Survey

What Have We Learned from Patient Satisfaction Surveys?

The HCAHPS patient satisfaction rating system has been tied to Medicare reimbursement since 2013. Scores indicate there is room for improvement, so how can nurses contribute to a culture of patient satisfaction?

If you’re in a patient-facing job, chances are good that you are already familiar with the HCAHPS (pronounced H-CAPS) survey, which measures patient satisfaction with the entire hospital experience. Recently discharged patients are asked to answer a series of questions, in eight key topic areas that include responsiveness of hospital staff, nursing communication skills, physician communication skills, pain management, quietness and cleanliness, explanations about medications, and discharge instructions.

HCAHPS is part of Medicare’s value-based purchasing (VBP) program, which is a shift to reimbursement models that pay for high-quality care, rather than volume of services. This means that hospitals can be financially rewarded or penalized for their HCAHPS scores. As a result, hospitals are taking patient satisfaction scores so seriously that many are adding a new executive position, known as the chief experience officer and abbreviated as CXO.

Nurses make up the largest group of healthcare workers, and they are the frontline providers of daily patient care. So it’s no surprise that the HCAHPS survey section on nurses’ communication has been found to have the greatest impact on overall patient satisfaction. Patients who rated nurses as highly responsive were more likely to indicate that they would recommend the hospital to family and friends. And a recent report by healthcare analysts at Press Ganey concluded that hospitals could potentially affect 15% of their VBP incentive payments just by focusing on that nurse communication survey question.

The tricky part is that the survey measures patient perceptions – and patients are likely to perceive an experience quite differently than the providers who were involved. As a nurse, you might feel like you responded to a patient very quickly. Yet the patient who was waiting for you with a sense of urgency and a full bladder might have a very different impression of how long she waited. And while providers correlate high-quality care with positive outcomes, patients put tremendous weight on kindness, compassion, and empathetic communication.

A quality initiative implemented at a hospital in South Carolina found that patient satisfaction scores improved when nurses went on daily rounds with physicians. What’s more, the clinicians used a specific rounding tool to guide the conversation in a structured manner, with the goal of making sure the patient understood all aspects of the treatment plan, and that any patient concerns were resolved. At the end of the evaluation period, patient satisfaction with both nurse and physician communication had increased. Perhaps not surprisingly, the greatest improvement was seen in patient satisfaction with physician communication – possibly due to having nurses present to act as a liaison and to advocate for their patients. Overall, using the communication tool as a sort of “script” seemed to boost the quality of the communication between patients and providers.

Having unit nurses make hourly rounds of patient rooms is another effective communication strategy that uses “scripting” to guide the conversation. In one model, nurses enter the patient room, introduce themselves, state they are making hourly rounds, and then use a script to ensure that all of the “four Ps” are covered: pain, positioning, personal needs (bathing, toileting), and placement (of items like the call button, TV remote, phone, tissue box, water glass, etc.) This strategy has been shown to reduce use of the call button, improve overall patient satisfaction, and even reduce patient falls.

You can use guided, or scripted, conversations in your daily practice even if your hospital does not have a program in place for making hourly rounds. The key is to be aware that it’s the patients’ perception of care that will matter – and that you can sometimes influence their perception in positive ways, through your dialogue. For example, since patients will be surveyed about how often you provided information about the medication you administered, you might say something like, “This is a new medicine for you, so I want to explain to you in detail how it works and what it is being prescribed for, and then answer any questions you have.” They will also be surveyed about how often you cleaned your hands upon entering the room, so if the sink or hand sanitizer station is outside the patient’s line of sight, you might introduce yourself first and then say something like, “Give me just a second while I wash my hands for your protection.”

If you’ve never seen the actual HCAHPS questionnaire, take a look at it now and become familiar with the topics patients will be asked about. When your hospital HCAHPS scores are released, review the data and compare it to other hospitals in your area, as well as to national averages. If you have specific ideas for changes that might improve the patient experience, be sure to discuss them with your nursing supervisor.

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