When people come to a hospital for care, they expect a positive experience even if the circumstances of their visit are serious. The expectation of hospital satisfaction is more than just personal, though. The federal government also prioritizes patient satisfaction with hospital care and measures it with the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) tool, which provides a national standard for information about patients’ experience with care. The data collected through HCAHPS means that valid comparisons can be made between hospitals on a local, regional, and national basis. HCAHPS scores also provide hospitals with important feedback about patients’ perception of staff performance while delivering care. Since 2014, VHHA has tracked HCAHPS scores through its Public Quality Report. The Association will continue to do so through 2024 in support of an overarching goal to achieve a 75 percent statewide average of patients scoring Virginia hospitals as a nine or 10 on the HCAHPS survey, which asks patients to rate their experience in 10 different areas of care. The results are published online at the Hospital Compare website. To evaluate how Virginia’s hospitals measure up, the VHHA Analytics team compared Virginia’s current performance to the 2014 HCAHPS baseline. October 2016 through September 2017 is the most recent performance period for which data are available. Figure 1 below shows data illustrating average “top box” scores for participating, publicly-reported hospitals in Virginia. The “top box” score for each measure reflects the percentage of patients at a given hospital who chose the most positive, or “top box,” response for each category. The data show that Virginia hospitals improved in 60 percent (6 of 10) of HCAHPS domains when compared to 2014 performance. Satisfaction scores in some categories, however, continue to lag. They include care transitions, communication about medicine, and hospital environment quietness. These domains are important in relation to Virginia hospitals’ continuing effort to prevent avoidable readmissions. It’s worth noting that the severity of the original acute illness for which a patient has been hospitalized is not necessarily predictive of whether a patient will require readmission.1 This finding has led health care professionals to examine the hospital experience and discharge process as key predictors of satisfaction and reduced readmissions. Indeed, compelling research exists about the effects of hospitalization as a determining factor in patient readmissions.2 Sleep deprivation, confusing medication regimens, and deconditioning are among the factors that are known to impact readmissions. These factors can be mitigated by ensuring smooth care transitions with warm handoffs between providers at hospital and home care or other facilities, clear communication about medication using patient teach-back methods, and the provision of healing hospital environments that promote rest and sleep. Conducting rushed discharges does not adequately prepare patients for a care transition, nor does it promote patient buy-in for the recovery process. Hasty discharges can also lead patients to be dissatisfied with hospital care. Preparing patients and families, including home caregivers, for a discharge should begin as close to the day of their admission as possible to emphasize the goal of a safe and timely discharge. Care partners should communicate regularly with patients about progress towards that goal. Implementing organizational changes that will have a lasting impact on patient satisfaction and readmission prevention takes coordination and collaboration among care providers, with a focus on engaging patients and families to prepare them for the road to recovery. High-performing hospitals take a multi-faceted approach to enhancing care transitions and preventing readmissions. Effective strategies can include partnering with patients to discuss and clarify medication routines, fall prevention, counseling about dietary restrictions and scheduling post-discharge follow-up appointments, and providing a clear channel for getting questions answered. Strong feedback loops and commitment from providers and families are a critical component of successful use of these strategies as a way to help improve HCAHPS scores and patient satisfaction.
1 Kansagara D, Englander H, Salanitro A, et al. Risk prediction models for hospital readmission: a systematic review. JAMA 2011;306:1688-1698.
Figure 1: Top Box Score