Bypassing the Heart can Kill the Patient Experience

Nurses Don’t “Speak HCAHPS”—and They Shouldn’t be Expected To! When I say “HCAHPS” to nurses, what words or phrases come to mind? “Great patient experience?” “Exceptional care?” “Quality improvement?” Not even close.  Instead, the words that most readily come to mind are words like: “Survey.” “Score.” Or even “Punishment.” I’ve literally spoken to thousands of nurses over the past couple of years. As I give presentations or consult with groups around the country, I will often bring up the subject of HCAHPS. When I do this in a group of nurses you can almost feel a change in the room. Eyes roll. Smiles disappear. Arms fold. They can look visibly tired, or beaten down. The Pain of HCAHPS As I talk with nurses about these responses, I find that many of them feel punished by leaders for low scores. This isn’t the intention of hospital administrators. But, when reimbursement and reputations are on the line, these feelings can be an unintended consequence of being under the spotlight. As HCAHPS become more important, leaders are bound to give the scores, and the source of the scores, more attention. There’s a responsibility to fix or to improve troubled areas and that means focusing on what happens during the patient encounters, specifically on nursing units. After all, it’s inpatients that receive the survey. The nurses’ response is not necessarily that leaders are focusing more, it’s HOW they are focusing on HCAHPS. In many cases it’s by handing down edicts and trying to enforce tactics. Here’s what we recommend: forget the score! That’s right. Forget about making the survey score the focus of all of your activity around patient care and the patient experience. The survey is not the focus. The patient is the focus. Nurses know that. One of the things I most enjoy about our Nurse/Patient Partnership course is that we start the program with stories. I ask the audience to think about a time when a nurse made a lasting impression on them—either positive or negative. I get them thinking about their own life stories. Then I remind them that they, as nurses, are part of their own patients’ life stories. And then I ask them to spend some time contemplating what they would like those stories to be. Relieving the Pain When we forget about the HCAHPS we can get back to a focus on what’s most important to nurses—and to the hospitals and patients they serve. Forget the survey – forget the score. Let’s go back to the basics of bringing out the empathy in nursing and why we love it; we love nursing because we love giving care to patients. That’s where the focus should be; the focus should be on the patient. Not to increase scores, but to improve service and quality of care. The scores will follow. Last year, Press Ganey released a report as part of its Insights series indicating that nurse communication was what they called a “rising tide measure.” Based on an analysis of more than 3,000 U.S. acute care hospitals using publicly available data, the study suggests that when hospitals improve nurse communications with patients, they will see a boost in other areas as well: responsiveness of hospital staff, pain management, communication about medication, and increased overall patient experience scores, for instance. As Christina Dempsey, Press Ganey’s Chief Nursing Officer said in the report, “As the bedside caregivers, nurses have the most interaction with patients and are positioned to have the greatest impact on their overall experiences.” Those experiences, of course, will have an impact on HCAHPS scores. Let Qualitative Drive Quantitative It’s not that we’re really going to ignore HCAHPS – clearly we can’t do that. What we can do, though, is to learn to connect with nurses from the heart first. The head (intellectual comprehension about the scores) and hands (the skills) will follow.  What can your hospital do? It can start by backing off on the singular focus on HCAHPS scores and helping nurses connect the heart. Speak their language—a language of empathy and caring, a language focused on the qualitative, not the quantitative. That’s the way you boost your HCAHPS scores. Want to learn more? Ask us about the Nurse/Patient Partnership.