One of health-care reform’s least controversial mandates was a requirement that hospitals improve their patient-satisfaction scores or take a reimbursement hit. In October 2012, CMS is set to begin withholding 1% of its payments to hospitals, putting the money (estimated at around $850 million for the first year) into a bonus pool that will be divided among hospitals that score highly on an array of measures, including “physicians always communicated well,” “got help as soon as they wanted,” and more. As Corinne Kereszturi, director of improvement services for Press Ganey Associates Inc, South Bend, Indiana, notes, “A lot of times, the challenge is making process changes that patients may feel, but won’t see.”
The CAHPS® hospital survey is the tool that CMS uses to collect feedback on the patient experience, with questions posed to patients in several topic areas: clinician communication, pain control, explanation of medicines, cleanliness of rooms, noisiness of rooms, and recovery information. The survey also asks patients to rate the hospital on a scale of 0 to 10 and to say whether they would recommend it to friends and family members.
Jody Cunningham, director of public reporting for Press Ganey, says, “The emphasis on the survey is resulting in improvement nationally in patient satisfaction, but the challenge, of course, is that these patient-satisfaction–improvement programs are not things you do once and then you’re done. For value-based purchasing, you have to improve every year in order to maintain your reimbursement. The bar just keeps getting higher.”
Indeed, Kereszturi and Cunningham agree, sustaining change is the most challenging aspect of improving patient-satisfaction ratings for most hospitals with which Press Ganey works. The organization assists hospitals with improvement initiatives “by helping them understand the best way to implement industry best practices, so that they have successful outcomes,” Kereszturi explains. “You have to implement the improvement initiative in a way that will work for your organization, and you have to be flexible. We can help organizations understand where they need to make tweaks and changes.”
Creating a patient-satisfaction–improvement program that will work for an organization’s specific needs requires a detailed assessment of both where the organization stands and where it wants to be. Patient and staff surveys, interviews with executives and staff members about the organization’s culture, and objective observations of how staff members are interacting with patients all contribute to painting a complete picture of an organization’s challenges and goals, Kereszturi notes. “We see what behaviors the staff is eliciting and what interactions are happening with patients, and we evaluate whether the staff is doing what leadership wants, but also where opportunities exist for better interactions or processes,” she says.
The next step is monitoring any changed behaviors or processes to assess their efficacy—and to learn what does and does not work for the organization. “Once you implement change, you have to evaluate how you’re doing it and whether the change will work in the long term,” Kereszturi says. “We can tell a lot from looking at patient-survey data, over time, to see where there have been improvements or declines. A facility may have had improvements in nurse communication, and would then want to ask why that has changed. If there’s been a decline in a particular area, the facility would want to know what is contributing to that negative change.”
Seeing Versus Feeling
Kereszturi and Cunningham note that as part of any patient-satisfaction–improvement program, there are changes that patients see and changes that patients feel—and they are not confined, for instance, to changes in patients’ physical environments, such as exam rooms. “A lot of times, we see that it’s not about the friendliness of staff or an issue like that,” Kereszturi says. “Instead, it’s more about how clinicians are arranging for tests and treatment, how nurses are communicating with physicians, and what the patient flow is like from the emergency department to the inpatient setting.”
One section of the survey that Press Ganey uses with its hospital clients focuses solely on tests and treatment, and Kereszturi says that this is increasingly an area of focus for organizations seeking improved patient satisfaction. “This is an area that can result in some big issues