HCAHPS: A Nail Looking For A Hammer

US soccer fans are a lot like locusts. However, instead of surfacing every seventeen years, we surface every four. Once we are out of the Cup, we are really OUT. Four years ago we will once again try to understand the relevancy of the “offside” rule, and wonder why FIFA does not increase the size of the net and use more than one ball at a time. To badly paraphrase Shakespeare, “We are now in the summer of our discontent,”—the doldrums of professional sports. Pro hoops and hockey, which most people do not equate with sports worth watching have concluded their seven month playoff run, baseball’s 162 games are hitting their midpoint, and football is just a dream on the horizon.

Maybe now American’s can get back to some of the other global sports televised on ESPN channels 31-57, like darts and lumberjacking.

Have you ever wondered why hardware stores sell drills? The next time you are at Home Depot, tell the clerk you need a two-inch hole, and ask the clerk to direct you to the aisle that sells the holes. Stores sell drills because they do not sell holes.
In keeping with the hardware theme, in my workshop I reached for one of my hammers. Have you noticed that hammers survived evolution intact? The one reason hammers haven’t changed is simple—nails have not changed. Long handle, heavy piece of metal at one end. All you need, and nothing you don’t.

The collective noun ‘patient experience’, as viewed by most of the healthcare industry, is no more evolved than a hammer. Thirty-two questions seeking thirty-two answers.
However, patient experience is made up of the individual experiences of thousands of individuals—small things. Small things, which when combined become one very big thing. HCAHPS is the repository by which hospitals have tried to herd the collective experiences of the people in their service area. The problem is that people are no easier to herd than cats.

For HCAHPS answers to be of any use they require the gift of hindsight. It would be better if hindsight was available ahead of time.

Hospitals have a tendency to treat HCAHPS scores like pieces of a large patient experience jigsaw puzzle. Unfortunately, nobody has seen the picture on the front of the puzzle box. Assuming patient experience can be improved just by trying to increase HCAHPS scores makes the solution seem artificially easy, like hoping the nail you are about to hammer isn’t a screw. HCAHPS has a finite number of questions, and a finite number of things to be fixed. But in truth, fixing the problem with patient experience is more like counting votes in Florida.

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