Cross Country Universitys Caregiver Safety Series

HCAHPS
Background and rationale for this presentation
The Centers for Medicare and Medicaid Services (CMS) has developed and mandated a
standardized patient satisfaction survey in which recently discharged patients can assess their
hospital experience. This survey is titled Hospital Consumer Assessment of Healthcare
Providers and Systems and pronounced h-caps.
The survey was developed over several years with input from a broad representation of
consumers, stakeholders, and scientists. The survey was extensively analyzed and piloted
before implementation. CMS says that they went to great lengths to assure that the survey is
credible, useful, and practical. (HCAHPS Fact Sheet, July 2010)
As of July 2007, hospitals receiving Medicare and Medicaid funding must report HCAHPS
results or lose up to 2% of that funding. As of October 2012, those hospitals may receive
additional, incentive funding as a result of HCAHPS performance.
Intent
Ultimately, the goal of HCAHPS is to incentivize hospitals to improve patient satisfaction, and,
indirectly, the quality of care. A standardized survey enables between-hospital comparisons of
patient experiences. In effect, survey results will be used to compare and rate hospitals
according to how well they meet their patients expectations. The results are publicly reported.
Hospitals have a dual incentive to address barriers to patient satisfaction: 1. Reimbursement
will depend, to some extent, on survey performance, and 2. Knowledgeable consumers will
make utilization decisions based on publicly available survey information.
Methodology
Hospitals may use one or more of the following survey technologies: mail, telephone, mail
with telephone followup, or active voice recognition (automated phone survey technology).
Official language versions include Chinese, English, Russian, Spanish, and Vietnamese. All are
available to the public.
Patients are surveyed between 48 hours and six weeks after discharge. A random sample of all
adult patients, not just those receiving Medicare, is chosen from a variety of diagnoses.
Content
The survey focuses primarily on (emphasis is the authors):

. . . critical aspects of patients hospital experiences (communication with nurses and doctors, the
responsiveness of hospital staff, the cleanliness and quietness of the hospital environment, pain
management, communication about medicines, discharge information, overall rating of hospital, and
would they recommend the hospital). -HCAHPS Fact Sheet
Additional survey questions are intended to adjust for differences between patients and
hospitals, assist patients in answering the survey questions, and support mandated reporting.
Measuring and reporting
Each hospitals survey is summarized for public reporting into ten HCAHPS measures. The
following table has been copied directly from the HCAHPS Hospital Comparison website. After
entering a zip code, the site allows selection of up to 3 hospitals for comparison. Below, two
hospitals in the 65203 zip are compared.

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Cross Country Universitys Caregiver Safety Series

Survey of Patients' Hospital Experiences

HCAHPS (Hospital Consumer Assessment of
Healthcare Providers and Systems) is a
national survey that asks patients about
their experiences during a recent hospital
stay. Use the results shown here to compare
hospitals based on ten important hospital
quality topics. Read more information
about the survey of patients hospital

Remove hospital from

comparision BOONE HOSPITAL
CENTER

Remove hospital from

comparision UNIVERSITY OF
MISSOURI HEALTH CARE

BOONE HOSPITAL
CENTER

UNIVERSITY OF
MISSOURI HEALTH CARE

1600 E BROADWAY
COLUMBIA,MO 65201
(573) 815-8000

ONE HOSPITAL DRIVE, ROOM

CE121, DC031,00
COLUMBIA,MO 65201
(573) 882-4141

Acute Care Hospitals - Opens in a

new window
7.1 miles

Acute Care Hospitals - Opens in a

new window
10.6 miles

experiences.

Measure

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Patients who reported that their nurses

"Always" communicated well.

83%

72%

Patients who reported that their doctors

"Always" communicated well.

87%

74%

Patients who reported that they

"Always" received help as soon as they
wanted.

67%

60%

Patients who reported that their pain

was "Always" well controlled.

71%

66%

Patients who reported that staff

"Always" explained about medicines
before giving it to them.

72%

56%

Patients who reported that their room

and bathroom were "Always" clean.

73%

69%

Patients who reported that the area

around their room was "Always" quiet at
night.

57%

52%

Patients at each hospital who reported

that YES, they were given information
about what to do during their recovery
at home.

89%

85%

Patients who gave their hospital a rating

of 9 or 10 on a scale from 0 (lowest) to
10 (highest).

76%

64%

Patients who reported YES, they would

definitely recommend the hospital.

82%

70%

As is immediately obvious, consumers have an at-a-glance ability to compare hospitals.

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Cross Country Universitys Caregiver Safety Series

Impact what you need to know to positively impact HCAHPS results
The above comparison brings to light several areas in which you, the healthcare professional,
can strongly influence your patients satisfaction with care and your patients response to the
HCAHPS survey questions.
Always is the best only answer.
Note that the first 7 domains score only Always responses. The survey question allows the
following responses: Always, Usually, Sometimes, Never. However, Always is the only answer
reported to consumers for those seven domains. This standard particularly applies to the
following situations:
Meeting patient requests, especially bathroom requests, and answering call lights
Maintaining room and bathroom cleanliness
Managing pain
Providing information about medications
Providing information about post discharge activities and medications
Maintaining a comfortable and quiet (especially at night) environment
Communicate the right message.
Verbal and non-verbal interaction with the patient and family members must always indicate
respect and caring. A professional appearance helps meet the patients expectations for how a
professional should look. Confident and open body language and posture will indicate a
willingness to listen and respond. Good grammar and word usage reinforces that message.
Be nice.
Sarah J. Breier, PhD, RN, Associate Director-MU Center for Health Ethics, has this to say about
the power of being nice in her course on professional communication:
The common belief that 'nice [healthcare providers]' get sued less than others is true and
has been well documented in the related literature. Every now and then, however, it is
hard to be nice, yet it is much easier than many other risk management strategies. It is
imperative to remember that when you are tired, harassed, or you find yourself in a highstress situation, stop take a deep breath, and simply be cheerful and friendly. You will
feel better, and it might keep you out of the courtroom some day. Here are some specific
things you can do to show your patients that you care when you are in a high-stress
situation:
If you have to keep your patient waiting, tell them what to expect. Never leave your
patients hanging in limbo.
Give the patient your full attention.
Don't interrupt. Listen carefully to what your patients have to say, especially when
you're in a hurry.
Respect your patients' privacy.
Treat patients as people, not medical conditions. A patient with potential breast
cancer won't appreciate being referred to as 'the breast mass'
Involve patients in decision making. Don't be a 'care dictator'!
Don't be critical of other care the patient has received. Nurse's criticism of other
nurses who have taken care of the patient can give rise to highly unnecessary gameplaying and is in very poor taste. It can also give rise to law suits!
Make sure your fellow nurses show your patients the same consideration that you
do. This is also a part of your role as the patient's advocate
Conclusion
The HCAHPS rating depends, to a large extent, on the patients relationship with their
professional healthcare provider. Hospital reimbursement and consumer choice are dependent
upon those ratings. Therefore, the healthcare professional/patient relationship is critical to the
hospitals bottom line.

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Cross Country Universitys Caregiver Safety Series

End of HCAHPS Lesson

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