A patient who feels listened to and genuinely cared for is a more compliant patient. A caregiver who feels trust and mutual respect at work will function at his or her highest level. But you won’t find either of these measures on the Hospital Consumer Assessment of Healthcare Providers and Systems survey.
Unfortunately, due to financial incentives associated with HCAHPS and a growing focus on value-based care, we tend to equate patient experience with HCAHPS. In doing so, we have departed from a richer assessment of how patients actually experience care. We’re missing part of the story.
The HCAHPS survey was originally designed to produce data about patients’ perspectives to enhance safety and accountability in health care. While HCAHPS does not measure the patient experience in its entirety, it does measure key aspects of care such as pain management, responsiveness of hospital staff, discharge information and so forth.
Measuring true patient experience and care value is more complex. Metrics must also include assessment of teamwork, communication, and the connection between patients and caregivers. The quality of the relationships creates the environment and culture of the workplace, which permeate all aspects of the patient experience.
Getting the whole story
A more comprehensive view of patient experience can uncover gaps and, ultimately, improve the patient experience. When we understand the need for a deeper level of engagement among our care teams and patients, we improve the value of care as well. The safest, highest-quality and most efficient care is achieved when patient experience levels are high. Appreciating this intimate connection can bring meaningful improvement.
In addition to HCAHPS, providers should examine other factors shown to be important to patients:
- The care team’s genuine concern and compassion.
- The amount of time caregivers spend with patients.
- The level of respect shown to patients.
- The ability of caregivers to listen to patient questions and concerns.
- The ability of caregivers to communicate and work as a team.
We need to focus on the quality of our interactions with patients. Do patients feel truly cared about, listened to and respected? Are we taking enough time to answer their questions? The most positive patient experiences arise from workplace cultures that understand the value of the patient relationship, and build teamwork, communication and processes that strengthen our engagement.
Patient experience derives from workplace culture — the fertile ground upon which all else grows. Work must begin here to realize gains elsewhere.
A strong culture consisting of teamwork, communication, trust and mutual respect will drive outcomes and safety in positive directions for both providers and patients. A strong workplace culture can have a tremendous impact on creating highly functional and reliable teams and in reducing physician burnout.
High levels of teamwork are proven to reduce health care–associated infections, reduce medical errors and increase employee safety. Leaders who make a deep commitment to nurturing a culture built on relationship-based, patient-centered communication can expect a 5-to-1 return on their investment.
The power of communication
So how do we nurture teamwork? Communication training for all staff, led by physicians, nurses and administrative leaders, is an excellent place to start. Effective physician and caregiver communication drives the highest-value care with an exceptional experience for both the patient and the caregiver team.
Communication breakdowns account for more than half of all preventable errors. Studies have shown that the best technologies and strategies will fall short if we do not have teams with the capacity to communicate, learn and improve. Excellent communication among members of the health care team decreases mortality in hospitals, and enhances staff morale and engagement.
We have a limited amount of time to influence our patients. Ninety percent of health care happens in patients’ daily choices outside the physician office and hospital. Excellent communication during the other 10 percent can buoy our efforts to help patients achieve success in their health journeys.
It’s the moment-to-moment conversations — the way we interact — that let people know how much we care. If we don’t get this right, the rest of our efforts will not flourish.
Data that makes a difference
To truly understand — and improve — the patient experience, we need to take a look at how we measure just as much as what we measure. The HCAHPS survey was developed through a rigorous validation process. The methodology most often used to generate survey responses, however, falls short: It represents only a portion of patients we serve. Typical response rates in urban areas are in the 15 percent to 20 percent range. The U.S. response rate was 29 percent in 2015 — down from 35 percent when HCAHPS started in 2006. This can result in responses from patients who are most dissatisfied or, alternately, highly satisfied, missing the 70 percent to 85 percent of patients between the ends of the spectrum.
To capture a higher response rate and achieve a more representative patient voice, we should consider other survey methodologies, such as phone-based surveys that can have response rates in the 40 percent range and capture a broader spectrum of the patients served.
By not capturing the voice of more patients, we compromise data accuracy and reliability. Providers then create tactical solutions based on individual domains of HCAHPS, which may represent only a small segment of patient views. Those solutions fail to result in sustained gains.
When we address a more complete set of patient experience metrics — those defined by a broad spectrum of patients over the past decades — we can achieve greater impact. We can implement more meaningful interventions that are far more sustainable than tactical solutions.
There are several ways to create a culture of excellence:
- Evaluate survey methodologies. Choose one that maximizes response rates rather than one that focuses on the size of the survey audience.
- Don’t be limited in what you measure. Include additional metrics in your HCAHPS that can help measure patient experience over time.
- To most accurately assess the culture you are creating, evaluate a composite of metrics that assess clinical outcomes, safety, efficiency, experience and the joy of practicing medicine.
- Work on culture first. Tactical solutions and checklists are helpful — but only when implemented in a culture that will nurture the tactical solutions. Focus on culture first, then layer on tactical and technical solutions.
- Focus on skills-based work that nurtures effective, efficient and compassionate communication. Culture is intimately related to our moment-to-moment conversations, so it is important to engage in peer-led, skills-based communication training.
Be patient. Culture change and improvement occur slowly and gradually. Creating a patient-centered, team-based culture rooted in trust, mutual respect and compassion sows the seeds for sustained improvement in clinical outcomes, safety and efficiency.
The resulting overall patient experience will stand up to any future HCAHPS and better position providers to overcome current and future health care challenges. It will restore joy and resiliency in the workplace as caregivers and leaders reconnect with the purpose of serving their communities.
William Maples, M.D., is the chief medical officer of Professional Research Consultants and the executive director of the Institute for Healthcare Excellence. He is based in the Jacksonville, Fla., area.
The opinions expressed by the author do not necessarily reflect the policy of the American Hospital Association.