Healthcare providers striving to improve their HCAHPS survey scores most likely need help with one critical area – communications with patients of all races, nationalities, ages and genders as researchers look at how much demographics affect the scores.
Informally known as "H-Caps," the Hospital Consumer Assessment of Healthcare Providers and Systems survey collects patients' perspectives on hospital care and issues four quarterly reports based on the data each year. While many hospitals have collected information on patient satisfaction for their own internal use, until HCAHPS there was no national standard for collecting and publicly reporting information about patient experience of care that allowed valid comparisons to be made across hospitals locally, regionally and nationally. In the burgeoning age of quality-based reimbursement, health systems can't afford low rankings.
In the Patient Experience index, survey respondents evaluate hospital performance on eight key metrics, with the four most critical elements being communication with nurses, communication with physicians, communication on medications and communication at discharge. The other four include responsiveness of hospital staff, pain management, cleanliness and quiet environment and overall rating.
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Matthew Bates, managing director for Chicago-based Huron Healthcare, a national consulting firm, works on improving patient experience in hospitals, medical practices and other healthcare settings. Huron is partnering with approximately 1,000 hospitals on the patient experience focus, helping them to implement best practices.
In Bates' view, hospitals have been challenged by the communications components for the simple reason that "it's hard – scores are lower and everyone has a litany of reasons why. But are they legitimate reasons? That is what they are trying to understand."
Drilling down into population characteristics is something that CMS is looking at with the HCAHPS survey and Bates agrees that demographics is integral to attaining better communications.
"The best answer for understanding the cultural differences in patient demographics is to meet patients where they are and not where you want them to be," he said. "Yes, change is hard – you have to make it a priority. But once you make it a priority, you can change."
To illustrate a typical communications problem related to demographics, Bates described the environment at a 250-bed hospital in an area where half the population speaks Spanish only.
"There are no signs or paperwork in Spanish and it's hard to find a staff member who speaks the language," he said. "It's not about where you're located, it's about where your patients are. What do you need to do to meet their needs?"
Even though not listed as a "communication" issue, Bates considers responsiveness of hospital staff to be one along with the other four.
"Are you delivering what patients are asking for?" he said. "If a patient asks for a blanket, are you responding?"
As a physician with a background in palliative care, Kevin Keck, MD, gained keen insight into cultural specifics regarding a patient's end-of-life care plan.
"Futile care is where one or fewer in 100 patients will benefit from what you're doing and it has given me an appreciation of how different cultures look at the end of life," said Keck, chief medical officer for West Hartford, Conn.-based SCIO Health Analytics. "I've found that certain cultures, like Filipinos, Russians and Native Americans want treatment to the last heartbeat."
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In appreciating the value of "cultural competence," Keck has learned some valuable lessons in dealing with certain ethnic groups, such as the importance of bridging the language gap.
"In my end-of-life work, if I was dealing with a Russian family, I would want a certified translator who will repeat exactly what I say," he said. "What I don't want is a family member modifying my words."
In order for hospitals to improve their survey ratings, enhanced communications must be systemic and endorsed at the highest levels, Keck said, recommending that a Physician Quality Leader position be created to ensure compliance.
"It should be filled by a respected clinician with a burning desire to improve communications," he said. "That person would be responsible for enforcing CMS rules, changing behavior so that physicians understand these targets and inspire physicians to make the necessary behavior changes. There should also be a Nurse Quality Leader to oversee the nursing staff as well."