November 19, 2007

This past week Results That Last reached number 12 on the Wall Street Journal’s Business Best Sellers List. This means that when many non-health care leaders are reading Results That Last, they are seeing that there is much to be learned from leaders in health care. We have learned a lot from non-health care leaders—it’s nice to see it works the other way also. To those who have purchased Results That Last and given it to leaders you know, thank you.

This week’s blog is on HCAHPS. This is another opportunity to use transparency to show others the best of health care. Studer Group had the first Toolkit on HCAHPS. We have just released the third edition. Karen Cook is one of our experts in HCAHPS. She has over twenty-five years of nursing experience and was one of our first Studer Group employees. She and her partners have been working with the HCAHPS tool since the very early pilot stages in 2005. She has put together this blog on HCAHPS as well as a Webinar and the third edition of the Toolkit. Known for her passion in focusing on the patient, you will see in this blog that it is about “always.”

Usually isn’t good enough

Early in my 26 years of marriage I received some advice to “never go to bed mad.” I even have a picture that serves as a visual reminder of that great advice—it says ” Always remember to kiss me goodnight.” But how often do I do it? I can honestly say that I usually do; but usually isn’t good enough. I invite you to think about a similar setting in your everyday life. For example, can you honestly say you brush your teeth every night?

“Always” is an interesting word—defined by Webster’s dictionary as “at all times.” This is a high standard to attain, yet that is exactly how we want the patients to view their hospital care. With the new Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey tool, the patients are asked to rate their hospital experience. Measured in frequencies, patients will be asked about their perception regarding how often they received particular aspects of care. Hardwiring processes to “always” deliver quality care means providing the best care to every patient, every time and with every interaction. Usually isn’t good enough.

Previously sheltered from public reporting of clinical quality data, hospitals have entered a new era of transparency. As part of a larger movement to help inform consumers, the patient perception of their experience with a hospital will now be reported with other quality metrics. The tool is a standardized, national patient survey, allowing public sharing of comparable data across acute care hospitals. While many facilities have been interested in their patient’s perception of care for a very long time, I have found that the potential for public reporting is a very powerful motivator to become even better.

In our national lab of more than 500 hospitals, executives are asking “how can we prepare for public reporting of the HCAHPS survey results?” Studer Group has created two new tools to help hospitals achieve their desired outcomes in clinical, operational and service excellence. Aligned to the survey questions, both the HCAHPS Webinar and a new Toolkit are available now. Here are a few tactics described in these new offerings.

Key Words at Key Times
The survey questions focus on communication with doctors and nurses, responsiveness of staff, cleanliness and quietness of the environment, pain control, discharge information, and communication about medications. One of the most challenging questions on the HCAHPS survey asks the patient how often “did the staff describe medication side effects in a way you could understand?” We’ve seen several organizations improve their results just by incorporating key words to directly address this question. For example, when administering a pain medication, a nurse would commonly have said “this medication will help manage your pain but you might have some nausea – make sure and let me know if you do.” When the nurse adds the key words, “this is a common side effect,” this connects the dots for the patients and helps keep them fully informed. To verify this occurs with every patient, the nurse manager can ask the patient on rounds, “have your nurses explained your medications and helped you understand any side effects to look out for?” When the patient is preparing for discharge, the nurses can ask open-ended questions for patients to review their medications and any potential side effects. Key words are important to deliver a consistent message and keep patients informed, and they play a vital role in impacting this particular question and the medication reconciliation process. They should be integrated into daily care conversations in multiple avenues and not just when the medication is actually being given.

The new HCAHPS survey asks the patients about how often the staff explained things in ways they can understand and how often they were treated with courtesy and respect. Our AIDET communication format is a great tactic to implement immediately to impact our communication with patients. Evidence shows us that if every employee would focus on Acknowledging patients, Introducing themselves and the anticipated Duration, Explaining things in ways patients can understand, and Thanking the patients, it would help reduce patient anxiety. To close the interaction, each staff member can ask the patient, “do you have any questions I can answer before I leave?” This will help impact the patient perception of listening carefully and explaining things in ways they can understand.

While we want to achieve excellent results on the patient perception of care survey, I think it is sometimes easy to lose sight of why we’re doing this. It is not about looking good on the survey. It’s about always providing the best care to our patients. This survey tool allows us to know what patients think about the elements of care that are most important to them and helps us understand if they would recommend our hospital to their family and friends.

If that is not motivation enough, the Centers for Medicare and Medicare Services (CMS) issued a final rule for hospitals paid under the Inpatient Prospective Payment System. Those hospitals eligible for the annual payment update must submit their HCAHPS data or forfeit 2% of the annual payment update. This is part of the quality measures required in the Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU) and is required as of July, 2007. The financial penalty varies from hospital to hospital, based on a number of factors including average daily census, but could be substantial. This requirement puts in motion the pay-for-participation concept and there seems to be a clear movement to eventually tie reimbursement to performance on quality metrics, including the patient perception of quality.

The HCAHPS toolkit provides more than 40 ideas to impact these questions. The ideas have been generated from hospitals already focusing on improving their patient, physician and employee loyalty. In the era of public reporting, this strategy takes on a whole new meaning and is key to long-term success. As leaders, we have the exciting opportunity to guide our organizations to a culture of “always.” Easier said than done, a culture of “usually” isn’t good enough.


6 Responses to “HCAHPS”

  1. I speak for hospitals on obesity sensitivity, specifically how it feels to be an obese patient in a hospital.Healthcare is one of the 3 well documented areas of discrimination against the obese More and more hospitals are receptive to this type of education in part because of HCAHPS. I am surprised however that knowledge of HCAHPS is slow to catch on.

  2. In some training I had, the question to ask for questions was: “What questions do you have?” instead of “Do you have any questions?”

  3. Patricia Mobilia Says:

    Quite some time ago in a staff meeting, I asked that each employee make it personal with one patient a day. Get to know them. I have found that over time using this as our “ALWAYS” has worked with patients comfort level. Now, they always ask for employees by name and seem to feel at home when they enter the facility.

  4. You wrote: “This survey tool allows us to know what patients think about the elements of care that are most important to them.”

    Well, maybe yes, maybe no. While the HCAHPS is certainly a noble effort, in my view it is a “cookie cutter” approach to care delivery. In the HCAHPS world, a patient is a patient is a patient. The HCAHPS approach to care assumes a great deal about every individual patient–including what’s supposed to be important to them. In the HCAHPS world individual differences between people are irrelevant. Prior perceptions are irrelevant. A person’s personal health priorities are irrelevant. How patient’s differ on learning styles, trust levels, or self-efficacy are irrelevant. In the HCAHPS world the focus is on things like how you ask the question “What other questions do you have?” With HCAHPS the “prescription” for communication and interaction is the same for every patient. It’s one-size-fits-all. If hospitals delivered that kind of care on the medical treatment side, alot more patients would never survive their hospital experience. Physically, hospitals gather tons of information about a patient’s state in order to properly tailor the care delivery. The treatment is very customized. But on the psycho-social side its the complete opposite. While I agree that HCAHPS will aid in transperancy, it also creates transperancy in the sense that hospitals are encouraged to not see the relevence of patient individual differences.

  5. Cynthia Torres Says:

    This is not so much a comment, but a question open to all. I was recently hired as a patient liaison to promote patient satisfaction. This is a new position and I listen to patients everyday both complimenting and complaining about current issues in the deliverly of healthcare. After doing some research I was motivated to meet others in the healthcare industry who held a similar position. I would like my position to be utilized to it’s fullest both to increase patient satisfaction as well as act as a true liaison/advocate for patients.

  6. LYNNE Says:

    I am looking for tools or ideas anyone is willing to share to help improve scores.
    We are doing the 8 behaviors and Aidet.
    We are rounding. What are you to ensure patient is getting the new medication informmation, and the S.E. information?
    Any ideas/ tools would be wonderful

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