Someone wrote to challenge my position on patient surveys in my last post, so I thought I would take another stab at my own thinking. I appreciate those who take the time to question my position, because I learn best when I hear how others look at the same issue.
I believe the work done by Press Ganey, Studer, and others is important. However, it seems most hospitals view improving HCAHPs as a means to an end with regard to improving patient experience. My issues with surveys have to do with what items CMS requires to be measured and with how healthcare providers view and utilize HCAHPs.
Because I have no clinical background, I segment healthcare into the business of healthcare—how it is managed and run, and the healthcare business—the services delivered. Out of fairness to those who make time to read my blog I limit my remarks to those focused on improving the business of healthcare.
Regarding what CMS require to be measured the following concerns me:
• Hospitals were addressing and would be addressing these items whether or not CMS felt it necessary to institute penalties for not being rated in the top fifty percent.
• By definition, no matter how good hospitals become at improving their scores, half of the hospitals will always find themselves in the bottom half.
• CMS’s survey questions are intermixed with clinical and nonclinical issues.
• CMS does not distinguish between the relative importance of any two questions; i.e. pain management and clean bathrooms.
• The survey responses are dated, subjective, and unquantifiable, and the responses require people to use superlatives like ‘always’ and ‘never.’
• There is no mention or measure of any of the dozens of experiences patients encounter prior to entering the hospital or after leaving the hospital and the effect those have on their total experience.
Regarding how hospitals respond to CMS’s mandates the following concerns me:
• The majority of the effort made by hospitals improve patient experience includes only improving their HCAHP scores.
• Improving HCAHP scores is not the same thing as improving patient experience.
• Hospitals do not focus on, nor do they measure the experiences patients have from interactions unrelated to the HCAHPs questions.
• Improving the score of a single question does nothing to ‘raise all boats,’ to improve the experiences of all patients.
• With the hospital’s entire focus on HCAHPs, the hospital has no understanding of the experiences prospective patients have when they try to interact with the hospital.
A final thought. If high HCAHP scores actually reflect high patient experience—as measured by the responses to those thirty-two questions—why don’t hospitals advertise their scores? Real people, patients, have no idea what HCAHPs means to them or how their hospital scored.
However, those same people do wonder why the hospital cannot meet their needs when they call, why they are unable to schedule a lab or an appointment online, and why they cannot find their discharge information online.
To me, managing patient experiences based only on HCAHP score is like forcing someone to drive a car forward while only being allowed to look in the rearview mirror.