Improving HCAHPS Scores In Healthcare through Architecture

HCAHPS Surveys are sent to patients following their hospital stays and are used to assess satisfaction with their hospital care and experience. Most patients are not educated on the importance of positive responses to the surveys and are usually not aware of the specific questions that will be asked. An over-arching strategy to ensure that patients provide positive responses is to dedicate a Patient Experience Advocate (sometimes known as a Social Worker) that initially greets patients in their rooms, explains what to expect during their stay and educates them on the importance of providing positive responses to the survey. The Patient Experience Advocate should check-in with patients periodically during their stay and should be present when patients are discharged to ensure patient satisfaction, or be made aware of issues that would affect their responses.

Family, friends and visitors also have an impact on patients’ perception of their care and the hospital environment. Although the HCAHPS survey focuses specifically on patient experiences, those experiences may be influenced by the views and perceptions of family, friends and visitors. It is important that their needs and concerns are also addressed during the patients’ hospital stays.

The HCAHPS Quality Assurance Guidelines V14.0 Survey that became effective October 1, 2019 contains 29 questions, of which 2 relate directly to THE HOSPITAL ENVIRONMENT, and another 3 that are tangential to a patients’ experience within the hospital environment. Below are the 5 questions along with strategies to be considered to improve patient responses and therefore overall scores:

Your Care from Nurses

Strategies:

To improve the probability of patients selecting “Always”:

• Train nurses to initially review the operation of the bedside call button, explain what occurs once the button is pressed, and commit to a maximum of 5 minutes or less to expect a response through the pillow speaker or in person.
• Include the operation of the call-button on a welcome video that patients view upon settling into their bed.
• Train nurses to periodically ask patients if they are satisfied with the operation of the call button, and their response times. Commit to improving if the patients are dissatisfied.

The Hospital Environment

Strategies:

To improve the probability of patients selecting “Always”:

• Train environmental services staff to greet patients upon entering their rooms, inform them of the purpose of their visit, ask the patients if they have any specific concerns regarding the condition of their rooms or bathrooms, and address any concerns they may have.
• Include a Clean Room field on patient room marker boards where Environmental Services staff write the date and time when the patient rooms and bathrooms were cleaned.
• Train nurses to periodically ask the patients if they are satisfied with the cleanliness of their rooms and bathrooms. Contact Environmental Services and commit to improving if the patients are dissatisfied.

The Hospital Environment

Strategies:

To improve the probability of patients selecting “Always”:

• Install decibel meters with visual indicators at nurses’ stations that alert staff when ambient noise becomes too intense.
• Train Nurses to ask patients if they are satisfied with sound levels emanating from outside of their rooms. Address if dissatisfied.
• Provide windows in doors leading to patient rooms that allow visual access to patients in their beds while the doors remain closed.
• Provide soothing music and/or sounds and images of nature through patient room televisions that mask outside ambient sounds.
• Provide adequate sound attenuating insulation in walls between patient rooms and corridor walls.
• Provide high performance sound attenuating doors and windows at the perimeter of patient rooms.

Overall Rating of the Hospital

Strategies:

To improve the probability of patients selecting 9-10:

• Dedicate resources to providing Patient Experience Advocates that maintain periodic in-person contact with patients.
• Provide a direct phone number to Patient Experience Advocates
• Ensure that care givers are trained to periodically ask patients if they are satisfied with their level of care, accommodations and environment, and take immediate corrective action if they are not.
• Provide patients with cards and handwritten notes from their care givers upon discharge.
• Train staff to educate patients on their care and environment during their hospital stay, and reference positive or unique characteristics involving their care or the hospital environment.
• Ensure that family, friends and visitors are treated with the same respect as that of patients, and their needs and requests are addressed.
• Have Patient Experience Advocates follow-up with patients via telephone within 24 hours of discharge.

Overall Rating of the Hospital

Strategies:

To improve the probability of patients selecting “Definitely Yes”:

• Implement the strategies outlined above.
• Review and monitor HCAHPS Survey results.
• Set goals and develop processes for constant improvement.

Following are the results for some current California hospitals HCAHPS Survey Scores pertaining to the 5 questions outlined above. According to the available data, Howard Memorial received the best overall scores, while Rideout received the poorest overall scores on average: