Improving HCAHPS Scores at Jacobi Medical Center

Introduction to HCAHPS and Jacobi Medical Center

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).

Score Analysis and Benchmarking

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.

Reasons for Jacobi's HCAHPS Scores

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.