Dealing with the disconnect
For those hospitals that have extremely high clinical rankings, when relatively low HCAHPS scores are delivered, it's a wake-up call.
Stephen Weber, MD, chief medical officer and vice president for clinical effectiveness at the 547-licensed-bed University of Chicago Medicine, talks proudly about how UCM has worked diligently to improve infection rates at all of its hospitals, but concedes that it has fallen flat in patient satisfaction. Scores show that UCM falls slightly below state and national averages in measures of how physicians communicate with patients. UCM received a 78% rating in this category, compared with the state and national average of 80%. UCM also received 53% on how often patents received help quickly from hospital staff, compared with the state average of 62% and national average of 65%, according to HCAHPS, as of June 2011.
While Weber offers no excuses, he points to the complex patient mix of a large-scale academic institution. He also suggests that the medical center has had an almost singular focus on improving clinical quality, possibly at the expense of patient satisfaction.
"We need to move away from saying these measures are terrible and not paying attention to them and instead move toward constructive collaboration," says Weber. "We want to enhance the reliability of our numbers. We don't feel we are chasing a number; we feel we have external measures that reflect something uncomfortable and accurate about us," Weber says.
Weber provides no explicit details of the institution's plans to improve its HCAHPS scores, though he outlines some broad-brush plans. "This has been a major focus for us. We have had meetings about this with our boards and community stakeholders. We need to deliver the service that matches our science. It's a great little sound bite, but it means we apply the same kind of rigor, the same kind of commitment, to make the patient experience better, setting new expectations. We know we have a lot of work to do, and we have the resources and the expertise to match that."
Benefits of planning and training
About 22 miles west of Chicago is the 333-licensed-bed Advocate Good Samaritan Hospital in Downers Grove, Ill., which was recently named by Thomson Reuters (now Truven Health Analytics) as among the nation's top healthcare systems. Recognized for a third time as one of the nation's best large community hospitals, Advocate Good Samaritan issued a statement saying the award was a "testament to our physicians and associates who are dedicated to delivering the highest quality of clinical care and health outcomes to the patients we serve."
Unlike the UCM, Advocate Good Samaritan Hospital has had relatively good patient satisfaction scores, for the most part. The HCAHPS scores show that Advocate Good Samaritan is above the national average for how patients rate the hospital overall, how well pain was controlled and how well nurses communicated with patients, and essentially tied with the national rate of how well doctors communicated with patients.
David Fox, president of Advocate Good Samaritan, attributes the high scores to long-term planning by the hospital since 2004 for improved clinical and patient satisfaction—well before the government came into the picture. He attributes much of the success to an intense concentration on training and hiring staff, particularly nurses and other caregivers. "We have gotten very focused on who gets to work here, and how we train them in terms of customer service," Fox adds. "We used to hire for skill and pray for attitude and cultural fit. Now we screen for skill, hire for cultural fit and attitude."
Like other hospital leaders, Fox also points to procedures performed daily in the hospital that can influence HCAHPS scores. Daily rounding is pivotal to not only improve various processes, such as communication, but also to ensure that patients get help going to the bathroom or have their pain routinely monitored, all important considerations for HCAHPS scores.