CMS Measures HCAHPS, What Do You Measure?

Sharks cannot turn their heads.  Sometimes it seems business leaders have the same problem.  What transformation or innovation would you undertake if you were not afraid to turn your head, to look for solutions if you were not of failing?

Hospitals either have satisfied patients or they do not.  Measuring satisfaction will not yield satisfied patients any more than Comcast’s ‘Customer First’ program got them satisfied cable customers.

Hospital executives do not need satisfied patients.  The term ‘patients’ is a plural, and no patients satisfaction program will satisfy the plural.  The very notion of having a satisfaction program should signify the organization, in fact has, a patients satisfaction problem, which often means it has an access problem.

Permit me a moment of sacrilege.  Forget the patients, or stated better, forget enhancing the satisfaction of the patients while they are in the hospital.  You are already doing everything you can for them. Your doctors and nurses have your patients covered better than any other country on the planet.  What patients complain about is access, but hospitals do not know that because access is not measured, nor is it penalized by CMS.

If a hospital is not to worry about the satisfaction of its patients, how then will it improve satisfaction?  Take out your highlighter and underline the next sentence on your monitor.

Worry about your customer, and worry about whether they can access you–can they do business with you.  Focus on the business processes that affect a single patient/customer.  At least half of patient satisfaction is comprised of things having nothing to do with why the individual is at your facility.  Patients know the clinical experience will not be fun.  They know before they get to the hospital that the clinical experience will likely be painful, intimidating, scary, and perhaps dehumanizing. They accept that. What they will not accept is having those same experiences on the phone.

Health systems assume the satisfaction of patients are tied to whatever clinical procedures they underwent.  That perspective is somewhat akin to the Ritz Carlton assuming the satisfaction of a hotel guest’s entire stay has to do with the success of the presentation they delivered at the Xena Warrior Princess Lookalike Convention.  It does not.  Their satisfaction depends on the cumulative of all of the experiences they had at the hotel.

Your system’s success or failure, the measure of whether a patient will come to you for additional services, whether they will refer other patients, whether they will purchase any services from you has to do with whether you can accomplish basic business processes, processes like scheduling.

People see themselves as customers.  People paying a lot of money for a service.  Their satisfaction includes how much effort it took prior to coming to the hospital and it includes how responsive the hospital was to them after they were discharged.

Health systems do not see people as customers.  The notion of the customer-patient/patient-customer flies in the face of everything of which hospital executives have focused.  It certainly flies in the face of the business processes designed to support a patient-only model.

Here is one way to view the distinction.  Patients get better or they do not.  Getting better, fixing their problem is what the patient expects; anything else is failure.  How that happens is the concern of the hospital.  Came in sick.  Walked out better. Cubs win.

On the other hand, patient/customers are evaluating the rest of their experience.  Patients measure their customer experience from before they check in until after they are discharged.

Total patient satisfaction is the sum of a patient’s patient experience and their customer experience.  HCAHPS only measure a portion of it. It is up to you to create measures for the rest of it. Start with your call center and your phones. If people cannot even schedule an appointment, everything upstream is moot.

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