Quality patient care is becoming a growing priority for healthcare facilities across the United States. The objective is to provide patients with a more-than-satisfactory experience during their hospital stay. Healthcare systems nationwide are beginning to realize that using a measurable and trustworthy method of calculating patient satisfaction levels is the key to operational success.
So, is there a standard hospital patient survey to assess patient satisfaction levels? The answer is yes. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), pronounced “H Caps,” was created in 2006 as a way to collect data about a patient’s perception of their hospital experience. The HCAHPS questions intend to help the Centers for Medicare and Medicaid Services (CMS) determine how well hospitals provide care. Similarly, the HCAHPS can also help patients make more empowered and informed decisions about their healthcare options.
What Are HCAHPS Scores?
The HCAHPS scores, also known as the CAHPS Hospital Survey, is a nationwide standard for patient satisfaction measurement. It is a survey that measures the quality of care provided by healthcare organizations.
After the survey was originally launched in 2012, the number of questions on the HCAHPS survey fluctuated. First, there were just 27 questions, which then increased to 32 questions in 2019. In 2022, three items were eliminated, bringing the official HCAHPS survey total to 29 questions that measure a patient’s experience at a hospital.
How Are HCAHPS Surveys Administered?
HCAHPS surveys can be conducted in the following ways:
- Mail-only surveys
- Phone-only surveys
- Mail with telephone follow up
- Interactive Voice Response (IVR), an automated telephone system that interacts with patient respondents via voice and dial pad
A random sample of discharged patients are given HCAHPS questionnaires. These surveys are intended to offer a uniform method of assessing and comparing hospitals based on patient input. Since HCAHPS scores are reported publicly—as part of the Hospital Inpatient Quality Reporting Program—patients may compare data on the quality of treatment provided by over 4,000 Medicare-certified hospitals in the US. These results are generally updated on a quarterly basis.
Why Are HCAHPS Scores Important?
HCAHPS scores are important because they provide healthcare companies with a better knowledge of their patients’ health and satisfaction with their care. Therefore, taking into account the results of HCAHPS surveys can assist healthcare practitioners in determining where they might improve to ensure that their patients are satisfied. Moreover, CMS mandates the completion of HCAHPS surveys by hospitals that bill through Medicare using the Inpatient Prospective Payment System (IPPS). If a hospital fails to submit HCAHPS surveys, CMS could reduce Medicare payments to IPPS hospitals.
Essentially, HCAHPS scores are a way to hold hospitals accountable for ensuring quality and compassionate care every time a patient walks through the door. HCAHPS ratings can also help patients compare how different healthcare facilities are performing, allowing them to make informed decisions about their healthcare providers.
How Are HCAHPS Scores Measured?
A CAHPS Hospital Survey will ask patients to answer questions about their interactions with healthcare personnel and caregivers. These questions will be specific to how a patient felt about their experiences with communication, respect, and responsiveness from hospital staff. HCAHPS surveys will also inquire about hospital cleanliness and level of noise. Additionally, HCAHPS surveys will ask questions related to how medical personnel managed a patient’s pain and how well-defined the patient's discharge instructions were.
HCAHPS summary scores are based on a five-star rating system. A one-star rating is the lowest a hospital can receive, and a five-star rating is the greatest. Stars are calculated by averaging the hospital's results across the 19 key survey items. As a result, hospitals with four- and five-star ratings are regarded as excellent from the standpoint of the patient. While many hospitals would ideally like to fall between four and five stars, many hospitals fall below this rating. According to recent healthcare insights, the average star rating from data collected by 3,286 US hospitals is 3.24. Considering these rating systems, the pressure is on hospitals to remain competitive in the healthcare sector by focusing on initiatives to improve HCAHPS scores.
What Are the HCAHPS Survey Questions?
The HCAHPS survey is composed of 29 questions that are broken down into 19 substantive items that cover crucial aspects of the hospital experience, three screening questions that direct patients to appropriate questions, and seven demographic questions that help with mandated reporting.
The bulk of the HCAHPS survey—and objectively the most important part—covers questions related to patient perception of doctor and nurse communication, hospital cleanliness, food services, and the clarity of medication and discharge instructions. Below are general categories of the HCAHPS survey with some sample questions:
***All original HCAHPS survey questions can be found in PDF version here.
How Hospitals Can Improve the Patient Experience
Over 3 million patients annually complete the HCAHPS survey, which is provided to over 4,000 hospitals. Hospitals must continue to face intense competition in order to reach and even surpass patient satisfaction standards. But what are some ways that hospitals can go above and beyond for their patients? In an effort to make the patient experience more positive, the following actionable initiatives could help hospitals improve their HCAHPS scores:
How to Help Raise Nurse Care Scores
Nurses can help raise nurse care scores on the HCAHPS by providing patients with compassionate and individualized care. This high level of care can include being timely and effective in communicating with patients and their families about decision-making and being clear about following care instructions. Additionally, nurses can take actionable steps to improve the patient experience by encouraging patient education and empowerment and fostering a positive and comfortable environment.
How to Raise Doctor Care Scores
Doctors can contribute to improving HCAHPS scores by listening to patient concerns and involving them in treatment decisions. Doctors should also be up to date on modern medical research and treatments, including healthcare technology that can enhance a patient’s experience. In addition, doctors can prioritize preventive care, educating patients on the importance of maintaining healthy lifestyle behaviors to prevent future illness.
How to Improve Staff Responsiveness Scores
Patients generally have a positive experience when their needs are accommodated efficiently and compassionately. Therefore, hospitals can strive to improve staff responsiveness scores by ensuring adequate nurse-to-patient ratios at any given time. Appropriate nurse-to-patient ratios make it possible for nurses to provide effective and safe care to their patients and prevent medical errors that can harm patients. One way hospitals can ensure they have enough nurses for any given shift is by using per diem nurses to account for patient intake fluctuations and nurse call-offs. Similarly, skilled per diem nurses can quickly adapt to new environments and patient loads, filling in necessary gaps when other staff are sick or on vacation.
How to Increase Hospital Cleanliness Scores
Hospitals can improve cleanliness scores by adhering to practical measures such as making a standardization system for cleaning procedures and protocols for each hospital area. Also, management should regularly audit and monitor for cleanliness levels. Patients and visitors can be encouraged to maintain good hygiene in waiting areas by placing educational posters around the facilities. Lastly, some hospitals may wish to reward and recognize medical staff who always maintain exceptional cleanliness standards.
How to Improve Patient Discharge Protocols
Hospitals that would like to achieve higher patient discharge HCAHPS scores should make sure that when patients leave, they feel confident and clear about their diagnoses and aftercare instructions. This clarity can be achieved by utilizing clear language and visual aids to boost the patient's understanding of how to take their medicine and carry out recommended aftercare procedures. Additionally, it's crucial to address any patient questions or ambiguities regarding patient discharge instructions. Speaking with family members and caregivers about the discharge process may also be necessary. Basically, when patients leave the hospital, they should feel supported and understood.
Improving HCAHPS Scores in Hospitals: The Bottom Line
Thanks to the widespread usage of HCAHPS ratings throughout the US, patients can now choose their healthcare providers with confidence. At the same time, the pressure is on US hospitals to continue to improve the multifaceted patient experience. This means making sure all areas of patient care are essentially “checked off,” such as paying attention to patient preferences, involving them in decision-making, and delivering individualized and compassionate treatment.
In addition, hospitals should always take care of fundamental requirements such as providing a patient with food and water and ensuring that hospital facilities are clean. Finally, hospitals can continue to improve HCAHPS scores by adapting to new information, apps, and technology that can all contribute to a more positive and empowering patient experience.