rank growth from the ~30th percentile to the ~70th percentile in 8 of the 9 HCAHPS domains. Our largest hospital had its most success ever in Q2 of Calendar Year 2015, surpassing goals in 5 domains and being within 2 points of goal in the other three. "By unifying our efforts from the C-Suite to the bedside, we were fulfilling the Inova Promise. We were empowering intentional, genuine and sustainable change,” Stauder noted.

Two of the premises in the Inova approach are 1.) Patient Experience improvement is not a tactic, and 2.) Cultural transformation cannot be delegated. Sustainable performance improvement is a result of systematic inspiration and commitment at all levels of the organization. And it’s not merely about moving the numbers. By focusing on culture, communication, human resources, leadership development and service excellence, enterprise-wide improvement occurred concurrently on all levels as the organization took intentional and measureable steps in delivering the Inova Promise.

Among the learnings in this cultural transformation were the following:

  1. Culture, communication, human resources processes and leadership drive tactics
  2. Defining "Patient Experience” and repeating over and over "what success looks like” provides unifying focus
  3. Cultural transformation cannot be delegated
  4. Data vs. opinion changes behaviors and drives engagement
  5. Human Resource processes empower and sustain service excellence
  6. Leadership’s role is to enable service delivery by removing barriers
  7. Patients need to be part of every step of the process
  8. Clear expectations for improvement must be articulated
  9. Answers lie with those closest to the bedside
  10. Leaders ask great questions, listen intently and invite action

In the realm of patient experience, we speak about "cultural transformation.” Admittedly, it is somewhat nebulous, intrinsically qualitative and difficult to measure. In the same breath, we are also compelled and driven to deliver objectively verifiable and proven scores with the goal of mitigating financial and reputation loss. What a quandary. It is as though we are caught in the middle between the seemingly ambiguous and the fanatically measurable.

In embracing our first premise that 1.) Patient Experience is not a tactic, it seems that asking for a "Return on Investment” may be too narrow of a question, as if the result of our efforts is going to be the sum of multiple tactics. The traditional ROI question seems to head us in an almost transactional tactical approach of a "quid-pro-quod ethic” – do these things to get that result. Perhaps the more appropriate question to ask is rather, "What is the ‘Return on Improvement?’” At Inova Health System, by focusing on hospitality principles across five core work streams, and approaching patient experience as a collective commitment, we experienced transformative- rather than tactical-success.

As we move forward, the Inova Promise is being realized, the spirit of the organization is palpable and the numbers, well they speak for themselves. Three years ago, we returned to hospitality, to a service-discipline of relieving fear, anxiety and suffering. We embraced "hospes,” warmth and welcome – and are realizing each day, a more significant ROI, the transforming "Return on Improvement.”

*This is the final piece of a special three-part guest blog series focusing on various components of patient experience excellence, including patient and family care, culture and leadership and employee engagement. Read Part 1 and Part 2.

Paul is the Vice President of Patient Experience at Inova Health System. Prior to joining Inova, Paul began his service delivery consulting company, Westbrook Consulting, LLC, with the mission of transferring his 35 years of hospitality service in branding, strategic deployment, and operations to other service industries, to give back to his community and make a meaningful difference in peoples’ lives. Paul is also part of The Beryl Institute's Patient Experience Executive Board.

Tags:  culture  improvement  patient experience  return on service 

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