In researching an article I'm writing for an upcoming edition of Hospitals & Health Networks on how hospitals are getting ready for the inclusion of the Hospital Consumer Assessment of Healthcare Providers and Systems, better known as HCAHPS, in the calculations of Medicare payments, I've come across two distinct schools of thought on how hospitals can best prepare. Starting next October, HCAHPS scores, which are based on patient surveys of their hospital experiences, will be among the measures used to make value-based Medicare payments, and hospitals are scrambling these days to strategize on how to end up at the head of the class.


The first school of thought, surveying the 18 core questions the survey asks patients about their hospital stays, prescribes a to-do list approach, focusing on how to improve individual aspects of the patient experience on everything from noise levels to the cleanliness of the facility to clinicians' communication techniques with patients. By addressing concerns directly, advocates hope their efforts will effectively translate into higher scores.

The second school of thought takes a more global approach, arguing that hospitals seeking to become top HCAHPS performers will need to effect a cultural change within their institutions that puts the patient squarely in the center of everything that goes on. In my early interviews, I've heard of action steps that range from looking for potential nurses who have customer service skills in addition to clinical skills to efforts that emphasize the importance of employee satisfaction as the first step in ultimately improving patient satisfaction.

Kimberly Bordenkircher, CEO of Henry County Hospital in Napoleon, Ohio, summarized this strategy aptly in a recent interview, noting that hospitals historically have focused on problem-solving, and not positive culture, because of the nature of the business. Only by embracing a more positive culture — and doing things like giving fellow staff members thank you notes for jobs well done — Bordenkircher says, can hospitals truly offer patient-centric care.

"We're in the business to fix people when they're broken," Bordenkircher said. "We're really trained to look for what's wrong."

Obviously, these tactics don't have to be mutually exclusive, and I've talked to hospital administrators who, in addition to taking a to-do list approach to potential gaps in specific areas, are launching major efforts to transform their hospitals' cultures. Still, there is a fairly stark difference between approaching HCAHPS as a series of individual problem areas that need to be dealt with, and as a call to action to transform the entire way hospitals view and serve patients. In a recent interview, Janna Binder, director of marketing and public relations at the health care marketing firm PRC, advocated for this latter strategy.

"The [hospitals] doing well are doing HCAHPS, but they're really focused on the patient experience," Binder said.

I'm interested in hearing from you, though. How is your hospital getting ready for the HCAHPS era? Email your thoughts to