HCAHPS: What’s it mean to you?

Two women and two men posing for a photo outside

Satisfaction scores show the way to improving the patient experience.

Every day –throughout HCA Healthcare facilities, conversations about improving patient satisfaction are happening. But what does that mean? What needs improving? And how is success measured and shared?

The main way patient satisfaction is measured is through a survey some patients receive after they go home. It’s called the Hospital Consumer Assessment of Healthcare Providers and Systems, or HCAHPS. The questions cover many aspects of the patient’s stay, from how well pain was managed to whether or not he or she was treated with courtesy and respect. Every aspect of a hospital stay is assessed, so it’s not just about how doctors and nurses interacted with a patient. Every contact matters.

“It’s important for everyone to understand how the survey touches many aspects of a patient’s stay,” explains Lyn Ketelsen, HCA Healthcare’s chief patient experience officer. “Often people believe that it’s just clinical staff who are being evaluated, or that it’s just one area, such as Med-Surg, that’s reviewed by patients in the survey. That’s not true — it’s the entire experience that person has while they are in an HCA Healthcare hospital.”

It’s important to remember, she adds, that “patients tend to see all staff as caregivers, from doctors, nurses and lab techs to environmental services and dietary staff. That’s why everyone who comes into contact with patients, be it admissions staff or post-discharge billing personnel, must realize that they are being evaluated as part of a team — and focus on providing outstanding service.”

HCAHPS is a critical driver of HCA Healthcare’s operations — and every employee has a role to play in helping hospitals get the highest scores possible. But how to start? To fully understand how HCAHPS works, and how its results affect every HCA Healthcare employee, it’s smart to start off with the survey itself.

Understanding how HCAHPS works

So how did HCAHPS come to be, and why is it the chosen benchmark for healthcare services? In part, Ketelsen explains, because there was a national need for continuity.

“HCAHPS is the first nationally leveraged patient satisfaction survey in the country,” Ketelsen says. “Prior to it, various vendors used their own propriety surveys. That limited the ability to benchmark consistently across all hospitals. The Centers for Medicare and Medicaid Services wanted to provide an opportunity for patients and families to select their healthcare providers using a common set of information, and so HCAHPS was created.”

As to how the survey responses are measured, there is a formula that takes many things into account, Ketelsen says.

“The majority of questions are evaluated by patients using a scale of: always, usually, sometimes and never, and the result is calculated based on the percent of patients who responded ‘always,’” she says. “This is known as the top box score. The overall rating, however, is rated on a numeric scale of 1-10 with the top box being the percent of patients who rated us 9 or 10.”

The high barrier of “always”

One struggle with improving HCAHPS scores is the presence of “always” as an option for many questions. Very few people will check “always” on a survey, preferring a lower score, even if they were perfectly satisfied with their experience, Ketelsen says.

“If you think about any activity it is very hard to commit to doing something 100 percent of the time and yet when it comes to patient care, that is what our patients and their families would expect,” she explains. “It’s a very high bar. Prior surveys were based on feelings, and would have the top rating be ‘very good,’ or ‘excellent.’ When the HCAHPS survey was created that changed to more of a frequency evaluation — and to do something 100 percent of the time is really hard.”

Making consistency an improvement goal

One opportunity to raise the number of “always” responses for every HCA Healthcare facility has come in the area of continued success. When an HCAHPS score indicates a problem to be solved, much attention is paid to making that happen. But for continued success, the issue can’t just be identified and fixed. It must stay fixed.

“We have to make sure things stay corrected, and that’s the hardest part of being a fast-paced culture and organization,” Ketelsen says. “We do so much so quickly, because we are taking care of people who in some cases are badly hurt, or very sick. But we have to remember that this is a marathon, not a sprint. We are very good at sprinting toward a goal or objective, then moving on to the next thing. Improving the patient experience is a marathon, and we have to think in terms of sustainability and consistency. It’s about what we’re doing over the long term, as well as what we’re doing in the short term to achieve a particular goal.”

As examples, she highlights initiatives like nurse leader rounding, where nursing leaders visit with patients and their families to see how their care experience is playing out, along with employee rounding (see page 14), a way to ensure constant feedback between employees and supervisors. There’s also the communication fundamentals which allow for more successful communication between staff and patients, and between staff members as well.

“These are methods we are deploying now, and there are several other strategies that will provide whole new opportunities to improve our performance levels,” Ketelsen says. “And we know that the same action plan isn’t going to work for every hospital, and that’s why we are creating cohorts that help every organization improve, no matter where they are in the HCAHPS journey.”

What HCAHPS means to HCA Healthcare

Providing the best experience and safe, quality care to all patients is the core goal of every HCA Healthcare facility and employee. As you might imagine, HCAHPS scores provide a solid roadmap in terms of what’s working well, and what areas need improvement. There also are some serious financial considerations.

The information patients provide affects many different parts of hospital operation, from measuring the quality of care to raising or reducing Medicare reimbursement rates. (Every year, The Centers for Medicare and Medicaid Services withhold two percent of payments to hospitals; those who score above the national average on HCAHPS receive that money back, while those who score below do not get the funds returned.)

The good news is, excellent patient care and going the extra mile translate into higher patient scores, as well as higher reimbursements. That’s why every employee, at every HCA Healthcare facility, matters when it comes to looking at current HCAHPS successes and challenges, and then mapping out strategies for improvement.

All across HCA Healthcare, plans to improve and enhance the patient experience are being developed and put into place. At the same time, patients are being discharged every day. What does that mean for employees as they approach their job?

“Be exceptional at the job tasks and competencies that you know are important in your role,” Ketelsen says. “Be keenly aware of who your ‘customers’ are, and be willing to listen to their needs and then address those needs. And be open to looking for opportunities for that one little thing that just might ‘wow’ somebody. The patients really do remember those things, and it shows up in the surveys.”

About HCA Healthcare

HCA Healthcare, one of the nation's leading providers of healthcare services, is comprised of 183 hospitals and more than 2,300 sites of care, in 20 states and the United Kingdom. Our more than 283,000 colleagues are connected by a single purpose — to give patients healthier tomorrows.

As an enterprise, we recognize the significant responsibility we have as a leading healthcare provider within each of the communities we serve, as well as the opportunity we have to improve the lives of the patients for whom we are entrusted to care. Through the compassion, knowledge and skill of our caregivers, and our ability to leverage our scale and innovative capabilities, HCA Healthcare is in a unique position to play a leading role in the transformation of care.

Recent articles