Hospital Consumer Assessment of Healthcare Providers and Systems

Patient satisfaction within hospitals is a relatively new concept. Data within hospitals has mainly been focused on patient mortality and morbidity rates. The shift towards patient satisfaction demonstrates the increasing competition healthcare industries face. This has increased in the advent of Obamacare which provides patients with the opportunity to not only choose their healthcare providers but also their insurance companies such as United Healthcare. A patient’s ability to choose which hospital they go to has provided hospitals with incentives to improve the satisfaction of patients who come to their facilities. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAP) is a survey tool designed to get data about patient satisfaction.

Hospitals have gathered information about patient satisfaction within their own facilities for many years. The HCAP is the first standardized tool that is used nationally to gather information about patient satisfaction. Jha (2008), found in the research a lack of literature on the topic of patient satisfaction. “Patients' perceptions of their care, especially in the hospital setting, are not well known. Data from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey provide a portrait of patients' experiences in U.S. hospitals.” (Jha, 2008 1921). The survey tool is a 27-item inventory that asks patients questions about various aspects of their experience within the hospital. The data gathered from this tool can provide information on not only which hospitals are performing better in terms of satisfaction, but also which geographical areas perform better in terms of hospital satisfaction. The data gathered can be valuable with improving hospital performance by identifying areas of need. The survey tool also holds hospitals accountable by providing patients with an avenue to make complaints or provide praise for their experiences within these hospital settings. The importance of the meaning of high and low scores will be explored to demonstrate the value of the use of the HCAP survey. 

High scores on the HCAP demonstrates high patient satisfaction with the care that they have received during their stay.  High scores can be used to increase traffic to the hospital as the facilities can promote themselves through these scores. The scores can also be used to acquire the best hospital staff which in turn would boost the scores in the patient care quality department. The HCAP is also able to demonstrate improvement within a hospital setting. This provides hospitals with an opportunity to use the tool to identify areas that need improvement, make policy changes and then boost their satisfaction score through the use of the HCAP. High scores on the HCAP speaks to the quality of a hospital.

Achieving high scores on the HCAP requires a hospital to put patient satisfaction on the forefront. Hospitals can implement certain policies and procedures to ensure that their hospitals have high scores on the HCAP. The main area of focus for the hospitals should be patient communication. Patients who feel that they had their needs understood and addressed will report higher satisfaction. Often patients will feel that they are in the dark about the procedures they are undergoing. Through increased communication with a patient their anxiety surrounding the procedure they may undergo will be relieved. Communication with a patient demonstrates that a clinician cares about the patient. Nurses can play a vital role in this process through educating patients. They can also demonstrate that they care through follow up phone calls with patients to ensure that they are following the discharge procedures and do not have any problems. Effective communication can also be achieved through ensuring that there are no barriers present to providing communication. By providing access to translator’s hospital administrators can ensure that their patients are able to communicate with the hospital staff. This would also ensure that multicultural treatment is provided to patients. Communication and education with patients will boost HCAP scores. 

Changes within the hospital staff can also boost HCAP scores. Through providing effective leadership a leader within the hospital setting can instill a culture of patient satisfaction throughout the hospital. This could be done through training which emphasizes focus on patient care rather than just speed and patient turnover. Changing the whole culture of the hospital will be felt by patients who will experience high quality customer service from admission to discharge. Patients have complained for years that they have felt rushed by their doctors and they no longer know their needs. Through changing a patient's perception about their experience, a hospital staff can create a patient who is willing to cooperate with them throughout their treatment. This attention to a patient can reduce the chances of hospitals receiving low scores on the HCAP.

While hospitals need to understand how to achieve high scores on the survey, they also need to understand what results in a low score occurring. By understanding this they can avoid the mistakes that are made by other hospitals. Lack of communication can result in patient dissatisfaction as has been explored earlier. However, lack of quality care can result in low scores. According to Burnett, (2012), high rates of readmission can lead to low scores on the HCAP. If a patient has to be readmitted to a hospital due to incompetent care that was received this can lower the hospital scores on the HCAP. While the main discussion has been focused on providing quality customer service to patients, providing effective health care also needs to be addressed. 

A hospital could have excellent customer services however if there are high rates of patient mortality the satisfaction scores will suffer. Isaac, (2010), found that the direct health care provided by the hospital’s clinicians is more important than the customer service provided by the nursing staff. “Patient experiences of care were related to measures of technical quality of care, supporting their validity as summary measures of hospital quality. Further study may elucidate implications of these relationships for improving hospital care.” (Isaac, 2010 1040). However, hospital administrators need to focus on both customer service and quality of health care services provided within their setting in order to improve HCAP scores. This can be difficult to juggle as at times quality customer service may suffer in order to deliver quality health care. Policies within the hospital need to be developed which address both areas of care which are provided to patients. 

Low HCAP scores can also be due to a lack of cooperation or teamwork between hospital staff. If a nurse is not collaborating with the doctor to ensure that a patient is receiving optimal care the patients’ health can suffer. Patients can sense if there is tension between hospital staff. Changes that are currently being made are not focused on increasing this cooperation between hospital staff. “Many current policies and approaches to performance measurement and payment reform focus on individual providers; they risk reinforcing the fragmented care and lack of coordination experienced by patients with serious illness” (Fisher, 2007 44). This lack of coordination not only results in low HCAP scores but it could be fatal for patients. Hospital staff must be provided with group training which focuses on collaboration between team and different departments.

Despite the amount of benefits that the HCAP provides to hospitals the survey aspect of the tool can provide some difficulties. Davies found that issues have been found regarding the validity of the HCAP tool to accurately reflect the care a patient received during their hospital stay. “They argue that data from consumers: (1) reveal more about the consumer than about the quality of care; (2) reflect how much was done, not how well it was done; (3) disagree with physicians’ judgment regarding quality; and (4) simply reflect whether the provider was nice to them” (Davies, 1988 37). While nurses may feel that they are providing optimal care the survey responses filled out by the patients may not reflect this. The anonymous nature of the surveys allows patients to be honest about their feelings. Patients may be reluctant to complain in person about their dissatisfaction. The disconnect between patient response and actual service may also be due to this lack of communication. These issues can be resolved by the hospital staff developing a relationship with their patients. Through building a rapport with patients they would be more likely to bring up any issues with the nursing staff directly. This would allow nurses to improve communication and address patient issues which in turn would increase the HCAP scores. 

Patient expectations are also another area in which the reliability of the HCAP scores come into question. Patients often have unrealistic expectations of what they will encounter during their hospital staff may at times contribute to these unrealistic expectations by making promises to patients that are unable to be kept. Through training hospital staff must be taught to not make promises to patients regarding their treatment or care. Patients can also be provided with education about their treatment and stay. By providing this education patients will be able to develop realistic expectations about their hospital stay and what they should expect in terms of medical treatment. This will bolster HCAP scores and reduce complaints made by patients.

Another area of improvement with the HCAP needs to be in regard to how the data is utilized within hospitals. Patients may only encounter one or two departments within their hospital stay. If a patient has only gone through the ER their survey will only reflect the experience they had within this department. The HCAP needs to be able to take this into account when addressing the changes that need to be made within the hospital. Oftentimes the focus of the low HCAP scores will be brought upon the nursing staff who work in 12 1/2 hour shifts to provide constant care to their patients. The care that nurses provide can affect the HCAP scores however all department of the hospital need to be able to deliver quality healthcare to their patients.  Patients encounter many hospital professionals such as the admitting staff, specialists or the discharge team that one negative encounter with any one of these professionals can also result in a low HCAP score. By focusing on solely improving nursing staff other areas of needed improvement may be bypassed that would result in consistently low HCAP scores. Hospitals need to make changes in the right areas and departments to improve their patient satisfaction scores.

While all departments do need to provide quality service studies have found that nurses can have a large impact on patient satisfaction. Specifically, increased time that nurses spend with their patients. “Additionally, patient-to-nurse workloads were significantly associated with patients’ ratings and recommendation of the hospital to others, and with their satisfaction with the receipt of discharge information. Improving nurses’ work environments, including nurse staffing, may improve the patient experience and quality of care” (Kutney-Lee, 2009 669). This could provide hospitals with the incentive to improve the nursing staff within hospitals either through increased pay or more training. Overworked and stressful nurses may make mistakes in the care that they provide and would not be as likely to provide quality customer service to their patients. 

The HCAP also suffers from another research problem in that those individuals who respond may not be reflective of the whole population. The small sample size of individuals who chose to respond to the survey may make the results of the surveys biased to those who either had disproportionately negative or positive views of their stay. Young, (2000), found that the survey may only reflect the views of certain individuals. “Among demographic characteristics, age, health status, and race consistently had a statistically significant effect on satisfaction scores. Among the institutional characteristics, hospital size consistently had a significant effect on patient satisfaction scores” (Young, 2000 334). This finding on small hospital size may demonstrate that smaller hospitals provide more quality care or that individuals in small towns are more pleased with their healthcare. The vagueness of analyzing the data can be problematic to the survey. The choices provided by the survey are also limited and can skew the response. Improvements can be made to the survey through addressing these areas which improve the quality of the survey measure. Areas could be included in the survey to allow for more open-ended responses to questions about quality of care. The survey could also be provided to every patient before discharge and an incentive could be provided to patients who complete them. This would result in an increased quality of patient satisfaction and quality of patient care within these hospitals.  

Hospitals have been making improvements to improve their scores. Hospitals use the data provided by the scores to identify areas in which improvement is needed. If patients have stressed that they are not receiving education about the treatment they are receiving, a hospital administrator can provide their staff with educational leaflets to provide to patients. Complaints about waiting longer period of time in the ER may result in the development of policies which would increase the efficiency of the ER department. Through specifically addressing needed areas in distinct departments, such as the ER, can continue to boost HCAP scores throughout the whole hospital. 

The HCAP is not a perfect measure however it is a step in the right direction to begin a discussion on how to improve the healthcare industry in our nation. As hospitals begin to see their patients as consumers, they will need to develop standards to ensure that patients are satisfied with their care. Healthcare reform has brought the debate to the forefront of political debate. Consumer driven care can result in quality health care services being provided to individuals. Patients in turn will expect more from their healthcare providers. Everyone benefits from improved health care and the HCAP can be an important tool for developing changes to the healthcare industry. By being able to experience what a patient feels when they have to endure a hospital stay, hospital administrators can develop patient centered care. Therefore, the HCAP is an important tool not just internally within a single hospital setting, but throughout the nation so that the issue of health care reform can be discussed in terms of patient satisfaction. Since healthcare has become an increasingly for-profit business, they must begin viewing their patients as consumers who deserve high quality care.

References

Burnett, D. M., Montgomery, V. R., Redden, C. B., & Stroh, K. (2012, March). Hospital 

Consumer Assessment of Healthcare Providers (HCAPS): Improving Patient Satisfaction," A Team Approach". In CLINICAL NURSE SPECIALIST (Vol. 26, No. 2, pp. E20-E21). 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA: LIPPINCOTT WILLIAMS & WILKINS.

Davies, A. R., & Ware, J. E. (1988). Involving consumers in quality of care assessment. Health Affairs, 7(1), 33-48.

Fisher, E. S., Staiger, D. O., Bynum, J. P., & Gottlieb, D. J. (2007). Creating accountable care organizations: the extended hospital medical staff. Health Affairs, 26(1), w44-w57.

Isaac, T., Zaslavsky, A. M., Cleary, P. D., & Landon, B. E. (2010). The relationship between patients' perception of care and measures of hospital quality and safety. Health services research, 45(4), 1024-1040.

Jha, A. K., Orav, E. J., Zheng, J., & Epstein, A. M. (2008). Patients' perception of hospital care in the United States. New England Journal of Medicine, 359(18), 1921-1931.

Kutney-Lee, A., McHugh, M. D., Sloane, D. M., Cimiotti, J. P., Flynn, L., Neff, D. F., & Aiken, L. H. (2009). Nursing: a key to patient satisfaction. Health Affairs, 28(4), w669-w677.

Young, G. J., Meterko, M., & Desai, K. R. (2000). Patient satisfaction with hospital care: the effects of demographic and institutional characteristics. Medical care, 38(3), 325-334.