With Medicare penalizing hospitals with low Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores, these publicly reported surveys of patients’ perspectives of hospital care are forcing facilities to reconsider their care environments. 

Jennifer Jasmine Arfaa, PhD, is chief patient experience officer at Thomas Jefferson University Hospitals (TJUH) in Philadelphia, a position created in 2013. She oversees numerous patient experience touchpoints.

“Service excellence is on the mind of every one of us, every day,” she says. “Our patients and their families are at the heart of every decision we make.” HCAHPS metrics, such as overall rating of the hospital, hospital environment, responsiveness of staff, communication with doctors and communication with nurses “drive existing programs and power new ones. Service excellence and patient experience are bottom-line issues.”

A Physician CARE Task Force, chaired and led by three physicians, is a major piece of the overall strategy for the patient experience at TJUH. The task force drives many of the initiatives relating to the patient’s perception of their experience with their physicians, including communication training. This training educates physicians on ways to introduce themselves, acknowledge the patient and family, explain to the patient his or her plan of care and thank them for choosing Jefferson.

Along with all levels of leadership, the frontline staff, support services staff and service physician/nursing/departmental champions all play a role. “We have strong leadership at Jefferson, but it truly takes everyone working together to enhance the patient experience,” Arfaa says.

As a result of their efforts, TJUH has been recognized as one of the top four academic medical centers to have a top score for staff responsiveness. 

Meanwhile, the organization has implemented GetWellNetwork which is an interactive patient care and education system that interfaces with TVs in patients’ rooms. The system greets patients and provides education about their medical conditions to better prepare them for discharge from the hospital. Through the system patients also can request hospital services related to the cleanliness of their rooms, adjust room temperature and request to speak with a patient services advocate about their concerns.  

“All of these efforts have led to more communication with—and empathy for—our patients,” Arfaa says. “It’s about making sure that every single person in our continuum of care—from housekeeping and transportation to technicians, nurses and physicians; from administrators to volunteers—appreciates what a patient is going through and does everything she or he can, to make it a little easier.”

Transforming the culture

Long Island Jewish Medical Center (LIJMC) was the recipient of the Association for Patient Experience’s inaugural Practice of the Year award. The facility also received the Commitment to Excellence award at the national Press Ganey conference in November. LIJMC partnered with the hospitality industry resulting in a significant cultural change and improvement in patient satisfaction scores. 

Analysis of both the overall HCAHPS scores and the “likelihood to recommend” Press Ganey parameter led to an imperative for change, says Agnes Barden, senior administrative director of LIJMC’s patient and family centered care department. “Our scores didn’t reflect the care we were delivering. We were providing excellent clinical care but we weren’t perceived as having a warm, compassionate, hospitable manner.” LIJMC made a commitment to change. 

At the same time, the organization was in the process of building a tower with a new lobby and hotel-like features, Barden says, which served as a “catalyst for culture change.” LIJMC researched companies known for their excellent customer service and decided to partner with an organization with extensive experience in the restaurant hospitality industry. “We decided that some of their key concepts—service, hospitality and teamwork—aligned with what we wanted to accomplish.”

Ten people from across disciplines were educated as master trainers. Each of LIJMC’s 5,000 employees received a letter from the CEO inviting them to an interactive class on hospitality and the patient and family experience. At the end of each class, participants signed a commitment to care certificate. Each class was comprised of individuals from various roles within the hospital setting.  

The organization also created the hospital observation team (HOT)—an anonymous group of employees that observed other employee behavior and acknowledged positive behavior and addressed areas that needed improvement. 

Today, leadership regularly conducts hospitality rounds on all units and departments “to ensure the new language and culture are embedded in day-to-day practice.”

The organization’s CEO created the patient and family centered care department to “enhance the experience for all our patients and families,” Barden says. “If you create an environment where the patients, family and staff are treated with respect and dignity positive outcomes will follow.”  

Barden also reports compliment letters have changed from individual recognition to a team concept where respect and caring are often noted throughout the hospital. “That speaks to the fact that this has to come from everybody.”

Taking time to talk

HCAHPS scores also drove changes at NCH Healthcare in Naples, Fla., a two-hospital system that has been a Mayo Clinic affiliate since 2012. Paul Clarke, patient experience director, began to develop a plan to increase those scores. He studied hospitals with the top HCAHPS scores and found post-discharge calls were a common theme. The organization conducted these calls but they were not done in a formal manner. 

The health system worked with a partner to provide the calls to patients from four adult inpatient units. The callers asked questions about patients’ experiences and gave patients the opportunity to ask questions and provide feedback on their stay during the call. 

The calls are conversational in tone to avoid the perception that the call is another survey. “The ultimate goal was to give the impression that we still cared for them once they left the system,” Clarke says. 

Within a few weeks of the pilot project, the system’s HCAHPS scores had improved, according to Clarke. After one year, the pilot expanded to all 14 of the system’s inpatient units. 

Each post-discharge call is recorded, transcribed and automatically delivered to an online database so NCH Healthcare can identify trends and respond accordingly. Clarke tracks the transcripts and noted that many patients from a certain unit felt nursing assistants did not spend enough time with them. A workshop was held for the nursing assistants to learn strategies they could use to appear more personable without spending more physical time with patients. Just talking to patients when taking vital signs, for example, leaves a more positive impression.

Clarke currently is working with the quality department to identify whether the post-discharge calls have had a direct impact on reducing readmissions. “We have a number of initiatives going on with that focus, and we continue to be the only southwest Florida healthcare system to not receive a penalty for excess readmissions.”  

Patient experience improvement efforts continue. This year, the organization partnered with another company to develop a skills-building modules program, The Language of Caring, on very effective caring communication. “We are only on our third module but we are experiencing great results,” Clarke said. The decision to use the Language of Caring program was a direct result of the post-discharge phone calls that provided qualitative information. 

Like LIJMC, NCH Healthcare found that “although our patients shared we provided excellent care, they also revealed that they did not really feel our caring. The Language of Caring in this case would be a perfect solution to address this root cause.”

Future landscape

The focus on patient satisfaction has grown rapidly in recent years, says Clarke. Healthcare systems using best practices, “in my opinion, have a dedicated role or department. The key here, however, is dedicated. I have met many individuals who have the task or even role of patient experience but have other duties that unfortunately reduce their impact for their own system.”

“Patient satisfaction is a critical and growing issue for hospitals,” says Arfaa. “Because of its increasing impact and importance, hospitals will be smart to establish senior level positions dedicated to and focused exclusively on the patient experience.”

Patient satisfaction surveys are like open book tests, Arfaa says. “If you know the specific questions being asked on the survey, you ultimately know the basis on which patients will rate you. If patients (and family members) take the time to write about their experience, you need someone to focus on those comments and do something about them.