In today's mailbag, readers respond to recent H&HN Daily articles on health care disparities, the link between employee engagement and patient satisfaction and different strategies for improving Hospital Consumer Assessment of Healthcare Providers scores.

In response to a recent blog I wrote on the persistence of disparities in health care outcomes, Lauri Andress, managing partner of Andress & Associates and a health equity analyst at the Center to Eliminate Health Disparities at the University of Texas, writes:

"We need to determine what percentage of health inequities are due to health care disparities. Access to health care is not the only driving force in the creation of social and health inequities. So it is alarming that we see no changes in health disparities. But it is not surprising because while we make no progress on health care access we also make no progress on policies that drive the social determinants of health. We would have to do both to decrease health and social inequities."

Brandon Clark, service excellence senior manager at Banner Good Samaritan Medical Center in Phoenix, wrote in with his thoughts on my blog analyzing the different strategies hospitals are using to prepare for the inclusion of HCAHPS scores in Medicare's value-based purchasing payments next year:

"I appreciated the way you juxtaposed the "micro" level strategy of diagnosing and treating individual HCAHPS elements against the "macro" approach of changing the patient-orientation of an entire culture. I absolutely agree that the recruiting/hiring element must be a point of emphasis going forward, i.e. bringing in staff who are predisposed to provide a great patient experience, rather than trying to engrain something that isn't there to begin with. I believe that these high-level, innovative strategies are going to be true game changers for the organizations that "get it," while others are going to be quickly left behind."

And finally, Vicki Hess, R.N. an employee engagement expert, responded to a recent blog I wrote on the connection between employee satisfaction and morale and the patient experience:

"I work with healthcare organizations across the country on improving employee engagement and your hypothesis is absolutely true. The other great news is that improving engagement doesn't have to mean spending big bucks or spending lots of time. I routinely ask employees to share one or two things their manager has done to help with their engagement and they are remarkably simple.  Some examples include "she filled me in on upcoming changes"; "provided encouraging feedback" and "challenging me." Leaders can use this appreciative inquiry format to get feedback from their frontline employees about what's working and then pass along the good news to the middle managers. Everyone benefits when the employees (and their managers) are engaged… most importantly, the patient."

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