If you ignore the fact that CMS requires you to report your HCHAPs, I think a mathematical argument can be made to stop scoring patient experience.  Here are a few thoughts as to why:

• Even without the heavy handed efforts from CMS, every health system worth its salt would be doing many of the same things to improve patient experience simply because they are the right things to do. You don’t need to be penalized to figure it out.
• Patient experience is cumulative. By the time the experiences related to HCAHPS come into play, most patients have already formed an opinion of their overall experience based on all of their prior interactions.
• Nobody ever asked patients their expectations with regard to what constitutes a good experience. The survey questions may or may not relate to what constitutes a good experience.
• Most experiences that determine a person’s loyalty and stickiness occur outside of the hospital setting.
• Using the survey as the sole measure of the experiences of a health system’s stakeholders is about as valid as having aliens land in the parking lot of a Home Depot and characterizing all Americans as people who drive pickup trucks with 4 x 8 pieces of sheetrock in the back.
• Improving patient experience scores using just the CMS approach will have very little impact on the ability of a health system to effectively manage consumerism, wellness, and population health.
• It is much easier to improve low HCAHPs than to improve high HCHAPS. Trying to squeeze blood from a turnip makes no sense.
• Once your health system’s scores are in the top fifty percent, there is little material benefit—because what you are trying to do is avoid being penalized—in trying to push them much higher.
• To raise your health system’s overall score by just one-tenth of a point you have to do one of the following;
  • Raise your scores on all 32 questions by one-tenth of a point
  • Raise your scores on 16 questions by two-tenths of a point
  • Raise your scores on 8 questions by four-tenths of a point
  • Raise your scores on 4 questions by eight-tenths of a point
  • Raise your scores on 2 questions by 1.6 points
  • Raise your scores on 1 question by 3.2 points

And what do you have after you’ve added all of your one-tenth points?  You have a marginally higher score. You may or may not have higher experience. Going from a score of 7 to 7.1 doesn’t add much value, but just to accomplish that every single one of your thirty-two initiatives has to succeed.

If your health system needs or wants to improve its scores by a meaningful amount, may I suggest the following approach, an approach based entirely on simple logic?

Compare your scores, question by question, against the average scores of all health systems.  And do the same comparison against the average scores of a grouping of the top health systems.  For any question where your score is within one or two tenths of the scores of the top health systems do not invest anything to improve your score on that issue—if the highest scoring systems are not much better than yours on those issues there may be reason to conclude there is not much you can do to drive those scores much higher. In that case, consider not working too hard to improve your results on those particular survey questions.

Now look at the survey questions for which the average scores of all health systems were the lowest.  For those survey questions where the average score among all heath systems is noticeably lower, that may be a pretty good indicator that to materially boost your system’s scores on those issues will require a significant expenditure of funds and effort.  In that case, don’t plan to raise those scores by a significant amount.

So now, we almost have a plan about where to invest your patient experience dollars.  Do not plan on fixing things where you score almost as well as the best systems, and do not plan on fixing things where you are not much worse with regard to the most difficult issues.

Let’s say that leaves us with 16 survey questions to be assessed about where to target your efforts.  Compare the issues where the average systems scored the highest to the issues where the best systems scored the highest.  For issues where both sets of average scores concern the same issue, flag that issue.  For example, if the scores from the average health systems, and the scores from the top healthcare systems, indicate both groups scored significantly better than your health system on a specific issue—take reducing noise as an example—develop a plan to target reducing noise.  And do this for every one of those types of issues.

Why?  Because if even the ‘average’ systems are markedly better, that should be a signal that your system can also be markedly better on those issues.  So, how do you figure out what to do?  Go talk to the health systems which scored higher in those areas, find out what they did, what worked and what didn’t, and borrow their ideas.

There are health system’s whose boards wants them to move their scores from let’s say an average score of ‘7’ to and average score of ‘9’—almost a thirty percent improvement across the survey, 64 total new points. Thirty-two, two-point increases, all of whose efforts must be successful to raise the total score.  The other way to do that would be to improve twenty-one categories by three points, moving those scores from a ‘7’ to a ‘10’ to net you 63 additional points.  The likelihood of scoring a ‘10’ on twenty-one categories is absurd.  That dog don’t hunt.

I hope you find some of this helpful.