Healthcare professionals are, by and large, a very committed, patient-oriented bunch. This is especially true of healthcare leaders who have been committed to providing exceptional service and clinical care to patients since long before they were faced with HCAHPS! But, HCAHPS has driven us all to be more clearly focused on measurable outcomes and results—and to have the opportunity to compare our performance to others as the service delivery bar continually rises.

One of the very interesting things I’m finding as the Baird Group works with healthcare organizations—very good, very service-oriented healthcare organizations—around the country, is how stymied many leaders are as they attempt to figure out why their HCAHPS scores are lower than they would have anticipated. These are good—often great—organizations, with committed and caring leaders; yet, they often are at a loss to figure out what exactly is going on when they take a look at their scores.

We’re generating some great insight through our care partner observer (CPO) mystery shopping methodology. CPOs accompany patients posing as a family member or friend as they are being admitted and throughout a large portion of their planned admission. Because a large percent of inpatient admissions originate in the ER, CPOs also join up with patients as they come into the ER, so they’re able to document the transitions of care between the ER and the inpatient unit. The CPO makes note of where things are great as well as where things could be improved.

CPOs are trained to carefully document the factual experiences that occur along the patient experience pathway as well has how to interview patients and family members throughout the entire visit. The CPO documents the facts that they observe, then delves deeper by asking the patient and family what they thought and felt about each encounter, often in very minute detail. As a result, we’re gaining insight into the patient experience and resulting HCAHPS scores, not only through our own direct observations, but, most importantly, through the in-depth interviews.  It is through this dual assessment that we glean invaluable patient and family member perspectives.

These in-depth observations and interviews are really allowing us to fill in some of the blanks that exist as healthcare leaders review their HCAHPS scores and think, for example, “Why in the world are we being rated so low on cleanliness?” We were able to answer this question. And what we find is that, as with anything, you are only as strong as your weakest link.  

Take for example a hospital that scores poorly on cleanliness. When the scores arrive, all eyes are on environmental services. And that may be true in some cases, but, in one example, here is what we discovered:

Our CPO documented that the environmental services staff was doing a thorough job of cleaning an area, but other staff members were creating clutter, which led the patient to feel that the room was not clean. So, for instance, a nurse started an IV and a tech did an EKG and both left wrappers behind on the bedside table. Every time food was delivered and placed on the bedside table, none of the old, half-full, warm beverages were removed. In another situation, a nurse helped the patient change his gown and then dropped the soiled gown on the floor where it remained for two shifts. When the patient was asked what he thought about the environment, he said it was dirty because of the clutter and mess left by staff.

These myriad activities, however minor in isolation, make a cumulative impression on patients and impact their perceptions—and your HCAHPS scores.

 The solution? Recognizing that you are only as strong as your weakest link and taking steps to ensure that your staff are working together as a team to make sure that they are incredibly astute observers, that they’re looking at the environment through the eyes of their patients, and that they are taking steps on an ongoing basis to continually make improvements.

A single, seemingly minor, chink in the armor of your service delivery can make all the difference. We’re ferreting out those chinks through our CPOs and learning some exciting things in the process.

If you want to dig deeper into your patient service experiences, give us a call. Our care partner observers can work with you to unearth the little things that may be making a big difference to your patients, and your HCAHPS scores.