Bellevue Hospital in New York received a 73.5 (C) in the recent HCAHPS patient satisfaction survey. New York State, on average received a 80.2 (B-)
According to the latest HCAHPS patient satisfaction survey results, most states do not meet the top grade in hospital care.
Every year patients of American hospitals are given the opportunity to rate the care they receive by participating in the Hospital Consumer Assessment of Health Plans Survey (HCAHPS®).
According to the HCAHPS survey Web site: “The HCAHPS survey contains 18 patient perspectives on care and patient rating items that encompass eight key topics: communication with doctors, communication with nurses, responsiveness of hospital staff, pain management, communication about medicines, discharge information, cleanliness of the hospital environment, and quietness of the hospital environment.”
Ranking each state based on the results to the following questions we can compare, on average, what grade of care each state provides:
- How often did doctors communicate well with patients?
- How often did nurses communicate well with patients?
- How often did patients receive help quickly from hospital staff?
- How often did staff explain about medicines before giving them to patients?
- How often was patients’ pain well controlled?
- How often was the area around patients’ rooms kept quiet at night?
- How often were the patients’ rooms and bathrooms kept clean?
- Were patients given information about what to do during their recovery at home?
- Would patients recommend the hospital to friends and family?
- How do patients rate the hospital overall?
The United States hospital average came in at a disappointing 80.2 (B-). Below are the patient satisfaction scores and grades for each state.
States receiving an “A” grade:
- None. As you’ll see below, no state graded above a “B”.
States Receiving an “A-”grade:
- None.
States Receiving a “B+”grade:
- None.
States Receiving a “B” grade:
- South Dakota : 84.1
- Wisconsin : 83.5
States Receiving a “B-” grade:
- Iowa : 83.3
- Louisiana : 83.2
- Maine : 83.2
- Vermont : 83.1
- Nebraska : 83.1
- New Hampshire : 82.6
- Alabama : 82.5
- Minnesota : 82.5
- Oklahoma : 82.5
- Kansas : 82.5
- Idaho : 82.3
- North Carolina : 82
- Indiana : 81.6
- North Dakota : 81.4
- Colorado : 81.3
- Utah : 81.3
- South Carolina : 81.2
- Texas : 81.1
- Wyoming : 81.1
- Mississippi : 81
- Kentucky : 80.9
- Alaska : 80.7
- Massachusetts : 80.6
- Arkansas : 80.6
- Oregon : 80.5
- Tennessee : 80.5
- Michigan : 80.5
- Missouri : 80.4
- Montana : 80.1
- Ohio : 80.1
- Washington : 80
- Rhode Island : 79.9
- West Virginia : 79.7
States Receiving a “C+” grade:
- Georgia : 79.3
- New Mexico : 79.2
- Virginia : 79.1
- Pennsylvania : 79.1
- Connecticut : 79.1
- Illinois : 78.6
- Arizona : 78.6
- Delaware : 77.6
- Maryland : 77
- Hawaii : 76.8
- New Jersey : 76.5
States Receiving a “C” grade:
- California : 76.4
- New York : 76.2
- Florida : 75.4
- Nevada : 74.6
States Receiving a “C-” grade:
- Dist. of Columbia : 73.4
On average, patients give American hospitals a B- grade to the patient satisfaction questions.
The implications for healthcare providers, administrators, and health plans (payers) are that patients are only satisfied. There is room for improvement in how patients interact with or are treated by care providers. As full service hospitals see margins getting thinner, it will be increasingly important for hospitals to not only retain patients, but create fans that will advocate services to their personal network.
For Patients: What has been your experience with the hospitals in your state and does it match up with this data?
Danielle Ofri, MD, PhD shares her experience taking her son to the ER at New York City’s Bellevue Hospital where she works. OFri had a better experience at Bellevue than the average patient would have at the average New York hospital. New York’s state average HCAHPS score was 76.2 (C), but Bellevue Hospital earned a 73.5 (C) in the most recent HCAHPS patient satisfaction survey.
For Providers: What efforts are you making to improve patient satisfaction?
Ofri’s anecdote reminds us of how patients can be critics or advocates. Ofri’s experience has been published as full stories on multiple Web sites and shared by hundreds (if not thousands) of people via social networking sites like Twitter and Facebook – modern-day word of mouth.
How good (or bad) are the experiences of the patients where you work? How actively do you (or your organization) pay attention to patient satisfaction scores, and what initiatives do you have to improve? Any insights into why your state scores so low or why South Dakota is at the top and Washington D.C. is at the bottom?
Can you please share how you got these averages? when I average the top box percents for April 2008-March 2009 for the 10 areas mentioned above, I dont get the same national (80.2) or Florida average (75.4). What am I missing?
thanks…shawn
twitter: @smhcs
I didn’t just take a simple average of the top box percents. Those percents are the ratio of respondents’ answers to each question and it wouldn’t make sense to average those numbers.
These HCAHPS scores were derived by first assigning each possible survey response a numerical value. The following are the values assigned to the possible responses:
Patients who gave a rating of 6 or lower (low) = 6 points
Patients who gave a rating of 7 or 8 (medium) = 8 points
Patients who gave a rating of 9 or 10 (high) = 10 points
Always = 10 points
Usually = 5 points
Sometimes or Never = 0 points
Yes (Yes Definitely) = 10 points
Yes (Yes Probably) = 5 points
No = 0 points
The percentage of responses (given in the HCAHPS data) for each possible answer is then multiplied by the point value/multiple per answer. The answer scores are then summed per question. That summed value is then multiplied by 10 to put the score on a common 100 point (100%) scale.
Here’s an example:
Survey Question: How often did staff explain about medicines before giving them to patients?
Responses, Point Value Multiple * Answer Percentage:
Staff always explained, 10* 57% = 5.7
Staff usually explained, 5*22% = 1.1
Staff sometimes or never explained, 0 * 22% = 0
Sum = 5.7 + 1.1 + 0.0 = 6.8
Multiply that question sum by 10 to get to the 100 point (percentage) scale: 6.8*10 = 68.0
Each question is then summed and an average is given per state.
You’ll notice that a lot of the answers to questions have ranges (e.g. 0-6), but I give the state the benefit of receiving a 6. I mention this because the average response for that question is probably not the full 6 points, so these state averages might even be a little lower than reported.
I did a little more research and found that Sarasota Memorial’s average is 79.07. That average is above the Florida average (75.40) but below the national average (80.23).
I am a nurse in Arizona. My concern about the surveys is that every hospital is being compared with no regard to the differences they possess. My belief is that staffing ratios, personnel satisfaction, acuity of the hospital and financial support of the institution play a big part in that equation. I am very distressed that the federal government will be able to base the pay to an institution based on patient satisfaction. There is not one other industry in the world that is treated this way, well, maybe prostitutes. I agree that poor care should not be acceptable or if you consistantly have low scores you might get a probation, but no pay at all? If you go to college and receive a C in your classes you still get a diploma. In this equation you get nothing. Maybe place a carrot out there of a bonus if you get A’s but not withhold payments. Medicare and Insurance companies are already cutting the reimbursements for procedures and hospitalizations to add patient satisfaction scores will bankrupt many institutions and then where will healthcare be?
I am not saying that patients should put up with poor care. That is not my point at all. But I do know that taking away support will not make things better as personal get distressed and people are not at their best when they are distressed. Patients are human beings, not machines and some things cannot be fixed. Every person sees situations from different perspectives. It is difficult to be everything to everyone which is what is required to get perfect scores. Also, it is well known that surveys are not the best way to measure as it is purely subjective. How do we know that the patient is the one filling out the survey? It could be an upset family member that staff did everything they could to please and nothing was acceptable. Do we really want to go down this path?
@Loretta Vukeles
Your comments are very valid. This will certainly challenge most, if not all, organizations to consider the level of service they offer their patients. I can also see your point to using a carrot (bonus based on patient satisfaction) instead of a stick (no reimbursement). The status quo might allow some organizations a few more resources to improve, but it also might prolong poor performance. You are also right that surveys have inherent data collection problems, and I think these will improve over time.
There is also evidence surfacing that high patient satisfaction scores are not necessarily correlated to quality outcomes. If that is the case, then we will have to question whether patient satisfaction is more of a business performance issue than about clinical outcomes? I do believe that we all want to be treated in a professional and empathetic manner, and that the way we feel about our care can impact our healing or the eventual outcome. There are too many anecdotes where providers go the extra mile to help a patient stay motivated or keep hope alive that it saves their life. I think that satisfaction does have an affect out outcomes, but we don’t yet understand that affect nor to the degree of that influence.
Let me ask you a couple questions.
1) Are hospitals compelled/mandated to offer their services? In most cases, not all, they are not mandated to provide certain levels of care. They can choose their status or category, etc if they choose.
2) Should hospitals have the liberty to choose which services are evaluated by a stakeholder for quality purposes?
It could be argued that hospitals generally have a choice about which services they offer and possibly could opt-out of the services that they don’t want to be evaluated. However, they should be held accountable for the responsibility with which they are entrusted.
Unless you’re referring to patients dying, I’ll also have to challenge your perspective that “some things cannot be fixed.” We should have the professional will and personal humility to never give up. We’re doing things today that were never possible or event dreamed of at one time.
Patients generally judge quality against the best possible outcome (as described by the one providing the service) and how they were treated. Because the second measure is not objective should we not measure it? If we do think it is worth measuring what should we do with that data? Tying it to compensation is certainly one way to get action.
Thoughts?
One of the biggest issues I have with HCAHP scoring is how the consumer is mislead. There are 4 choices for the consumer to choose from when rating their hospital experience: Always, Usually, Sometimes, and Never. However, Always is rated the highest with a scoreing of ZERO for the other 3 options. If it si all or nothing, to be transparent and fair, the scoring should consist of 2 options: Always and Never.