Is There an Echo Out There?

Maureen Larkin, for HealthLeaders Media, March 13, 2008

When I was interviewing sources for this month's quality story for HealthLeaders magazine, I asked a representative from Press Ganey why a hospital would continue administering its own patient satisfaction survey when the federally-administered HCAHPS survey provides them with much of the same information. Her response was, "Why wouldn't you?"

But HealthStream Research, another survey vendor, tells me that many of their clients are opting away from customized surveys and using HCAHPS alone to measure patient satisfaction.

"[Hospitals] are delighted to hear that the HCAHPS survey is measuring the same thing. It eliminates the need for two separate surveys," says Thomas Hutchinson, senior vice president at HealthStream Research of Nashville. "There are too many conflicting points in trying to measure two different ways."

Hutchinson says a majority of the firm's clients are using HCAHPS as their sole way of measuring patient satisfaction. Many HealthStream hospitals are also adopting an HCAHPS-like survey to review areas that aren't covered by the HCAHPS survey--namely emergency and outpatient services. Using one type of survey helps hospitals spread the word about what patients think about their facility.

"It makes the communication of results fairly easy throughout the hospital," Hutchinson says. "It's easier than explaining, 'On HCAHPS we're on this scale, but in our ED, we're on this scale.' It's just easier to communicate the results."

William Powanda, vice president of Griffin Hospital in Derby, CT, says that HCAHPS is the first of many CAHPS surveys coming from the Centers for Medicare & Medicaid Services. Concentrating solely on the results of the HCAHPS survey will only help his hospital down the road, he says.

"We're convinced that HCAHPS is effective and realize that not so far down the road, CMS will roll out an ER survey and surveys for other areas," Powanda says.

But for Deirdre Mylod, PhD, vice president of public policy for Press Ganey, there's more to patient satisfaction than what's covered in HCAHPS. By using an "HCAHPS plus" survey, hospitals can get a bigger picture of the care that's offered at their facility, she says. The South Bend, IN-based vendor has developed a survey tool that asks the HCAHPS questions first, followed by "additional questions that allow patients to comment on the care they received--not just how well it met their needs," she says.

HCAHPS questions are broad--and providing patients with a place to expand on the information they reported on the HCAHPS survey may provide a hospital with insight about why patients are claiming their rooms weren't cleaned often enough, or their floor was too noisy at night.

"The HCAHPS survey does not include patient comments," Mylod says. "But with comments, you get real words from real patients. Real words can make things real for an organization. You can use them with your staff and say, 'Look what this patient thought about you.' That can be really key in keeping up the momentum for quality purposes."

Redge Hanna, director of service performance for Emory Healthcare in Atlanta, says having that additional data is the only way to truly satisfy patients.

"We try to measure everything we do, by looking at what we do and how we do it at the same time," he says. "That essence does not always come through in the HCAHPS survey. It doesn't give us comments or the overall perception we're leaving people with."

Maureen Larkin is quality editor with HealthLeaders magazine. She can be reached at
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