Patient satisfaction—“the patient experience”—is given great weight by hospitals and the public alike. Physicians have always aspired to take excellent care of patients. What has changed is that assessments of the patient experience are now being used to measure and report the quality of our care. Although there are many venues for patients to share their opinions, including reviews and online ratings, only the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey is standardized and allows for comparisons nationwide.
Given that HCAHPS is the standard by which hospitals, health systems, and individual hospitalists are judged, it is vital for us to understand the core drivers of measured patient experience—especially the factors within our control. Armed with this knowledge, we can more effectively promote a positive experience within our daily patient care.
HCAHPS (H-caps) is a national, standardized, and publicly reported survey of patients’ experiences in the hospital. The Centers for Medicare and Medicaid Services (CMS) and the Agency for Healthcare Research and Quality (AHRQ) developed and piloted the survey in 2002 and launched it in October 2006, with results first published in March 2008 on the Hospital Compare website.
The survey must be administered to a random sample of hospital inpatients 48 hours to six weeks after discharge, and it is offered in multiple languages, either by phone or mail. Twenty-one core questions cover seven composites (communication with doctors, communication with nurses, responsiveness of hospital staff, pain control, communication about new medications, discharge information and planning, and cleanliness/quietness) and two global items (patients’ overall rating of the hospital and likelihood to recommend it to family and friends). There are several additional questions adjusting for patient mix between hospitals, as well as any supplementary questions desired by individual hospitals.1
With the exception of the two global items, all core HCAHPS questions ask “how often” a patient experienced a particular aspect of hospital care. Possible answers are “Always,” “Usually,” “Sometimes,” or “Never”; credit is given to the hospital only for a “top box” score of “Always.” The three questions that are most applicable to hospitalists make up the “communication with doctors” composite; they focus on the quality of physician-patient communication:
- 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?
Importance to Hospitalists
A tremendous amount is tied to HCAHPS scores: hospital reimbursement from CMS (through value-based purchasing), hospital rating and “brand,” patients’ choice of hospital, and, in some cases, hospitalist performance bonuses. Hospitals and health systems therefore emphasize HCAHPS heavily. This emphasis has sparked some controversy, particularly surrounding the risk that inappropriate medical decisions (e.g. prescribing antimicrobials or pain medications when not indicated) will be made in order to generate higher patient satisfaction scores. Given the evidence that physicians’ biomedical skill and interpersonal qualities are equally important in determining patient satisfaction, however, we can remain optimistic that time spent explaining the rationale for appropriate medical care is highly valued by patients.2,3
The more satisfied patients are with the care they receive, the more likely they are to continue to seek care from the same provider, hospital, and/or clinic. Improved continuity can help increase adherence, improve patient safety, and decrease healthcare costs. Positive healthcare experiences are also correlated with improved patient compliance with treatment regimens and medical advice, which will lead to better outcomes.
We must also recognize that both the patient experience and physician-patient communication impact clinical care. First, a positive patient experience is linked to higher continuity of care.4 The more satisfied patients are with the care they receive, the more likely they are to continue to seek care from the same provider, hospital, and/or clinic. Improved continuity can help increase adherence, improve patient safety, and decrease healthcare costs. Positive healthcare experiences are also correlated with improved patient compliance with treatment regimens and medical advice, which will lead to better outcomes.5,6