Winter 2014
HCAHPS Insanity: Why Doing the Same Surveys Over and Over Limits Your Results James H. Killian, Ph.D. Vice President | Assessments, Findly Talent, LLCe
The patient experience has become increasingly important in driving business outcomes within the health care setting. Patient surveys are routinely administered to gauge patient satisfaction, and numerous vendors have designed simulated surveys to help hospitals shed light on areas of strength and concern. However, these descriptive measures mostly focus on opinions, attitudes or observations that have already occurred and do little to predict whether those providing direct care (or support) have the capacity to deliver outstanding patient experience. We will explore the importance of using both predictive and descriptive assessment jointly to pinpoint the importance of potential and performance to drive better patient outcomes. Leveraging quality data for organizational initiatives and policy is long overdue – hence the “Big Data” movement, which advocates deep analysis of disparate data sources to drive more informed decision-making. Among health care systems, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) has become the core data analytic focus of most providers driving change in patient-centered programs and policy. These patient satisfaction ratings are aggregated by each hospital and reported publicly1, meaning that hospitals’ treatment of patients is as exposed as restaurants are to Yelp reviews. HCAHPS scores themselves have become an incredibly important metric driving everything from the creation of chief experience officer roles, to corporate branding and messaging, to employee training and onboarding and far more. But more directly these scores also affect Medicare and Medicaid reimbursement for each establishment. Thus, there is a rather large indirect and direct relationship between patient satisfaction and the overall culture, operation and financial performance of health care providers. Yet, still unaccounted for among the cadre of data is the fact that HCAHPS scores themselves are an aggregate result of individual experiences of people interacting with other people – in this case, patient and provider. Recent research by Gallup has pointed out the fact that by the time patients fill out the surveys, they are no longer under the direct attention of the providers they are rating2 meaning the conversion of survey ratings into HCAHPS scores is based on lagging patient ratings (i.e., fuzzy recollection of events), rather than real-time or leading indicators of those who are likely to provide an outstanding patient experience. Raw score differences could be minimal, but appear more disparate once calculated and adjusted
– thus presenting the potential for a feedback loop wherein practically insignificant differences are magnified and acted upon, putting our health care systems in a reactive mode as opposed to a strategic and proactive one. Despite there being some flaws in HCAHPS (as with any data), the program provides an excellent platform to universally focus U.S.-based health care providers to set a standard for patient-centric care. This critique comes more from the viewpoint of leveraging other sources of data that contribute to, or help account for the variance in, HCAHPS scores. It’s about not putting all our eggs in one basket so we enable our health care providers to be successful in staffing, resourcing and maintaining their corporate brands. The above points out an obvious consideration: A successful patient engagement begins with the people providing the care. The theme that long-dominated hospital settings was one of medical and technical superiority, with far less emphasis on the “soft skills” of patient care – “we are a hospital, not a hotel.” Although this attitude has softened over the last 15 years or so, there also has been limited focus and progress determining among individual skilled health care providers (i.e., nurses, doctors, support staff) who can deliver the best care with the best experience. Yet, most anyone in this space agrees that a quality patient-centric experience is a critical ingredient for HCAHPS ratings. That said, what is largely missing (in my experienced opinion) are predictive indicators of the likelihood that each individual contributor will have a positive engagement with each patient receiving care. Research by PricewaterhouseCoopers has indicated that the attitude of health care staff is a major factor in impacting consumers’ decisions about their providers3. Identifying those individuals up front who have “the right stuff” to provide quality medical care and patient experience complement an institution’s measurement of satisfaction via HCAHPS surveys. Quality people lead to quality outcomes; hospitals that perform better on clinical metrics also fair better on patient experience surveys4. Many health care systems believe they are already addressing this issue of quality via their existing employee selection processes of interviews, reference checks and multi-rater-type instruments, but they are still missing a large piece of the puzzle. In reality, the talent acquisition industry has simply changed the format and delivery of methods we know are flawed and biased (e.g., interviews).
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