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In early July, my mother was admitted to ICU. She has since finished rehab at a transitional care unit (TCU) and is now home. This experience and the recent release of the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) scores has me thinking about what providers, patients and patient advocates can do to improve the experience. 
For those of you not familiar, the HCAHPS are significant for two reasons:
First, results are used by Medicare to determine payment for each hospital.
Second, HCAHPS are a measure of patient experience, which along with health of a population and per capita cost make up the framework for optimizing health system performance known as the Triple Aim.
So, what did we learn from the recent HCAHPS scores? Quality of care and outcomes are dominant metrics and significantly affect a provider’s score but there are three key “soft skill” areas hospitals can focus on to improve scores:
1. Improving employee engagement. Recent data from The Advisory Board Company (a provider education and resource tool) showed that for every one percent increase in employee engagement an organization’s overall score increases by 0.33 percent. In the point-based system that is HCAHPS, increasing employee engagement by 10 percent, which translates to an HCAHPS increase of 3.3 percent, is like Usain Bolt shaving a full second off his 200 meter dash. This increase can also mean the difference between two and three stars in a four-star rating system. An “engaged employee” is one who has or is:
- Pride an employee has being associated with the hospital and its brand.
- Confidence an employee feels knowing that the care patients/consumers being treated by their hospital is receiving the right and appropriate care.
- Support with staff, tools and training to work effectively
2. Meaningful engagement with patients. So much of HCAPS is based on the patient’s own perception of the care they received. E.g., “Did your provider always explain what the medications you were given were and why were you were taking them?” “Did you always receive help when you needed it?” In addition to affecting HCAHPS scores, negative word of mouth and online comments from dissatisfied patients and families are likely costing your hospital revenue. So, what can providers do to improve consumer perception?
- Create a hospitality department, think 5-star hotel– Making sure the care experience is “seamless” and “comfortable” for the
patient and his/her family improves patient experience. But the actual experience is made up of a million little things: wait times, “hand offs” between care units, retail/food options, cleanliness, noise levels (attention shoemakers: non-squeaky soles for hospital staff are desperately needed. If I hadn’t been so exhausted, I would have recorded the cacophony of squeaks and alarms that lulled me into my own version of ICU psychosis), appearance of the room and waiting areas. Did you notice, I did not mention quality of care? - Training and development. To provide a consumer-oriented experience, ensure proper standard operating processes and protocols are in place that help ensure staff explain and, maybe more critical, that patient’s “understand” care delivery instructions and are clear/accept their role in their care. I.e., is the patient Responsible, Accountable, Consulted or Informed (RACI) of/for care delivery? In the case of my mother, who actually suffered from ICU psychosis, she never felt that she received a “good accounting” of what happened to her and what care she needed upon discharge from the hospital or TCU. Maybe a follow up call with a nurse once the propofol wore off would have been helpful.
3. Think human-centered healthcare. Whether a person thinks of themselves as a “consumer” or a “patient” depends on where they are in the care continuum. If you consider that most Americans spend more time researching a refrigerator than they do choosing a doctor, as actual consumers of healthcare, we have a long way to go. How do you make sure you’re there, ready to “greet” healthcare consumers when they arrive?
- Consider where the patient is in this journey. And, adjust your care delivery accordingly. Where is the patient on the RACI matrix? I
n the case of my mom, she is now home thanks to the great care she received at the hospital and TCU. While she is capable of being responsible for her own care, she is wrestling with her accountability to a healthy lifestyle. - Bring the family into the conversation. A patient’s family and support network can strongly influence a patient’s perception of care. By being asked to participate in my mother’s care, I was able to facilitate care while she was in the ICU. Now post-TCU, my role has been to support discharge instructions and move my mom from being “cranky” about her condition and new reality to a motivated healthcare consumer. Wish me luck!
How do you think hospitals and providers could improve your assessment of them? What role do you have? Do you have a personal care story to share?
Also, check out how CMS rates your hospital, in this interactive map.