The HCAHPS bandwagon continues to roll. The Hospital Consumer Assessment of Healthcare Providers and Systems, to give it is full but very infrequently used name, has been mandated by the federal government; the scores hospitals receive on this measure help determine their reimbursement rates. As one hospital group put it, HACAHPS “is now the key to our financial well-being.”
Many in healthcare have expressed doubts about the accuracy of HCCAPS. One study reported “little relationship between a hospital’s patient satisfaction scores and most quality ratings” in regard to surgery.
Some issues have been raised on this point in this blog. While we’ve found the questions reasonable, we have asked whether they go far enough and we’ve noted that too much of an emphasis on numbers can actually be detrimental.
It seems that the more that any set of numbers is used, the more other systems of numbers will be generated. A good example of this tendency is the Press Ganey Engagement Portal. This provides an “intuitive, web-based results-delivery system” that “offers health care leaders the ability to identify areas of opportunity and prioritize actions within just a few clicks”.
Inasmuch as HCAHPS has been described as superseding Press Ganey’s earlier benchmark survey, it’s only logical that they would develop other tools. After all, HCAHPS asks a limited number of questions and only to patients so there is a rationale for going beyond that.
Metrics have become have become what might be called faddishly omnipotent in the world of business. Naturally, the possibilities of technology (apps particularly included) are being exploited and touted. “Run your entire business from your tablet,” says one advertisement.
Medical practice does of course depend on measurement. So the Press Ganey dashboard can be considered a logical development, whether one finds its plethora of numbers and its implication that the CEO can control the hospital from his desktop like the Deity overseeing the universe to be inspiring or frightening.
Yet one aspect of such dashboards is surely important: HCAAPS can’t tell the whole story of hospital performance because patients are not the sole or perhaps even the best judges. To take an analogy: diners’ review of restaurants or movies may be useful but so also are those of professional critics.
Patients see a lot of the hospital but they don’t see it all and may not understand everything. Their answers on surveys may not be based so much on objective reality as on their feelings and beliefs. Hence to really evaluate hospital care it would be advisable to get input not just from patients but others.
Nurses, for example, certainly know a lot about hospital performance. As one article puts is, “Nurses develop substantial knowledge of the strengths and weaknesses of hospital systems and how they fail. Their ability to create workarounds to broken or dysfunctional systems is legendary in health care.”
Of course the doctors who work there or have privileges are also competent to evaluate hospitals. Indeed, there a Consumers’ Guide to Hospitals incorporating doctor’s ratings.
Others hospital workers may also have knowledge, some of which might not be captured by surveying others. Even hospital visitors (though often viewed as a problem, particularly as a potential source of infection) might notice things that might escape attention.
What do readers think? If the goal is to evaluate hospitals via surveys, what questions should patients be asked, other than those already in HCAHPS? What questions should asked of nurses? Of doctors? Of other hospital workers and visitors?
Just asking questions can be a means of opening up knowledge. Beyond the value of and the uses to which the data is put, surveying can a tool toward improvement simply by increasing awareness, provoking thought, and inspiring dialogue.
–Jim Murphy has a solo consulting practice called Management 3000, focusing on organizational development and change management. Formerly he led the Massachusetts Bay Organizational Development Learning Group, was Human Resources Director for the City of Boston Assessing Department, and served as a consultant with the Boston Management Consortium. His consulting practice includes management coaching as well as research and writing on employee relationships, leadership, healthcare and collaborative practices. Having produced newsletters for several organizations and being a frequent content writer for the”Confident Voices in Healthcare” blog, he is interested in writing and research opportunities, as we all consulting and coaching. www.manage2001.com firstname.lastname@example.org