In the era of Yelp, Facebook and online forums, where patients can report anything at all to the Googling masses; where your competitive advantage partially rests on patients’ perceptions of your listening, caring and respect, gathering detailed, objective, comprehensive and actionable accounts of patient experiences are even more important than ever. The usual research methods of focus groups, surveys family councils and rounding, etc., help in various ways, but they don’t tell the whole story of the patient experience. To do that requires a very special kind of knowledge and insight that can only be acquired through multiple and comprehensive patient experience accounts or exhaustive direct observation of people and processes. It’s why service industries such as hotels, airlines and restaurants use Mystery Shoppers to evaluate the customer experience. Today, mystery shopping is a 2 billion dollar plus industry. However, only a small amount is healthcare’s share, perhaps because its methods, benefits, opportunities and/or perceived threats are not widely understood. Whether that may be changing is unclear.
With the final ED – CAHPS survey (The Emergency Department Consumer Assessment of Healthcare Providers and Systems) expected to become mandatory sometime in late 2015 or early 2016, now is the time for hospitals to make sure they have sufficient, in-depth, feedback about patients’ perceptions of their experiences in their emergency department. The survey from CMS will assess information about the patient experience during arrival in the Emergency Department, during care, and after being admitted to an inpatient unit or discharged from the ED.
More specifically, the final surveys will ask questions about how quickly patients receive initial care, the perceived quality and timeliness of communication with nurses and doctors, wait times, medication and pain handling, interpreter services and discharge instructions — plus the overall rating of care and likelihood to recommend the hospital to others. The Centers for Medicare & Medicaid Services (CMS) is still testing the draft surveys.
Similar to HCAHPS on the inpatient side, CMS’s goal in developing the Emergency Department version of CAHPS is to better understand the ED experience from the patient’s perspective, allow for objective comparisons of the care that patients receive, and improve the quality of Emergency Department visits across the country. Likewise, a portion of Emergency Department reimbursement is expected to eventually be tied to the hospital’s ED-CAHPS scores.
In the September 2013 issue of the Allegheny Medical Society Bulletin, Dr. Fred Rubin provides a first-hand account of his experience as a patient in the hospital where he works. He recalls the various tests, procedures, diagnosis and care he received in the Emergency Department and during his 14-day hospital stay.
Dr. Rubin describes the frustration of sleep-disrupting procedures and the helplessness he felt as he lost control of his body. In summarizing the “good and the bad” of his time spent as a patient, he concludes that his overall hospitalization was a “terrible experience.”
Although this likely wasn’t what hospital management wanted to hear, Dr. Rubin’s knowledge of the hospital’s policies and procedures — along with his expertise as a physician — put him in the ideal position to suggest changes to improve the patient experience.
I had a similar opportunity when my husband, a physician, needed emergency care last fall. My background as a hospital executive and a medical mystery shopper enabled me to “see” instances worth reporting to management as I sat by my husband’s side during his visit to the hospital’s Emergency Room, his 17-day hospital stay and discharge to home care. Like Dr. Rubin’s account, there were good and not so good experiences.
In the January 2, 2014 Hospital Impact blog, Jason A. Wolf, president of the Beryl Institute suggested that finding the greatest opportunities for excellence and improvement in the patient experience comes back to a willingness to constantly ask questions, try new things and avoid being lured in by promises of “best practices” or prepackaged solutions.
I found Jason’s comments interesting when thinking about why more healthcare organizations don’t try mystery shopping to take their service and patient satisfaction to the next level. Unlike other service industries that routinely use mystery shopping reports to increase customer satisfaction and retention, many healthcare leaders are reluctant to take advantage of this powerful decision-influencing tool. It’s sometimes perceived negatively as a “gotcha” program rather than a way to make factual observations or a way to assess performance against standards.
The mystery shopping report
Mystery shopping reports are produced by individuals who know how to think, speak, and behave like “real” patients. These individuals have fictitious but believable symptoms, complaints or needs. Sometimes a doctor or two is involved in the plan. As ER patients, outpatients and inpatients, or as callers scheduling appointments and making inquiries, the mystery shoppers inconspicuously take notes about their encounters and observations, and turn these notes into a clear and insightful first-hand account of their entire experience. Depending on what the organization wants to know about its operations, the compilation of these individual accounts plus associated questionnaire responses are then turned into detailed reports that:
The New Year brings a new change in the way DRG reimbursement is distributed. The reimbursement implications are significant, and many hospitals either have lost or will lose much needed federal funding, or collect sizeable incentive payments.
Which outcome will your hospital achieve?
As you know, one factor that determines whether your hospital receives an incentive payment or gets hit with a reduction in DRG reimbursement is inpatient satisfaction. That’s because Medicare’s Value Based Purchasing Program weighs inpatient satisfaction as 30% of a hospital’s performance score.
For this year, up to 1% of DRG reimbursement was at stake at underperforming hospitals. Next year, the percentage increases to 1.25% and increases again in 2017 to 2%. Even if yours is considered a top-performing hospital in its region, its DRG reimbursement may still be at risk because your facility is now being compared to the top 5% of ALL hospitals, with rolling benchmarks.
In anticipation of this change, hospital executives have been retraining staff and revising policies and processes with the goal of improving quality and increasing patient satisfaction at their facilities. Perhaps that’s what you’ve done, too.
Today’s patients are armed and potentially dangerous – but not with handguns or grenades. Their weapon is the Hospital Consumer Assessment of Health Providers and Systems, or HCAHPS. And how patients respond to this standardized national survey could be risky to your facility’s bottom line.
When asked to participate in the HCAHPS survey, many patients are telling it like it is – or at least the way they perceive it to be. But perception is a problem with this tool that promises a more consistent and comparable way to measure patient satisfaction. That’s because perception is subjective, and even though participants can respond with only one of four answers — either “always,” “sometimes,” “usually” or “never” — their responses can still be skewed by their perception of how they and their care were handled.