Why You Shouldn’t Be “Teaching to the Test” When Trying to Boost Patient Satisfaction Scores

“Teaching to the test” is a phrase used in education to refer to the common practice among many educators who tailor their instructions to focus on what students will find on the many standardized tests they’re required to take. It’s a practice that has been widely vilified and, recently, education advocates have called for an end to test-based teaching.

Healthcare professionals should do the same. While teaching to the test is being vilified in education, healthcare organizations are adopting the practice more frequently.

Lately I’ve been coming across more and more examples of healthcare organizations attempting to “teach to the test” when it comes to the patient experience. The desire to improve patient care is one thing—and a good thing—but gaming the CAHPS system by exhorting staff to use specific words and phrases from the questions patients will later be asked is not a good thing. In fact, many patients question the attempts.

Here are some recent examples:

  • During a recent mystery shopping project, we heard back from a number of the mystery shoppers about a hospital that had taken all of their whiteboards and written along the top: “Our goal is to provide very good care.” The mystery shoppers, almost without exception, questioned why the hospital wouldn’t strive to provide exceptional care. We knew that Very Good was the top box on their survey tool. They felt that if they kept repeating very good care and stressing very good care on the white boards, that patients would subliminally adopt their language and their thinking. They’re teaching to the test, but leaving the patient wondering about marginal goals.
  • In another hospital, hanging from the ceiling throughout their ambulatory center were little banners with the word “Always” on them; another thinly veiled attempt to game the system.

My question: why not focus on changing the culture rather than trying to change people’s minds? What I’m finding is that, instead of doing the tough work around changing culture—which is tough work—they’re teaching staff, instead, to try to change patients’ minds about their care. To me, that borders on deception.

Ever since value based purchasing and HCAHPS emerged on the scene, healthcare professionals have been really stressing what to do to improve specific elements of survey responses; they’re “teaching to the test” to improve their scores.

This started innocently enough, I think. For example, early on discharge instructions were a significant area of focus. Nursing staff would meet with patients and explicitly tell them something like, “I’m going to give you your discharge instructions now.” It’s important for patients to know that they’re receiving instructions they will need to follow once discharged. It’s also, of course, a dimension on the HCAHPS survey. When I hear leaders tell me that staff is expected to use the word “always” during every discussion with patients I feel we have reduced their behavior to the car salesman who blatantly asks for a score of 5 out of 5 so he can get his bonus.

Let’s focus time and attention on promoting behaviors that will earn top box scores and then leave the grading up to the patients.

How about hiring for compassion and empathy traits and then teaching our staffs to be great communicators? If we focus on the right things, the scores will follow. Trust me on that.

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