A monthly column featuring insights and ideas on the most challenging communication issues facing health care professionals

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One year later…
Think H-CAHPS doesn’t matter? Think again.

The press release didn’t make the nightly news or front-page headlines across the country. But its message should have been “breaking news” in boardrooms and executive suites of the nation’s health care providers: “Unprecedented Spike in Patient Satisfaction Follows Launch of Public Reporting.” This September 23, 2008, release from Press Ganey Associates (CLICK HERE), the nation’s leading vendor of patient satisfaction survey research, has broad implications for hospitals – and even more promising implications for the patients and families they serve.

Hospitals are Paying Attention to H-CAHPS

As Press Ganey’s press release clearly points out, this record shift in satisfaction ratings is not by accident. According to the release, “The overall goal of H-CAHPS was to allow consumers to directly compare healthcare providers and to ultimately improve patient satisfaction, and Press Ganey now has data that proves this effort is working. Press Ganey recently pulled patient satisfaction data (which included the H-CAHPS measures) from April - June of this year, and the results so far are astounding.” The statistically significant increase in patient satisfaction represents a real change in the way care is being provided in our nation’s hospitals.

The skeptics who said H-CAHPS wouldn’t matter because most consumers would never go to the Hospital Compare website missed an important dynamic: leading hospitals and health systems did pay attention to H-CAHPS and are using the survey’s findings to improve the patient experience in ways that matter most to patients and families.

Why is that so important? First, the bar is being raised.  With the Agency for Healthcare Research & Quality (AHRQ) research, health provider organizations have a clearer, more targeted picture of what really matters to patients and families about their hospital experience. Hospitals that pay attention to and improve these factors will begin to widen their patient satisfaction lead over those who do not.

Second, years of research across many industries tells us what intuitively we already know: when you are extremely happy with a service or product, you’ll tell a few people. When you are unhappy, you’ll tell four to five times more people. While improving patient satisfaction may indeed inherently be the right thing to do, focused business strategies in this area pay off in higher patient loyalty and market position.

So what are the leading institutions who have high satisfaction scores doing differently?  Looking at the first seven questions of the brief H-CAHPS survey provides a clear picture of what AHRQ determined was important in patient satisfaction:

• During this hospital stay, how often did nurses treat you with courtesy and respect?
• During this hospital stay, how often did nurses listen carefully to you?
• During this hospital stay, how often did nurses explain things in a way you could understand?
• During this hospital stay, after you pressed the call button, how often did you get help as soon as you wanted it?
• During this hospital stay, how often did doctors treat you with courtesy and respect?
• During this hospital stay, how often did doctors listen carefully to you?
• During this hospital stay, how often did doctors explain things in a way you could understand?

Looking more closely at the total survey reveals that almost 75% of its evaluative questions directly or indirectly address communication competencies of front-line staff and physicians.

Without dispute, good communication is one of the – if not the – most important factors in determining whether a patient is satisfied with a hospital’s care and will recommend the institution to friends and family.

No mention of remote electronic access or EHRs.  Nothing about the latest wireless technology.  No expensive leading-edge equipment necessary.

Respect.  Accuracy.  Compassion.  Listening.  The specific factors H-CAHPS®  measures are at the very heart of a hospital’s communication culture.  And arguably are the toughest for an organization to change.

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The new H-CAHPS®  instrument provides the perfect springboard for hospital leaders to frame the opportunity for improving interpersonal communication. But there are other resources, as well.  The correlation analysis in your current patient satisfaction survey results likely points to a number of communication-related factors that have a significant impact on your overall “willingness to return” and “willingness to recommend” scores.

When did you last conduct formal patient and family focus groups to better understand your customers’ experiences in your hospital?  This tried-and-true qualitative tool can offer important insights that go beyond the numbers to better understand the communication factors that drive satisfaction.

Finally, remember that as pay-for-perform­ance plans evolve, a patient satisfaction component will almost surely be included.  At least for Medicare and Medicaid patient populations, H-CAHPS®  will provide a starting-point for that effort.

Even the most compelling rationale and enlightened strategies for change will be D.O.A. without the involvement and buy-in of key clinical, operations and human resources executives.  To be effective, communication improvement initiatives must be broad-based and sustainable. Simply, interventions need to reach all key employees consistently over an extended period of time.  The strongest, best implemented communication improvement strategies are inclusive strategies.

What patient satisfaction improvement efforts have been adopted by your institution over the past five years?  What has worked?  And why?  And, as importantly, where have programs fallen short of reaching goals?

Remember to look at both the actual impact past programs have had on satisfaction scores as well as employees’ reaction and acceptance of the efforts.  Building on past successes can strengthen new initiatives and help minimize the chance that efforts are simply viewed as another “program of the week” that will come and go.

One-time “events” are seldom effective in changing employee behavior for the long-term.  Make sure that whatever strategies you adopt to improve communication skills and practices include ongoing support components for supervisors and managers that are designed to help them help their front-line staff.  Also, incorporating communication competencies in annual performance reviews sends the clear message within an organization that effective communication is an absolute requirement, not an option.

For health care marketing professionals, H-CAHPS®  represents a unique chance to strategically influence a critical component of what makes patients most satisfied with the care we provide.  If we miss this window of opportunity, it is unlikely another one like it will come along in the foreseeable future.

For hospital leadership teams, H-CAHPS® represents a unique platform to focus on communication issues that most influence patient and family satisfaction with the care we provide.  For many front-line professional staff, this return to “the basics” of compassionate, individualized, humanistic care strikes at the heart of why they chose a career in health care in the first place.

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