By one measure of quality, 52-bed Westlake Regional Hospital in Columbia, KY seems to have more patients who are extremely pleased with their care than any other hospital in the country that garnered 300 or more responses to the Hospital Consumer Assessment of Healthcare Providers & Systems (HCAHPS) survey.
That is, 98% of Westlake's patients said they would definitely recommend the hospital to family and friends and only 1% said they would probably or definitely not recommend Westlake, according to the May 17 update on the federal government's Hospital Compare web site.
That's much higher than the 70% national average and the 70% that Kentucky averages for patients responding to the question.
Some argue that responses to the "would you recommend" questions are not the best to gauge the quality of a patient's experience; that responses are influenced more by a hospital's community reputation rather than how a specific patient perceived his or her treatment.
Better measures of patients' perceived experiences might be found in their replies to other questions, such as whether doctors or nurses communicated well with them during their stay and how their pain was prevented.
That may be so, but by all other measures on the HCAHPS survey, Westlake scored exceptionally high.
For example:
- 82% gave it the highest ranking of 9 or 10;
- 96% said the room was always clean;
- 98% of doctors and 100% of nurses "always" communicated well with their patients;
- 97% said their pain was always well-controlled
Westlake is one of about 100 hospitals around the country that self-administer their own surveys rather than hire vendor such as NRC Picker or Press Ganey, according to Centers for Medicare & Medicaid Services spokeswoman Ellen Griffith Cohen. A hospital employee calls patients after their discharge, asks them survey questions and fills out the forms for them. Since CMS conducts oversight of the survey process from training to double checking response forms, self-administration shouldn't make a difference in the scores, she says.
The hospital with the second highest score was 17-bed Surgical Hospital of Southwoods in Youngstown, OH, with 97% of patient responders saying they would definitely recommend it.
And 99-bed Oklahoma Heart Hospital in Oklahoma City, OK, was third, with 96% of respondents saying they would recommend it. Oklahoma Heart tied with 32-bed Heart Hospital of Lafayette, LA.
On the other side of the scorecard for hospitals with 300 or more responses, patients at 326-bed Jackson Park Hospital in Chicago seem to be the least pleased with their care, with only 36% saying they would definitely recommend the hospital and 29% of patients saying they definitely would not or probably would not recommend.
Other survey responses from Jackson Park's patients were similarly negative. For example:
- 35% gave the hospital a high ranking of 9 or 10;
- 53% said the room was always clean (24% said it was never or sometimes clean);
- 52% and 68%, respectively, said nurses and doctors communicated well.
- 55% said their pain was always well-controlled.
Other hospitals on the negative side of the scorecard include 88-bed Lehigh Regional Medical Center, in Lehigh Acres, FL and 146-bed St. Joseph's Hospital of Philadelphia. Of Only 35% of St. Joseph's patients and 39% of patients at Lehigh said they would definitely recommend the hospital to family and friends, with 28% and 26% saying they would probably or definitely not recommend their hospitals.
There's a huge gap between 98% and 35%. HealthLeaders asked some of these hospitals to explain the difference.
Beverly Smith, Westlake Regional's patient representative, says she calls patients on the phone and speaks to them in person after they've been discharged. It's been her full time job for the last five years. She reads each question to each patient and notes their response on the form.
The reason Westlake gets such good responses, Smith says, "is we just have excellent doctors and nurses."
Cohen says that CMS does adjust for patient factors that might influence how someone may respond to a survey, such as education, age, and how the responder rates their own health status. And there is a correction for phone versus mailed surveys, because patients asked questions by a live human during a phone call are apparently less likely to give a negative response.
There is no adjustment for self-administering hospitals versus those who hire a vendor.
"We feel we would get better responses doing these on a one-to-one" Smith says. Besides, she adds, Westlake "could not afford a vendor or a company (to do these surveys) at the time we started (doing them)," Smith says.
The hospital also is the biggest employer in community of 15,000 people, and Smith attends the same church as many town residents.
Smaller, specialty surgical hospitals tend to do well on the HCAHPS "would you recommend" question, especially if they are newer and physician-owned as many of them are.
At 10-year-old Oklahoma Heart Hospital, director Cindy Miller says, "the whole architecture is designed so that patients feel they're the only patient in the hospital; it's quiet." But key to their high-end patient experience scores is their low nurse-to-patient ratio, which Miller says "is unmatched. If a patient needs three nurses, that's what the patient gets."
Second on the OHH's list is an aggressive service recovery effort. "We openly admit our boo-boos and try to amend with the patient proactively," Miller says. For example, if there's a scheduling mixup, a patient might receive a free hotel stay, flowers, free meals "whatever we can do."
Now eight years old, Lafayette uses concierges to escort patients where they need to be at all times, and "takes every complaint seriously," says Richard LeBlanc, Heart Hospital of Lafayette's director of performance improvement and risk management. "I don't care if they say they don't like the TV remote, we get them a new one. Or if anything is wrong with the food, the dietician comes to fix it." Family members can stay with their loved ones through their ICU recovery.
Some officials for some hospitals on the lower end of the HCAHPS scorecard blame their poor responses on the fact that they serve a low-income population or are located in a lower socioeconomic region.
Patricia Simon, Jackson Park's vice president for quality and compliance, says that Jackson Park treats a population in a highly underserved area where a lot of patients are funded through public aid programs.
Cathy Kutzler, CEO of St. Joseph's, says her hospital has a disadvantage on the HCAHPS survey because 98% of the patients that come there are brought in by fire and rescue services and don't see St. Joseph's as their hospital. Additionally, she says, while the emergency department was rebuilt in the last three years, the rest of the hospital is old. "We receive a lot of complaints about our rooms. That they're old and they look dirty, no matter what we do."
Kutzler says that St. Joseph's is trying to get a better "face in the community, but I've been here since 1990 and the community has always viewed this hospital as one that just takes care of the poor."
The hospital recently endured a 100-person staff layoff, and is struggling with employee morale. "We are still working with our nursing issues, trying to convey that the call bell is everybody's call bell and the call light is everybody's call light." Additionally, she says, "we've had some issues with our physicians, a lot of older physicians." St. Joseph's recently contracted with Drexel University to provide some University-based doctors in an effort to align with a large academic center.
At Lehigh, a comment from CEO Joanie Jeannette is posted on the Lehigh's website:
"We want to make sure that you are extremely satisfied with the care you receive. If at any time you are not satisfied with your care, please let us know. All of our staff is committed to achieving your standards of excellence.
"Following your stay with us, you may receive a survey in the mail asking for your feedback. I hope you will take a few minutes to fill it out and let us know how we are doing. Again, it is both an honor and a privilege to serve you and we want to make sure we provide you and your family the very best of care… Always."
In response to an inquiry, Lehigh marketing director Diann Cimring replies: We are constantly striving to achieve the highest level of patient satisfaction, and have implemented processes and procedures to ensure that the patients receive the finest quality healthcare at Lehigh Regional Medical Center. However we are constantly measuring scores and processes in order to give our patients the best experience and to exceed their expectations."
In general, hospitals that scored poorly indicate that they have a harder road to climb because of their demographics. But while CMS spokeswoman Cohen acknowledges that smaller rural and specialty hospitals "tend to score more highly on HCAHPS compared to larger, urban and general hospitals" that's not a reason to give the hospitals a statistical break or correct the data to reflect that.
"These are hospital, not patient characteristics, it is not appropriate to adjust for these characteristics," she says. And besides, many hospitals that are poor and large and in urban areas do well on the HCAHPS, and likewise, some hospitals that are small and in rural communities do poorly.