Strategies for improving HCAHPS performance

By Greg Hyman
07:57 AM

For hospitals relying on Medicare reimbursement as a vital source of revenue, the importance of achieving strong performance on HCAHPS cannot be overstated.

Part of the federal government's legislative push toward a value-based financial model for the healthcare industry, the HCAHPS survey is designed to provide a high-level assessment of patients' experience of care, with scores on the survey ultimately tied to a portion of hospitals' Medicare reimbursement. The survey's impact on revenue can vary from several thousand dollars for small critical access hospitals to millions for multistate health systems.

With so much on the line, healthcare leaders are under great pressure to maximize their organizations' HCAHPS scores, and all signs indicate that the investments are having an impact. From 2011 to the most recent reporting period, average scores on all survey composites, or groupings of questions, have shown improvement. However, this trend does not represent unqualified good news for hospitals, as national improvement has resulted in increases to the achievement threshold, or the 50th percentile standard that organizations must meet in order to obtain HCAHPS achievement points. In fact, from 2013 to 2014, average points awarded to hospitals actually decreased slightly.

So how can organizations stay ahead of the curve?

The first step is to confirm that the proper organizational structures and resources are in place to support efficient, successful improvement initiatives. To wit, a study included in "The Four Cornerstones of an Exceptional Patient Experience," a paper published by The Beryl Institute, found that high-performing organizations had dedicated individuals with service-oriented positions who were responsible for leading their service initiatives. These organizations tended to devote 16 percent more time to their service efforts than low performers.

That same study found a marked disparity in levels of employee buy-in on improvement initiatives, when comparing high and low performers. Because internal buy-in across the organization is critical, high-performing organizations are recognizing that meaningful collaboration between patient experience leaders, Human Resources, and hiring managers is a must. While most managers understand the importance of hiring service-oriented employees, many don't have access to formal tools for evaluating desired qualities, particularly those that fall outside of their area of expertise. Behavioral assessments such as the Myers-Briggs Type Indicator and more tailored instruments represent a popular approach that high-performing hospitals have implemented with success.

Just as formalized tools should be made available to managers, all employees must be equipped to provide a patient experience in keeping with the organization's goals. As team members who interface with patients, front-line staff such as nurses, environmental technicians, and doctors are directly responsible for most aspects of the patient experience, as reflected in the preponderance of HCAHPS items that assess communication, care, and the hospital environment. As such, there is enormous opportunity for many hospitals to improve their HCAHPS scores through innovative forms of ongoing training for staff.

In recent years, simulations and roleplaying have become increasingly popular approaches to training, not least of all due to the tendency for personal, emotional experiences to support memory retention. Private, not-for-profit Crouse Hospital, of Syracuse, New York, took this approach with its "Operation Momma" initiative, a cultural change process designed to reinforce the importance of understanding the view of the patient at all times. The initiative has new onboarding managers spend the day as a patient, wearing a gown, riding in a wheelchair, and experiencing typical wait times. In conjunction with related initiatives, the program has helped Crouse Hospital achieve significant improvement in its HCAHPS scores.

Of course, HCAHPS surveys themselves provide a wealth of actionable data for identifying opportunities to improve, prioritizing investments, performing service recovery, and more. Though not factoring into scores or reimbursement, an optional comments section can prompt patients to provide clarifying information or detailed feedback on their experience. Hospital leaders can incorporate the comments into weekly team meetings and use them as a tool for recognizing and modeling excellent service. When attributing comments to the behaviors of specific teams and staff members, transparency should be phased in over time, so that feedback can gradually become accepted as part of the service improvement process.

As the HCAHPS achievement threshold rises, hospitals nationwide must continuously outperform their latest accomplishments in order to maintain their position in the competitive landscape. The rigor and diligence required cannot be exaggerated. Yet, with value-based purchasing expanding its reach into the realms of the physician clinic, ambulatory care setting, and more, the lessons healthcare leaders are learning today will serve them very well tomorrow.

With the right structures and approaches in place, even struggling organizations can improve the satisfaction of patients and, as a result, better secure the money they need to finance outstanding care.

Greg Hyman is marketing content manager for Avatar Solutions