The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is the only national, standardized survey assessing patients’ experience with US hospitals. It contains 32 questions covering doctor communication, nurse communication, cleanliness, pain management and other domains. A random 50 percent of all patients discharged from Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center receive the HCAHPS in the mail.
HCAHPS results are reported publicly by the Center for Medicare and Medicaid Services (https://www.medicare.gov/hospitalcompare/search.html). As of October 2015, both JHH and JHBMC fell to ratings of three stars out of five. We are not proud of this. We strive for all of our patients to perceive an outstanding experience in our hospitals.
Doctor communication was one of the individual domains rated at three stars for both hospitals. This is particularly concerning as patients’ experience with doctor communication is associated with clinical outcomes and adherence to therapy (BMJ Open 2013;3;e001570 is a good systematic review). Our Department of Medicine scores were especially poor, with a ranking among the worst 20 percent of all academic departments of medicine in FY2015.
There are three questions in the doctor communication domain. These ask whether doctors,
- “treated you with courtesy and respect”
- “listened carefully to you”
- “explained things in a way you could understand”
The department is eager to help all faculty and trainees improve and preserve good communication behaviors. We are taking the following steps.
- Committing to understanding and improving provider satisfaction over the long term, especially regarding workload and systems to support efficiency
- Working with the Service Excellence Department to promote a “behavior model” mnemonic likely to be called the Hi-FIVE
- Hi (knock and seek permission to enter patients’ rooms)
- Familiarize (introduce yourself and the team)
- Interact (sit down and affirm the patient’s experience)
- Voice (incorporate the patient’s voice in creating the agenda and plan)
- Exit (assess understanding and allow questions)
- Establishing Leadership Rounds for clinical leaders, executives and administrators to meet and hear feedback from patients and front-line providers regularly
- Piloting a system of surveying patients directly about their residents’ communication skills and delivering this feedback to residents as an educational tool that may lead to improved experience for future patients
- Making available the “Language of Caring” online modules through MyLearning for short, practical didactics in communication that recognize the demands of high patient volume
-Stephen Berry, Associate Vice Chair for Quality, Safety & Service