Use patient satisfaction data for improvement
Low scores could affect reimbursement in the future
If you're not using your patient satisfaction data to develop process improvement projects, you're missing a chance to improve patient care, says Quint Studer, CEO of Studer Group, a health care consulting firm based in Gulf Breeze, FL.
Studer particularly recommends paying close attention to your hospital's scores on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), which he says will transform the way hospitals do business.
"To raise your HCAHPS scores, you have to identify and fix the core underlying causes of low patient satisfaction. Patients aren't going to perceive your quality any better than it actually is you can't fake it. If you have quality issues like readmissions or high rates of hospital-acquired infections, that's where you need to focus to move both HCAHPS and quality results. HCAHPS helps you know how to focus," he says.
HCAHPS is a 27-question survey created by the Centers for Medicare & Medicaid Services and the Agency for Healthcare Research and Quality. It is designed to measure patients' perception of the care they received while in the hospital.
HCAHPS is far superior to patient satisfaction tools of the past because of its focus on quality, Studer says.
"The HCAHPS includes questions like pain management, responsiveness of the staff, communicating the side effects of medication, and understanding home care instructions. No clinician can say those items are not important," he says.
In addition to measuring issues that affect clinical quality, HCAHPS measures the frequency of how often something happens, Studer points out.
Answers to the survey questions include "never," "sometimes," "usually," and "always."
"For instance, many other tools ask if someone explained the side effects of medication. This is different from asking if the side effects are always explained. To do well in today's health care environment, hospitals can't be content with responses of 'usually.' If they want to be a stellar performer, they should move to 'always,'" he says.
HCAHPS gives hospitals an accurate snapshot of how well they are performing in comparison to their peers, Studer says.
The drawback of patient satisfaction tools in the past was that a hospital could compare its ranking only with other hospitals that were using the same measuring tool.
"HCAHPS creates a level playing field. It allows hospitals to see how they really stack up against the competition in the eyes of patients," he adds.
The issues covered by the HCAHPS are crucial ones that hospitals must address in order to be able to produce good outcomes in a tight money situation, he adds.
The Centers for Medicare & Medicaid Services (CMS) announced its intention in 2007 to include HCAHPS scores as part of its value-based purchasing initiative, points out Carolyn Scott, RN, MEd, MHA, vice president of performance improvement and quality for Premier, a health care performance improvement alliance.
Although the details of how and when value-based purchasing will be rolled out have not yet been announced, it's clear that how patients score a hospital on the HCAHPS will affect reimbursement, she adds.
"CMS is building the voice of the consumer into the quality equation. Hospitals are paying more and more attention to HCAHPS scores," Scott says.
Scott recommends that in addition to reviewing their HCAHPS scores, hospitals dig deeper into the results for specific questions to find out where the problems lie.
"Vendors often are able to segment results by hospital unit, which helps hospitals identify the specific departments where issues may reside," she says.
That's what happens at Integris Baptist Regional Health Center in Miami, OK, according to Alice Hunt, MBA, the hospital's director of service excellence.
The hospital's patient survey integrates the HCAHPS data with the standard Press-Ganey patient satisfaction survey, she says.
"When we look at the HCAHPS data and something doesn't look right, we dig deeper using the Press-Ganey questions to see if there are any underlying issues. We can identify more specific problems and focus on areas where we can make a difference," Hunt says.
If patients give the hospital a low rating on the HCAHPS global questions that measure the overall rating of the hospital and their willingness to recommend the hospital, Hunt uses the Press-Ganey data from the same time period to see if there are specific areas where patients expressed dissatisfaction and comes up with process improvement projects to address the issue.
The hospital administration looks at HCAHPS data to determine if the percentage of "always" or "usually" answers changes in any category.
"It's difficult to meet the expectations of 'always' but some hospitals are doing it, and that is what we are working toward," Hunt says.
Newton-Wellesley Hospital in Newton, MA, uses its HCAHPS and Press-Ganey data to identify gaps in processes and procedures and to develop initiatives to correct the situation, says Patrick Jordan, senior vice president, administration, and COO.
Every month, the hospital administration produces a leader report card that goes to every manager who, in turn, takes the information to his or her staff.
The care coordination report card includes information such as staff turnover, timeliness of completion of annual evaluations and orientation, number of thank-you notes written to the staff, employee satisfaction, customer care activities, productivity, response to patient and family complaints, and budget performance.
"We track to see if there are a pattern of complaints and take this as a signal to look at opportunities to bring together a small group of people to look for solutions," says Elaine Bridge, RN, MBA BSN, senior vice president patient care services and chief nursing officer.
For instance, patient satisfaction data had shown that patients were unhappy about the length of time it takes to be discharged.
"The scores are not troublesome, but there always is an area for improvement,"says Monica Ferraro, RN, MS, manager of care coordination.
The hospital created a work group that includes staff nurses, RN case managers, and hospitalists to analyze the discharge process for nurses, physicians, and discharge planning staff and identify improvement opportunities. The multidisciplinary team has looked at all aspects of the process from the time the physician writes the order until the patient is out the door.
"The discharge process frustrates the staff as well as patients at times. Each step of the process is dependent upon another clinician completing a part of it. The delays in discharge are not intentional delays. They are directly related to the complex processes. We have a motivated group of people on the team who are looking for rapid cycle improvements as well as long-term solutions, such as leveraging technology," Ferraro says.
Meanwhile, as part of a statewide initiative to reduce avoidable readmissions in collaboration with the Institute for Healthcare Improvement, the team on some patient care units is analyzing whether patients receive discharge education, whether the right person to receive the education is identified and involved in the teaching, and what kind of information is being communicated to the next level of care, she adds.
For instance, the orthopedic unit is looking at the key items patients should be educated about and who is the appropriate person to receive the information.
"We are trying to find ways to be sure that the patient is able to process the information using the teach-back method. We want to make sure they completely comprehend what they are supposed to do after discharge," Bridge says.
Take proactive approach to HCAHPS
Take a proactive approach to the HCAHPS questions and ask patients the questions while they are still in the hospital so you can address the issues and make changes before the patient leaves the facility, Scott suggests.
For instance, if a patient reports being confused about his or her medication or discharge destination, the nurse or case manager can spend more time making sure the patient understands, she says.
"There's not a lot a hospital can do to improve its rating once the patient leaves. But if things aren't going well, paying attention to the gaps in information can turn the tide, especially if the patient sees that the hospital staff are interested in them as people," she says.
Some hospitals participating in Premier's QUEST: High Performing Hospitals collaborative engaged in practices to assess the patient experience prior to the time of discharge. These hospitals have reported that when they ask questions before patients leave the hospital and address the issues identified, they begin to see some improvement in patient experience statistics.
Scott suggests overlaying HCAHPS with other data such as readmission rates and clinical quality scores to identify trends that may be parallel to patient experience scores.
In addition, look at staff satisfaction and see how it trends with the patient experience, she adds.
"Typically, when staff satisfaction goes up, so does the patient experience," she says.
Studer suggests calling patients 24 hours after discharge and going over the home care instructions.
The phone calls have paid off for Integris Baptist Health Center by raising HCAHPS scores as well as potentially avoiding readmissions, Hunt says.
An analysis of the HCAHPS data determined that patients who get a post-discharge phone call usually rank the hospital in the 90th percentile or above on whether they'd recommend the facility to family and friends. Those who don't get a phone call rate the hospital much lower, Hunt says.
"The phone calls have helped us catch potential problems, such as when patients have a reaction to their medication, when they haven't gotten their prescriptions filled, and when their symptoms indicate that they should see their doctor. All of this filters back to the case managers, and we work to ensure that there are no gaps in care," adds Linda Hollan, RN, BSN, CDE, ACM, director of case management.
Make your focus improving clinical outcomes, not just raising patient satisfaction scores, Studer advises.
"People are not likely to be motivated by a project with the goal of raising scores. Instead, hospitals need to determine where they need to focus their process improvement efforts to remove the barriers that get in the way of quality care," he says.
For instance, look at your answers on the pain control measures of HCAHPS. If the patient answers include mostly "sometimes" and "never," look at what your team is doing to deal with patients' pain, he suggests.
Correcting the problem could pay dividends in a number of areas, he adds.
If a patient's pain is controlled, the patient isn't hitting the call button to ask for more medication and the family isn't rushing out to the nurse on a regular basis to say that patient is in pain. This leaves the nurse free to deal with other issues, Studer adds.
"One in every five patients discharged from the hospital have adverse events. About 60% of these are because they aren't taking their pain medications correctly and have side effects so they call in or go to the emergency department. If you're doing things right while patients are in the hospital, keeping their pain under control and teaching them about their medication, you can avoid these adverse events," Studer says.
Include all departments in the hospital in your process improvement initiatives, Scott suggests.
"It's not just doctors and nurses who affect the patient satisfaction scores. HCAHPS measures issues like cleanliness and noise are often impacted by non-clinical staff. Every employee has the potential to impact the patient experience," she says.
When the HCAHPS scores indicated that patients at Newton-Wellesley Hospital were disturbed by noises on some units, the unit staff met to brainstorm ways to reduce the noise. In some cases, the solution was to put up a glass partial partition in the nursing station. On one unit, the hospital moved the ice machine away from patient doors. On the obstetrical unit, the hospital set up a two-hour quiet period where no one but a significant other could visit in order to give the patients a chance to rest.
"We received wonderful feedback on those changes," Bridge says.
[For more information, contact: Linda Hollan RN, BSN, CDE, ACM, director of case management, Integris Baptist Regional Health Center, e-mail: [email protected]; Patrick Jordan, senior vice president, administration and COO, Newton-Wellesley Hospital, e-mail: [email protected]; Carolyn Scott, RN, MEd, MHA, vice president of performance improvement and quality for Premier e-mail: [email protected]; Quint Studer, CEO of Studer Group, e-mail: [email protected].]
If you're not using your patient satisfaction data to develop process improvement projects, you're missing a chance to improve patient care, says Quint Studer, CEO of Studer Group, a health care consulting firm based in Gulf Breeze, FL.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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