It seems to me that every mention of a hospital attempting to improve patient experience is a misnomer.
While an improved experience may be an adjunct result of the hospital’s efforts, the hospital does not call a meeting to improve patient experience. The hospital calls a meeting to improve its HCAHPS score. Net-net, the actual purpose of the meeting is to avoid the financially penalty that results from having the hospital’s HCAHPS scored ranked in the bottom 50 percent.
For example, suppose a hundred hospitals in Canada or the UK set goals to improve patient experience. The executives in charge of the effort meet at Crayola World for a week in of barn-storming sessions to determine the drivers of patient experience and to agree upon the specific things they need to address to improve patient experience.
What would that meeting look like?
Maybe they would start by defining patient experience.
US providers as a whole do not have a definition of what constitutes patient experience. Ninety-percent of US hospitals do not even have a definition of patient experience for their own institution. Perhaps that is because providers believe CMS subsumed that responsibility through HCAHPS.
The definition from which US hospitals assess how well patients are experiencing their hospital has three fatal flaws:
It knows nothing of the experiences of most of the people who interact with the hospital:
- 70 percent of inpatients
- Discharged patients
- Former patients
- Prospective patients
It knows nothing of all of the experiences people have before and after they enter the hospital
It knows nothing about the experiences of an individual — HCAHPS provides an aggregate score of a percentage of inpatients several months after the fact.
Suppose aliens landed in the bohemian Haight Ashbury district of San Francisco with a mission to report to their constituents about the people who live in America. Dude. Or, perhaps they landed in Montreal with the goal of profiling Canadians — the pen of my aunt was on the desk of my uncle (this only makes sense if you took French in the eighth-grade… Je vais aller à la bibliothèque). Or perhaps they landed in West Virginia, and everyone they encountered drove a pickup truck loaded with sheetrock. Would the assessment the aliens provided of Americans or Canadians be accurate?
To bet that the data provided by a provider’s HCAHPS scores told a hospital’s leadership everything they need to know about patient experience requires the hospital’s leadership to suspend reality. It requires the leadership to believe that everything they need to know about patient experience can be learned from a small subset of the people they survey. It also requires the leadership to believe that everything that is important to your individual experience has been assayed by the hospital’s purchase of aggregated survey data.
Suppose you spent two hours on the phone trying to schedule an appointment? Suppose you received several letters from the hospital stating that your unpaid pill had been sent to a collection agency even though you have the cancelled check? Suppose you asked to speak with a nurse and you were told that someone would contact you within 48 to 72 hours?
You know that the next time you need care, you will choose another hospital. Your hospital knows that former inpatients rated that the noise factor of their hospital rooms are better than the noise factors of 82 percent of all of the other hospitals.
HCAHPS are egregiously misleading. Do you want to be led, or do you want to lead?