HCAHPS results are publicly reported on Hospital Compare as “top-box,” “bottom-box” and “middle-box” scores. The “top-box” is the most positive response to HCAHPS survey questions. The “top-box” response is "Always” for five HCAHPS composites (Communication with Nurses, Communication with Doctors, Responsiveness of Hospital Staff, Pain Management, and Communication about Medicines) and two individual items (Cleanliness of Hospital Environment and Quietness of Hospital Environment), "Yes" for the sixth composite, Discharge Information, "‘9’ or ‘10’ (high)" for the Overall Hospital Rating item, and "Would definitely recommend” for the Recommend the Hospital item.

The “bottom-box” is the least positive response category for HCAHPS measures. The “bottom-box” response is "Sometimes or never” for five HCAHPS composites (Communication with Nurses, Communication with Doctors, Responsiveness of Hospital Staff, Pain Management, and Communication about Medicines) and two individual items (Cleanliness of Hospital Environment and Quietness of Hospital Environment), "No" for the sixth composite, Discharge Information, "‘6’ or lower (low)" for the Overall Hospital Rating item, and "Would not recommend” for the Recommend the Hospital item.

The “middle-box” captures intermediate responses to HCAHPS survey items. The “middle-box” response is "Usually” for five HCAHPS composites (Communication with Nurses, Communication with Doctors, Responsiveness of Hospital Staff, Pain Management, and Communication about Medicines) and two individual items (Cleanliness of Hospital Environment and Quietness of Hospital Environment), "‘7’ or ‘8’ (medium)" for the Overall Hospital Rating item, and "Would probably recommend” for the Recommend the Hospital item. There is no “middle-box” response in the Discharge Information composite.

HCAHPS On-Line, the official HCAHPS Web site, houses a series of tables that summarize current and historic HCAHPS results. These HCAHPS Tables, available exclusively on HCAHPS On-Line, are based on the HCAHPS data participating hospitals submit to CMS. Before being publicly reported, data are adjusted for the effects of patient-mix and mode of survey administration.

To view the full set of current results on each HCAHPS measure for individual hospitals, please visit the "Survey of Patients’ Hospital Experiences" section of the Hospital Compare Web site (www.hospitalcompare.hhs.gov).

Presented here are the calendar quarters of HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey results that will be publicly reported on Hospital Compare (www.hospitalcompare.hhs.gov) from April 2011 through April 2012.

Please note: The dates of preview and public reporting are estimates based on current timetables and thus are subject to change.

APRIL 2011 HCAHPS Public Reporting
QUARTERS INCLUDED: 3Q09, 4Q09, 1Q10, 2Q10
DATE RANGE: 7/1/2009 to 6/30/2010
DATE OF PREVIEW: January 2011
DATE OF PUBLIC REPORTING: April 2011

JULY 2011 HCAHPS Public Reporting
QUARTERS INCLUDED: 4Q09, 1Q10, 2Q10, 3Q10
DATE RANGE: 10/1/2009 to 9/30/2010
DATE OF PREVIEW: April 2011
DATE OF PUBLIC REPORTING: July 2011

OCTOBER 2011 HCAHPS Public Reporting
QUARTERS INCLUDED: 1Q10, 2Q10, 3Q10, 4Q10
DATE RANGE: 1/1/2010 to 12/31/2010
DATE OF PREVIEW: July 2011
DATE OF PUBLIC REPORTING: October 2011

JANUARY 2012 HCAHPS Public Reporting
QUARTERS INCLUDED: 2Q10, 3Q10, 4Q10, 1Q11
DATE RANGE: 4/1/2010 to 3/31/2011
DATE OF PREVIEW: October 2011
DATE OF PUBLIC REPORTING: January 2012

APRIL 2012 HCAHPS Public Reporting
QUARTERS INCLUDED: 3Q10, 4Q10, 1Q11, 2Q11
DATE RANGE: 7/1/2010 to 6/30/2011
DATE OF PREVIEW: January2012
DATE OF PUBLIC REPORTING: April 2012

At our hospital we are in year three of a Service Excellence Initiative. Partnering with Custom Learning Systems we have been been teaching all our staff hard and soft skills to improve customer service through service excellence. Being on the Service Excellence council has given me many opportunities to directly and indirectly influence the process and see first hand the cause and effect results of the program.

Here on my website I try to focus on Environmental Services related topics and the all important “room and restroom always clean” question.

Here are some initial steps for improving your HCAHPS scores:

Train and implement patient visits and staff rounding, utilizing HCAHPS scripting

Have regular, (daily or weekly) 15 minute stand up huddle with each shift to share HCAHPS scores, patient satisfaction and tips to continuously improve the patients experience

Create a regular report to share with your staff and direct reports recapping your scores, efforts and results

Pick one thing to focus on each month to increase your performance. Preferably something you can tie back into your HCAHPS questions.

The clinical measures will account for 70% of a hospital’s VBP score and the HCAHPS survey for 30%. For FY 2014, CMS will add the heart attack, heart failure and pneumonia mortality measures to the VBP program, as well as eight measures of hospital-acquired conditions and two composite patient safety and inpatient quality indicators developed by the Agency for Healthcare Research and Quality. The VBP program will apply to all acute-care prospective payment system hospitals with certain exceptions. For example, for the clinical process measures, CMS will exclude from hospitals’ scores any measures for which they report fewer than 10 cases and will exclude from the VBP program any hospitals for which fewer than four of the 12 proposed clinical process measures apply. CMS will also exclude from the VBP program any hospital that reports fewer than 100 HCAHPS surveys during the performance period.

For the FY 2013 incentive payments, CMS proposes that it will use data associated with hospital discharges from the third and fourth quarters of 2011 and the first quarter of FY 2012, as the “performance period” for the proposed clinical process of care and HCAHPS measures. So starting July 1, 2011 and running to March 31, 2012, our scores for “Room and restroom always clean” will be very, very important. All your hard work improving your scores will now be validated.

A hospital’s performance on each measure during the performance period will be compared with a “baseline period” from July 1, 2009 to March 31, 2010. Whether the hospital receives a value-based incentive payment, and the amount of such payment, will be based on either how well the hospital performs on the specified quality measures during the performance period or how much the hospital’s performance improves on the quality measures from its performance during the baseline period. The higher a hospital’s achievement or improvement during the performance period, the higher the hospital’s value-based incentive payment.

Do you know what your HCAHPS scores were July 1, 2009 to March 31, 2010? If you have been tracking and working on your performance good for you. If not, well, I’m sure you will be now. You should already have a spreadsheet setup for doing your own comparison and tracking.

In upcoming posts I will be writing about steps you can take to improve your scores and staff performance. Go HCAHPS!

1. Customer satisfaction surveys; HCAHPS, Press Ganey, Picker or your favorite. Don’t forget to add internal surveys and patient rounding results.
2. Department team building. Always very important.
3. Hazardous waste; transportation, handling and storage.

Chasing the numbers

I spent a good part of the day writing performance evaluations. I find it somewhat refreshing to think about a staff member and write wonderful words that reflect their performance during the last year. Of course not every word is, glowing, but for the most part all my staff are good, hard workers and each one has positive qualities that work together for the department, and the hospitals good.

A good portion of the rest of the day was spent chasing numbers. You know, the NRC Picker, or Press Ganey satisfaction survey results that go along with the HCAHPS survey results. I find I’m more and more often aligning strategies, scripting, and work teams to push these numbers up. It can become an obsession… the daily logging into Press Ganey, running the queries, reading the reports.

Hurray! +.5 % on the mean score for courtesy, oh sad, -.6 on cleanliness, but wait, the emergency room waiting area jumped up 7%. Lets go clean the furniture again, did we make enough patient room rounds today? It is not enough to manage by walking around (MBWA), we need to fill out some quality assurance checks and speak to a dozen patients as well, hold staff huddles, post the numbers, give more praise and recognition, re-train on high dusting, pass out more putty knives to scrape those corners, look into 55 gallon drums of floor finish, as we go through gallon jugs too fast and so on, so forth.

I find it rather exciting to push the numbers. Of course it is not smoke and mirrors. Behind those gains are many staff members and other hospital employees working hard, doing things right, taking care of the patients, guests and each other. That is why I am in this business, but we measure, measure and measure again to make sure we keep on doing those right things.

Chasing the numbers? Yes, it can seem that way. And those are moving targets, what with the hospitals we compete with doing everything they can to improve just as we are. I might achieve an increase in my cleanliness mean score but if other hospitals also increase, and higher than I do my percentile will go down. So we compete against ourselves, and against other hospitals. Makes it all just a little more complicated.

Survey results are posted on the web at www.hospitalcompare.hhs.gov along with other clinical measures to give patients a fairly complete view of the quality any given hospital is providing. One idea behind this is that consumers will “shop around” for their healthcare, something like one would shop around for a restaurant or a new car.

At my, like most hospitals we use in addition to HCAHPS, another survey tool that measures many more aspects of patient care and performance. A drawback to HCAHPS is that it measures only the basic elements of patients care, excluding a lot of factors important to patients in their overall experience.

For my area of responsibility HCAHPS includes only one question: “During this stay, how often were your room and restroom kept clean?” -Never, Sometimes, Usually or Always. This can be misleading because it does not measure the level of cleanliness, only the frequency. If the housekeeper makes several visits to your room does that mean “Usually” or “Always”. If the housekeeper makes several visits to tidy or straighten up but does not clean would that influence the response”.

Regardless of the answer to that we take definite and clear steps to improve our scores and raise the patient awareness that we are cleaning, and we want their room and restroom to always be clean, really clean. Our staff are trained with scripting and hospitality programs that include greeting the patient and letting them know what we will be doing in their room. We use leave behind cards when the patient is asleep or away for a test letting them know their room was cleaned and a phone extension to call if they would like any further service.

I have no doubt that HCAHPS, in the present form or revised will remain. I work hard to help my staff be successful at delivering a quality service to our patients and guests worthy of the “Always” score. We will continue to do so regardless of this survey though. Our greatest satisfaction comes from the patient who really feels their room is very clean and safe for them.

We have been doing patient rounding where we go see the patients and ask a few questions like, was your housekeeper friendly, was your room cleaned satisfactorily, is there anything we can do for you? We get good feedback and has helped our HCAHPS and Press Ganey scores.

Recently I’ve started using workers that have restrictions to the point where I can not work them, but they can walk, talk and write come in for ES Ambassador duty. I give them some scripting, a clipboard and the rounding questions and have them spend hours going to talk with patients. We talk about our goal of having their room always clean, how the survey works, and so on. I’ve had very positive feedback on this and it helps get the staff back to work with a better attitude.

I’ve increased our cross training and we all know how that helps. I’ve also moved staff more frequently to play to their strengths more than I have done in the past.

I put a large communication board in our common room. This happens to be our laundry and storeroom area where we check in and out the keys and pagers. During our standup meetings I share Press Ganey positive comments and other good comments and post them on our communication board. The increased focus on the score has helped I believe.

So far my HCAHPS score for the first quarter of 2009 is running 81%. This is a 10 point improvement over last years average, and higher over just November and December of last year.

What things have you all been doing to raise your scores and your staff satisfaction?