Anyone who has been hospitalized knows the drill. Shortly after your release you get a multiple choice questionnaire asking you how you felt about the food you were served, the attention you received from the nurses and physicians and the neatness of your room. The cover letter specifies that what you have to say is important to the hospital or health care facility you have recently stayed in.
There are other questions, of course, but the gist of the survey is to give you a feeling that what you have to say in answering the questions will somehow affect how patients are treated at the facility in the future. It is a nice thing to do, and it does give you the feeling that somebody really cares about your recovery. However, an executive in one of the largest patient satisfaction survey organizations told me recently that even though a significant percentage of patients fill out and return the forms, hospitals have been paying less and less attention to the findings because they are so preoccupied with financial matters.
So recently, while going through my in-box, I was quite interested in a mailing I received from The Beryl Institute, which studies various aspects of clinical quality with the aim of improving patient care. I was quite taken by what the institute’s executive director, Jason Wolf, had to say about the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey and its implications for the industry. With the advent of “value-based purchasing” – under which part of Medicare payment will be based on HCAHPS scores – there is suddenly a lot of anxiety in the industry about how to use the survey results to improve scores.
“The entire industry has dramatically increased its focus on the patient experience and service with the emergence of HCAHPS survey as a standard and publicly reported measure,” Wolf writes. The HCAHPS survey consists of 27 questions that cover everything from the cleanliness of the patient room to nurse-patient communications to pain management. The survey must be administered to patients 48 hours to six weeks following discharge. With everyone suddenly flustered by value-based purchasing, Wolf sees a lot of confusion out there among hospital leaders. He thinks there is a nomenclature problem; how do you define the patient experience?
“It is through definition that we create a standard by which to understand, act and measure,” Wolf writes. “If an organization is on the path to improve the patient experience, it needs to know what it is attempting to change.”
Thus, the institute, working with healthcare providers around the country, has defined the patient experience as: “The sum of all interactions, shaped by an organization’s culture, that influence patient perceptions across a continuum of care."
Wolf also believes patient responses to survey questions can be positively influenced if healthcare organizations develop a standard framework to help drive their interactions with patients. Underlying that framework must be a standard definition of the patient experience.
This is no academic exercise. According to a 2008 study by Avers, a global strategy company, organizations that use a clear definition for customer service to guide everyday decisions are more profitable than those that don’t. That should certainly catch someone’s attention!
The fact is that over the years some hospitals have worked to greatly improve the customer experience, but many have only paid lip service to it on a mission statement. They thought it wasn’t worth the investment, and their corporate culture was not conducive to focusing on service. However with HCAHPS coming into play, things are about to change dramatically.
Patient satisfaction, it turns out, isn’t just about food quality or cleanliness. There is also a link between patient satisfaction and patient safety. As we look back on the last decade and contemplate the future it is important to note that in 1999 there was a study released from the Institute of Medicine called To Err is Human. What the study showed was that nearly 100,000 patients were dying each year as a result of preventable medical errors. That finding shocked the medical profession and the public. All kinds of organizations were formed to study the subject and eradicate medical errors. All those involved were committed and sincere about their efforts but today we are still losing close to 100,000 patients a year to medical errors – maybe more.
With the advent of HCAHPS and the fact that reimbursement is involved, maybe this time in our history things will really change. After all, the patient should be at the very core of what every healthcare organization is about. Maybe soon that will finally be true.