Recently, Cardinal Health asked nurses working in healthcare settings across the continuum — acute care, ambulatory care and home care — to take a survey
about the issues and challenges they face in their profession today and what concerns them most. Among the insights that stood out, from more than 300 responses, are nurses' thoughts about patient satisfaction; only 64 percent either strongly agreed or somewhat agreed that they often think about patient satisfaction scores when they are caring for a patient.1
This article touches on the patient experience, how it is measured and the important role that nurses play. By virtue of the number of touchpoints alone, there is no one in the provider setting who can define a patient's experience — positively or negatively — more than nurses.
What is patient satisfaction?
First, it's important to make the distinction between patient experience and patient satisfaction, which are sometimes mistaken for one another. According to the Centers for Medicare & Medicaid Services (CMS), which develops, implements and administers customer experience surveys to help measure the performance of U.S. healthcare providers, patient experience surveys focus on how patients experienced or perceived key aspects of their care — versus how satisfied they were with their care.2 Patient experience surveys focus on asking patients whether or how often they experienced critical aspects of healthcare, including communication with their doctors, understanding their medication instructions, and the coordination of their healthcare needs. They do not focus on amenities.2
Is HCAHPS a patient experience survey?
Yes, most healthcare professionals — nurses especially — working in the acute-care setting are familiar with HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) or Hospital CAHPS. Until HCAHPS, there was no national standard for collecting and publicly reporting information about a patient’s experience of care that allowed valid comparisons to be made across hospitals locally, regionally and nationally.3
Also, HCAHPS is just one of a family of patient experience surveys owned by CMS called CAHPS®. These surveys have been approved by the CAHPS Consortium, which is overseen by the Agency for Healthcare Research and Quality (AHRQ). Others include Home Health CAHPS®, Fee-for-Service CAHPS®, Medicare Advantage and Prescription Drug Plan CAHPS®, In-Center Hemodialysis CAHPS®, Nationwide Adult Medicaid CAHPS®, Hospice CAHPS®, a CAHPS® Survey for Accountable Care Organizations Participating in Medicare Initiatives, Outpatient and Ambulatory Surgery CAHPS® and CAHPS® for PQRS (Physician Quality Reporting System).
A CAHPS survey for the Emergency Department is currently in development and was tested in the first quarter of 2016.4
How does the survey work, and what kinds of questions does HCAHPS include?
The HCAHPS survey asks discharged patients 27 questions about their recent hospital stay. The survey includes 18 core questions about critical aspects of patients' hospital experiences — communication with nurses and doctors, responsiveness of hospital staff, cleanliness and quietness of the hospital environment, pain management, communication about medicines, discharge information, overall rating of hospital, and whether they would recommend a hospital.3
Questions specifically addressing care from nurses include:
- During this hospital stay, how often did nurses treat you with courtesy and respect?
- During this hospital stay, how often did nurses listen carefully to you?
- During this hospital stay, how often did nurses explain things in a way you could understand?
- During this hospital stay, after you pressed the call button, how often did you get help as soon as you wanted it?
Examples of other HCAHPS questions include:
- During this hospital stay, how often were your room and bathroom kept clean?
- During this hospital stay, how often did doctors explain things in a way you could understand?
- How often did you get help in getting to the bathroom or in using a bedpan as soon as you wanted?
- During this hospital stay, how often did the hospital staff do everything they could to help you with your pain?
- When I left the hospital, I had a good understanding of the things I was responsible for in managing my health.
Why is there so much emphasis on HCAHPS and other CAHPS surveys?
What’s important about CHAPS surveys is the role they play in the federal government’s efforts to improve healthcare in the United States — in particular, pay for performance. Instead of only paying for the number of services provided, CMS also pays for providing high quality services, which are measured clinically, administratively, and through the use of patient experience surveys. The Patient Protection and Affordable Care Act of 2010 (or Obamacare) includes HCAHPS among the measures it uses to calculate value-based incentive payments in the Hospital Value-Based Purchasing program.3
What this means is, under the value-based purchasing program, hospitals could be financially penalized for low HCAHPS scores. In addition, hospitals' increased transparency and patients' greater involvement in choosing their hospital will force hospitals to provide a positive experience to attract patients.5
How do nurses play an important role in the patient experience?
By virtue of the number of touchpoints alone, there is no one in the provider setting who can define a patient’s experience — positively or negatively — more than nurses. And while HCAHPS categorizes certain questions specific to care from nurses, as we've listed above, nurses can influence many of the practices defining the patien t experience in HCAHPS — for example, proper adherence to protocols for pain medication management or discharge instructions.
“The power of HCAHPS is that it has forced institutions to take the patient's perspective into serious consideration,” says Elaine Townsley, DHA, MSN, MBA, faculty, health sciences and nursing at American Sentinel University.6 “We now have a science focused around patient-centered care and a way to measure care that was not in place before. When a nurse is aware of the patient’s perception of the care they are receiving, the nurse can now take measures to correct any negative habits and use the information as a learning tool to increase quality of patient care.” Dr. Townsley says “it's critical that nurses practice communication, continuity and compassion,” offering the following tips for improving patient satisfaction6:
- Listen to the patient – don't just hear them. Listening takes many avenues. If patients know that their nurse is listening and that he or she will act on their concerns and then follow up — this is the first step to increasing patient satisfaction. A best practice approach is to clarify what the patient is saying by repeating back to them what they just stated. This way, everyone is on the same page and the patients will know that their nurse both heard and understood what they were saying.
- Think like a patient. Reflect about how it would feel to voice a concern about something and not know what was happening due to a lack of communication. Communication is key and keeping everyone – patients and family members – informed can play a large role in helping to improve patient satisfaction.
- Be responsive. And, set clear expectations and follow through. Avoid telling the patient something is going to be done to help him or her in a specific timeframe and not meet that timeframe.
- Practice communication skills. If a patient or family member voices a concern, truly listen to his or her concerns and use your critical-thinking skills to assess the issue. If the concern is legitimate, try to solve it before the patient leaves. If the issue is not addressed, nor a solution found, while the patient is still in the facility, more likely than not he or she will give a lower score via the satisfaction survey. While working to address concerns, it is important to keep in constant contact with patients or family members to let them know that their issue is being investigated.
- Show compassion. When speaking with other staff members, avoid labeling patients during their hospital stay (e.g. “the complainer,” “the person who stays on the call light,” “the person who falls”). Remember that they are not only patients, but also members of families who should receive the best quality of care while maintaining their dignity. Put yourself in their shoes and treat all patients as you would like to be treated if you were a patient yourself.
Footnotes & references:
1 Survey conducted by Cardinal Health. March 2016.
2 Centers for Medicare and Medicaid Services. Available at https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/CAHPS/. Accessed on June 2016.
3 Centers for Medicare and Medicaid Services. Available at https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/HospitalHCAHPS.html. Accessed on June 2016.
4 Centers for Medicare and Medicaid Services. Available at https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/CAHPS/ed.html. Accessed on June 2016.
5 Becker’s Infection Control & Clinical Quality. Available at http://www.beckershospitalreview.com/quality/4-strategies-to-boost-hospitals-hcahps-scores.html. Accessed on June 2016.
6 American Sentinel University. 2012. Available at http://www.americansentinel.edu/about-american-sentinel-university/newsroom/effective-nurse-communication-key-to-patient-satisfaction-in-health-care-system-2. Accessed on June 2016.