Are we relying too heavily on HCAHPS?

Data drives decisions. It’s no wonder, then, that the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey has become the lynchpin for measuring patient experience. After all, it provides information on critical metrics, and survey scores have a financial impact. But does HCAHPS tell the whole story? And why does having the whole story matter?

Unfortunately, due to financial rewards or penalties associated with HCAHPS, we have equated patient experience with HCAHPS and have moved away from richer assessments of how patients experience their care. The critical elements which are not assessed in the HCAHPS survey include teamwork and the compassionate connection between patients and caregivers. HCAHPS can provide an idea of the frequency of how often specific tasks occur but not provide insight into the quality of how these tasks are being delivered.

Healthcare executives and providers desire to provide the best and safest care that maximizes the health of both patients and the communities we serve. A comprehensive picture of how patients perceive their care would offer a better platform for uncovering and, ultimately, improving gaps in patient experience. This, in turn, will help provide the safest, highest quality, and most efficient patient care. 

Although HCAHPS does not measure the patient experience in its entirety, it does measure aspects of care such as pain management, responsiveness of hospital staff, discharge information, etc. The critical element missing in HCAHPS include teamwork and the compassionate connection between patients and caregivers which result in the absence of essential information providers need to assess and improve the environment/culture in which care is delivered.

Sustainable solutions

It is important to recognize that the HCAHPS survey was developed through a rigorous validation process and provides valuable information. However, with the most commonly used survey methodology, typical response rates are in the 15% to 20% range and do not capture the voices of the complete spectrum of patients we serve. Specifically, the methodology can generate responses from those patients who are most dissatisfied or alternatively, highly satisfied, missing the 85% of patients between the ends of the spectrum. By not capturing the full voice of the patients, the data accuracy and reliability are compromised.

The problem occurs when providers focus on individual domains of HCAHPS that may not truly represent the accurate voice of the patient population. This can lead to tactical solutions that fail to result in sustained gains and ultimately fatigue staff with “just one more initiative to drive patient experience.”

When we address a more complete set of metrics that accurately capture what is important to patients for an exceptional experience-those defined by patients over the past few decades- and captures the voices from the broad spectrum of patients we serve, meaningful interventions and action plans can be implemented and sustained to drive culture change.

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