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The Good and the Bad: Using HCAHPS Scores to Your Advantage

By Kim Shaw, MBA, BSN, FACHE, President, St. Joseph Health

June 23, 2023 Posted in: Leadership

If your health care organization takes Medicare or Medicaid, you’re familiar with the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). Since the mid-2000s, the Centers for Medicare & Medicaid Services has required all hospitals under their regulatory oversight to distribute HCAHPS surveys to their patients after discharge. 

Unlike customer satisfaction surveys in other industries, patient satisfaction surveys carry significant weight. HCAHPS outcomes determine your rate of reimbursement. They’re also tied to quality scores generated and made public by the Leapfrog Hospital Safety Grade and other patient care watchdogs.

It’s vital for health care leaders to understand the strengths and weaknesses of HCAHPS surveys, understand the results they receive, and view them as an opportunity to raise the bar and improve the patient experience.

Recognize the Benefits and Use Them Wisely

Thanks to HCAHPS, hospitals can instantly compare their patient satisfaction scores to comparable health care organizations across the country. Having this data enables you to develop benchmarks and set goals.

However, this public information also gives potential patients opportunities to compare health care organizations. Today’s consumers pay particular attention to data regarding patient experience. Patients are eager to learn how others feel about their health experience. If you have excellent HCAHPS results, you’re in good shape. 

However, HCAHPS scores do have some inherent weaknesses that may hinder their usefulness to hospital administrators. For example:

  • The survey is too long. Most HCAHPS surveys are four or five pages and have redundant questions. Few patients will take the time to fill out such a lengthy survey. Those who do are either extraordinarily pleased or extremely disappointed, leaving you with a noticeable lack of responses from your typical patient. 

  • Low response lowers reimbursement. Early on, HCAHPS survey completion was around 33.3 percent. Today, we’re lucky to reach 26.7 percent. This can have an adverse effect when hospital scores are linked to reimbursement, especially if you receive many negative responses during a short period. 

  • The industry starts “teaching to the test.” Best practices often get shaped by the survey. Years ago, HCAHPS asked about adequate pain control. In response, well-meaning clinicians overprescribed narcotics in an effort to achieve better scores in this area. When narcotic prescriptions quadrupled, the HCAHPS dropped the question, and prescription rates reduced as well.

  • Paper surveys yield dated results. HCAHPS surveys get distributed through the U.S. Postal Service, often landing in mailboxes a week or more after a hospital discharge. This is a long time to wait for a survey, and time can skew memory, leaving you with results that are less accurate than what you might receive if the survey were distributed at discharge, maybe in a text message.


Understanding the Results

Patients’ written responses elicit the greatest wealth of information. There, you frequently find one element responsible for influencing the patient's perception of their care in a positive or negative manner. Once you mine that information, you can begin to look for ways to either affirm current processes and procedures or mitigate specific issues going forward.

As you work through the survey results, be cognizant of the white noise. Because the feedback is anonymous, you will get some unusual comments that are unusable. If the patient provides contact information, follow up to learn more. You might also each out to the nurse managers for any feedback they might have.

Keep an eye on the bigger picture. While it’s important to review survey data monthly, pay closer attention to trends than individual incidents and expect an occasional bad month. When scores dip for two or three months in a row, however, it’s time to start investigating.

Helping Patients to Help You

A lack of patient education can cause confusion as some patients may not have an understanding about what the health care experience is, which may be a failure on our part for not providing the education they need. Many of us settle into our roles, caring for patients and performing our tasks without considering the patient perspective. We often forget to inform patients of their rights and responsibilities. Patient satisfaction scores may improve if we took time to explain our processes and why things are the way they are.

You should also look for easy wins. If a patient room is near a loud door, buy equipment to make the door shut more quietly. Replace worn-out casters that squeak as carts get pushed down the hall. 

Grab the Low-Hanging Fruit

Another great way to improve patient satisfaction is to identify two or three departments that, based on survey responses, offer the greatest opportunity for improvement. Focus intently on these departments and implement key drivers that lead to improved scores. This may mean one or more of the following: 

  • Bedside shift reporting

  • Hourly rounding

  • Improved discharge instruction scripting and communication

  • Leadership rounding


When a team member gets praised by name on a survey, always recognize that team member in front of the whole team.

Once you get those surveys moving in the right direction, find other low-performing departments and do the same thing. By raising the scores in the lowest-performing departments, you affect your overall scores. Improve those, and you will not only have better survey results, but also happier patients and better, more patient-focused care.

Throughout the improvement process, communicate a single goal to your frontline team. Tell every person in your organization they’re responsible for positive patient experiences and remind them of this often. Just watch how you do it. Browbeating the clinical staff about improving HCAHPS scores doesn’t work. Being transparent and recognizing excellence, on the other hand, does. Use carrots, not sticks, to drive improvement. 

Most people are naturally competitive, so capitalize on friendly competition by awarding prizes to team members who round on the most patients or perform another satisfaction-improving duty. Any efforts you take to reward your team will ultimately benefit your patients — and your patient satisfaction scores.

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