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Why the Big Names in Healthcare Are Not Leaders in Patient Satisfaction

Patient satisfaction has become a major focus of hospitals and health systems, especially after it became tied to the value-based purchasing program in 2012. Under the program, patient experience, as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems survey (HCAHPS), is weighed even more heavily than overall safety, and facilities with poor scores risk negative adjustments to their Medicare reimbursement. In response, hospitals have invested heavily in patient experience initiatives, in some cases even creating new positions like chief patient experience officer. While an analysis of the hospitals with the best HCAHPS scores suggests that some facilities may be unable to ever achieve similar ratings, hospitals have several viable options to improve patient experience.

The HCAHPS survey is given to patients at participating hospitals after discharge who are asked to rate their stay on several different measures such as provider communication, room cleanliness, and pain management. Roughly 3,500 hospitals participated in the HCAHPS survey and had enough completed responses to be assigned a star rating so far in 2016, according to data from Definitive Healthcare. While CMS gives facilities a star rating of one to five based upon a rounded value, individual measure scores can serve as a rough ranking system for hospitals that share the same rating. The following table shows the top ten five-star hospitals that also had enough volume for hospital compare ratings by the highest average score of most HCAHPS measures. Room cleanliness and hospital recommendation measures were excluded for their obvious solution and overly broad and subjective criteria, respectively.

Top 10 Hospitals with Five-Star Patient Experience Rankings by Highest Avg Measure

Hospital Average HCAHPS Measure Discharges Staffed Beds
Citizens Medical Center 92% 527 40
Orthopaedic Hospital of Wisconsin 87% 1,190 30
Black Hills Surgical Hospital 87% 1,600 26
Surgical Hospital at Southwoods 86% 1,098 24
Oak Leaf Surgical Hospital 86% 623 13
Patewood Memorial Hospital 86% 1,285 36
Wellspan Surgery and Rehabilitation Hospital 85% 699 25
Sioux Falls Specialty Hospital 85% 1,751 35
Heart Hospital of Lafayette 85% 1,466 32
Mariners Hospital 85% 587 25

Source: Definitive Healthcare

Like the vast majority of all five-star ranked hospitals, the top 10 hospitals are very small, none with over 50 beds or over 2,000 annual discharges. Their size gives them a natural advantage in some patient experience areas, such as nightly noise level, which would be lower in more remote facilities without as many staff or patients.  It’s also possible that each provider has fewer patients to manage than those at larger hospitals, which could explain higher scores in patient communication, discharge care instruction, and response frequency. Another notable characteristic is that most of the top 10 are specialty hospitals. Studies have noted that specialty hospitals generally have higher rates of satisfaction than normal medical centers. Potential reasons include a less severe case mix, leading to fewer complications, and a lower daily census of patients.

Average Individual HCAHPS Measure Scores at Top Hospitals Compared to Natl Avg

HCAHPS Measure Top 10 Hospital Average National Average
Gave scores of 9 or 10 91% 72%
“Strongly Agreed” that they understood care at discharge 72% 52%
Given recovery-related information at discharge 93% 87%
Always quiet at night 85% 62%
Staff explained medicine before administering 81% 65%
Pain always well controlled 84% 71%
Always received help as quickly as wanted 90% 68%
Doctors always communicated well 90% 82%
Nurses always communicated well 92% 80%

Source: Definitive Healthcare

If the highest satisfaction scores are almost exclusively limited to smaller specialty hospitals, what do the high-scoring, mid- to large-sized hospitals look like? The following 10 hospitals have a four-star patient experience ranking, at least 500 staffed beds, and are ranked in the same way, determined by the average rating of the same patient satisfaction measures.

Top 10 >500 Bed Hospitals with Four-Star Patient Experience Rankings by Highest Avg Measure

Hospital Average HCAHPS Measure Discharges Staffed Beds
 Baptist Medical Center (MS)  76% 21,177  594
 Mayo Clinic Hospital Rochester  75% 39,181 1,079
 UAB Hospital  75%  43,121 1,017
 New Hanover Regional Medical Center  74%  34,881  630
 Sharp Memorial Hospital  74%  31,102  832
 University Of Kansas Hospital  74%  31,843  685
 Abbott Northwestern Hospital  74%  35,363  579
 University of Wisconsin Hospital  74%  28,999  516
 Emory University Hospital  74%  24,961  504
 Houston Methodist Hospital  73%  34,668  914

Source: Definitive Healthcare

Average Individual HCAHPS Measure Scores at Top >500 Bed Hospitals Compared to Natl Avg

HCAHPS Measure Top 10 Hospital Average National Average
 Gave scores of 9 or 10  79%  72%
 “Strongly Agreed” that they understood care at discharge  58%  52%
 Given recovery-related information at discharge  89%  87%
 Always quiet at night  65%  62%
 Staff explained medicine before administering  67%  65%
 Pain always well controlled 73%  71%
 Always received help as quickly as wanted  69%  68%
 Doctors always communicated well  83%  82%
 Nurses always communicated well  82%  80%

Source: Definitive Healthcare

These hospitals don’t have the size or possible patient acuity advantages of the other group, but they have been able to score higher than the national average due to a concerted effort to improve patient experience. Some of their initiatives have been detailed publicly. Baptist Medical Center, for instance, is at the top of the list among large hospitals, but as recently as 2014 had patient satisfaction indicators lower than the national average, according to a case study by consulting firm Creative Health Care Management. The study attributes the improvement to a culture change emphasizing the responsibility of all staff, rather than simply direct caregivers, to ensure a positive patient experience. Visible, ongoing leadership from senior staff also served a critical motivational role for employees.

UAB Hospital also improved its quality scores after a change in business culture. A presentation by Essential Hospitals shows that in 2010, UAB launched an initiative it called UAB CARE, which advocated a better care experience for all patients. Similar to the strategy employed at Baptist Medical Center, it involved all staff in the process while recognizing the special role of providers. UAB Medicine also created an office of patient experience and engaged physicians to come up with educational tools and best practices.

Technology can also be a useful tool to achieve higher HCAHPS scores. In late 2012, Sharp Healthcare began using GetWellNetwork’s Interactive Patient Whiteboard, a patient engagement program. The software offers a variety of data to patients, including current caregivers, clinical goals and notes, and discharge information, most of which is addressed in some form by the HCAHPS survey. Giving patients electronic access to information on their condition and treatment can be an effective way to improve the hospital experience for some patients, especially if providers do not always have the opportunity to explain things face to face.

While tying HCAHPS scores to reimbursement may be an effective way to encourage hospitals to focus on patient experiences, some fear that organizations may be missing other equally important areas of patient interaction. Based on results of an ongoing survey of patient experience officers, a consulting firm found that 50 percent do not make an attempt to gauge experience in other ways, such as the creation of family advisory councils or supplemental patient surveys. Either way, the growing emphasis on experience is definitively a positive step for patients.

 

 

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