This paper examines the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores for Jacobi Medical Center in the Bronx, New York. It presents a data-driven analysis of patient satisfaction across key categories — including nurse and doctor communication, medication education, pain management, and facility cleanliness — and benchmarks those scores against regional peers and national averages. The paper identifies low communication scores and inadequate patient education as the primary drivers of Jacobi's below-average ratings, then proposes a structured improvement strategy drawn from UC Irvine Health's performance management model. A six-month implementation timeline, stakeholder analysis, and evaluation framework using the National Public Health Performance Standards Program round out the plan.
The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) gives consumers an opportunity to compare available healthcare options across the country and to decide what care they want. This paper provides a scenario illustrating how the HCAHPS score of a specific organization can be improved, including a full data and impact analysis, an improvement plan, and an implementation timeline.
Jacobi Medical Center is located in the Bronx, New York. Its HCAHPS scores indicate that 63% of patients were satisfied that nurses communicated effectively with them, and 47% indicated that help always came as soon as they needed it (Hospital Compare). 58% of patients would recommend the facility, and 55% would give it a favorable rating of 9 or 10 on a 1–10 scale (Hospital Compare). 75% indicated that doctors' communication was good, and 80% of patients reported that they received information about what to do during their recovery at home, while 47% said it was quiet in the evening in the area surrounding their rooms (Hospital Compare). In matters of sanitation, 66% of patients indicated that bathrooms as well as rooms were always clean (Medicare). 51% of those polled said that staff provided explanations about the medications being given to them, and 61% indicated that their pain was controlled well (Hospital Compare).
The demographics at Jacobi Hospital reflect good ethnic diversity (Jacobi Medical). 3% of patients were Asian, 33% were Black, 10% were white, Hispanics made up 32% of the population, and American Indians made up 1% (Jacobi Medical). Jacobi Hospital provides inpatient care that includes infection isolation rooms, neonatal intensive care, psychiatric care, heart catheterization, and neonatal intermediate care (Jacobi Medical). Outpatient care services include kidney dialysis, chemotherapy, HIV/AIDS services, women's health services, an urgent care center, and dental services. Imaging services include ultrasound, MRI, CT scanning, and diagnostic radioisotopic facilities (Jacobi Medical). The facility also offers patient support services covering cancer support, patient support groups, pastoral care, and government services assistance.
75% of patients at Jacobi Hospital rated doctors' communication as good. The national average in this category is 82%, while the New York average is 77% (Hospital Compare). The percentage of patients who gave the hospital a rating of 9 or 10 on the 1–10 scale was 55%, compared with a national average of 71% and a New York average of 63% (Hospital Compare). The percentage of patients who indicated that help came when they needed it was 47%, comparing unfavorably to New York's 61% and the national average of 68% (Hospital Compare).
Jacobi can be compared with two other area facilities: St. Barnabas Hospital and Montefiore Medical Center. Montefiore scores 78% of patients as indicating good doctors' communication, while St. Barnabas is rated at 80% (Hospital Compare). Montefiore's figures indicate that 59% of patients received medication explanations from hospital staff, while St. Barnabas scores 75% in the same category (Hospital Compare). 67% of Montefiore's patients would recommend the facility to others, while 57% of St. Barnabas patients would do the same (Hospital Compare). Survey response rates for Montefiore, St. Barnabas, and Jacobi were 21%, 13%, and 15%, respectively (Hospital Compare).
Educating patients may be the most effective means through which the issues raised in the HCAHPS survey can be addressed, given what the questionnaire measures. The survey's standardized design raises concerns that cannot easily be resolved through operational changes alone — every facility must use the same template without adjusting questions to fit the specific hospital's circumstances or to avoid areas of weakness (Raise HCAHPS). The tool available to facilities is expectations management, which can be achieved through consistent and uniform patient education. While patient education has been shown to improve outcomes, a review of HCAHPS programs suggests that most focus on operational issues, with very little modification to patient education programs (Raise HCAHPS). No systematic efforts appear to be in place to manage patient expectations through a uniform and well-planned education program (Raise HCAHPS).
Sociocultural differences between providers and patients have been shown to influence both communication and decision-making. Evidence links clinician–patient communication to patient satisfaction, health outcomes, and treatment adherence. Failure to recognize these sociocultural differences may result in lower quality care (Cross-Cultural Care). HCAHPS directly impacts hospital reimbursements by measuring clinician–patient communication and weighting it heavily in satisfaction scores (Cross-Cultural Care). Research on the effects of cultural competency on patient satisfaction is further supported by the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Cultural Competence Item Set (Cross-Cultural Care).
While providing high-quality patient experiences has long been a moral obligation for medical facilities, the tying of reimbursements to HCAHPS scores has made it a financial priority. Patients in hospitals across the country use 27 categories to rate their stay, including communication effectiveness, pain management, sanitation, and noise levels (Letourneau, 2014). Hospital payments in a given fiscal year are tied to these scores; hospitals could gain or lose up to 1.5% of their Medicare payments in fiscal year 2015 (Letourneau, 2014). The Centers for Medicare and Medicaid Services (CMS) has continued to raise the stakes, with projections suggesting up to 2% of Medicare dollars at risk by fiscal year 2017 (Letourneau, 2014). As the financial implications grow, facilities are actively seeking strategies to improve patient experience and HCAHPS performance.
One primary reason for Jacobi's low HCAHPS scores appears to be communication. The figures for good communication by doctors and nurses are notably low — 75% and 63%, respectively. These numbers should be approaching 100%, as there is no acceptable operational justification for poor communication in a healthcare setting. As Darin Vercello writes in his blog "Simultaneously Enhance HCAHPS Scores and Patient Flow," good communication is among the most appreciated aspects of medical care. High HCAHPS scores are consistently associated with effective clinician–patient communication. Patients appreciate moments when a doctor took time to speak with them or when a nurse offered a clear explanation. Rarely does a patient praise a particular medication choice (Radak, 2012). In light of this, improving communication techniques — such as better use of recall-enhancing instructions and expanded interpretation services — could significantly boost Jacobi's scores.
Poor patient education also helps explain Jacobi's HCAHPS performance in certain areas. While all patients should receive instructions on what to do during recovery, only 80% reported receiving this information — a figure that falls short of expectations. Even more concerning, only 51% of patients reported receiving explanations about their medications (Hospital Compare). No patient should leave a hospital without adequate information on how to take their medication or what to expect during recovery. Improper medication use can cause further harm and lead to worsened health conditions. Every interaction between a clinician and a patient represents an opportunity to educate the patient about their illness, their medications, necessary follow-ups, and post-discharge plans (Rodak, 2012). Keeping patients informed and involved in their own care process not only improves outcomes but can also reduce anxiety upon discharge.
UC Irvine Health's organizational strategy is well suited for adoption at Jacobi. Results from the HCAHPS Technology Study indicate that hospitals using well-structured performance management approaches are more likely to report better patient experiences (5 Strategies). This finding underscores the importance of linking HCAHPS outcomes to employee goals, feedback mechanisms, and performance appraisals. On joining a healthcare organization, employees should be nurtured and encouraged to excel in their roles (5 Strategies). This begins with clearly communicating the behavioral expectations tied to HCAHPS measures. Automating accountability mechanisms makes holding employees to these expectations both easier and more consistent (5 Strategies). Systematizing performance management produces consistency and ensures employees understand what is expected of them at all times, resulting in improved performance. The best healthcare organizations have established a culture of accountability through rigorous performance management, with industry leaders identifying techniques that focus employees on the importance of HCAHPS scores and align their conduct with patient needs (5 Strategies).
The plan's structure emphasizes excellent staff engagement, sound financial performance, family and patient satisfaction, coordination across the continuum of care, and physician-sensitive quality indicators (Nursing Strategic Plan Summary). Elevating Jacobi's performance will require advancing clinical excellence, advancing research, building strong teams, providing excellent education, achieving financial security, and strengthening existing community partnerships (Nursing Strategic Plan Summary). To bring these goals to fruition, Jacobi must provide compassionate, patient-centered medical care grounded in relationships, while continuously monitoring performance and implementing targeted improvements. The hospital must consistently exceed national benchmarks and ensure that infrastructure and funding are available to support research (Nursing Strategic Plan Summary). Translational research — which bridges basic science and clinical application and promotes collaboration between researchers — should also be strengthened. In addition, Jacobi should actively market its services to the community to boost revenue and expand fundraising opportunities.
Telemedicine uses modern technology, including the Internet, to connect physicians with patients, enabling real-time interaction that eliminates travel time and associated costs (Christ). This field is growing rapidly and will continue to expand alongside advancements in technology. Patient-centered medical homes represent a complementary technology-driven approach, enabling physicians to coach patients on their health with around-the-clock access. Electronic medical records are central to this model, and communication between physician and patient is a key concept (Christ). Pilot programs of this kind are being run by Medicaid in several states to test their effectiveness for broader implementation. The shift from paper to electronic medical records, already underway, is expected to continue and ultimately replace paper-based systems. According to the CDC, 38% of physicians have already made this transition, and the figure is expected to grow (Christ).
"Performance management and technology-driven improvement plan"
"Six-month phased rollout with staff training and technology"
"NPHPSP framework used to assess progress and outcomes"
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