The Patient Experience

As Leaders of the Care Team, Hospitalists Play a Vital Role in How Patients View Their Hospital Stay

Karen Appold

Disclosures

The Hospitalist. 2015;19(9):1, 19-22. 

In This Article

Introduction

Hospitalists are often perceived as the face of the hospital, whether that is their official responsibility or not. They are on the front lines of hearing, seeing, and understanding where gaps exist in a patient's experience.

"Whenever I hear a patient complain, I can almost piece together what happened without having to interview other staff," says Jairy C. Hunter III, MD, MBA, SFHM, associate CMO for care transitions at the Medical University of South Carolina in Charleston.

Patient experience, which is not exactly the same as patient satisfaction but is often thought of interchangeably, is more important now than ever before as federal regulators use how patients view their hospital experience as a major factor in performance measures, reimbursement, incentives, and penalties.

"Up to this point, there hasn't been as much accountability regarding customer satisfaction in our industry compared to other industries," Dr. Hunter says.

The paradigm shift has occurred because payers are demanding it. They want value and satisfaction in what they are paying for. In fact, there is a movement to try to standardize procedures whenever possible, such as the amount of time it takes someone to answer a call bell or the volume of noise in a hallway.

"Patients are being asked questions about such topics in surveys," Dr. Hunter says. "Although these types of questions don't involve medical decision-making or a course of treatment, they do include personal interactions that influence how patients feel about their hospital experience."

Another reason for the shift is the significant increase in the use of electronic communication devices and the explosion of online ratings of consumer products and services. Naturally, consumers want access to accurate and easy-to-use information about the quality of healthcare services.

Patient experience surveys focus on how patients' experienced or perceived key aspects of their care, not how satisfied they were with their care.[1] One way a hospital can measure patient experience is with the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, which was developed by the Centers for Medicare and Medicaid Services (CMS) and the Agency for Healthcare Research and Quality (AHRQ).[2] Although other patient satisfaction/experience vendors offer surveys, the Deficit Reduction Act of 2005 states that all Inpatient Prospective Payment Systems (IPPS) hospitals who wish to receive their full annual payment update must collect and submit HCAHPS data to CMS.

The HCAHPS survey, which employs standardized survey instrument and data collection methodology to measure patients' perspectives on hospital care, is administered to a random sample of patients throughout the year. CMS cleans, adjusts, and analyzes the data and then publicly reports the results. All CAHPS products are available at no cost at www.cahps.ahrq.gov.[2]

Christine Crofton, PhD, director of CAHPS in Rockville, Md., notes that the HCAHPS survey focuses on patient experience measures because they are considered more understandable, unambiguous, actionable, and objective compared to general satisfaction ratings. Although CAHPS surveys do ask respondents to provide overall ratings (e.g. rate the physician on a scale of one to 10), their primary focus is to ask patients to report on their experiences with specific aspects of care in order to provide information that is not biased by different expectations.

For example, if a patient doesn't understand what symptoms or problems to report to his or her provider after leaving the hospital, the lack of understanding could lead to a complication, a worsening condition, or readmission.

"A specific survey question about written discharge instructions will give hospital administrators more actionable information concerning an increase in readmission rates than a response to a 10-point satisfaction scale," Dr. Crofton explains.

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