This title may be a bit misleading. Of course you can’t change the past. Your inpatient customer service experience is over, but you can make your feelings known to your doctor and the institution’s administrative staff. Your experience can prompt changes that can improve the experience for future patients. While hospitals and outpatient facilities typically poll their patients to conduct Satisfaction Surveys, I think a better way to make your experience known in a way that can bring about change is to send a letter to the appropriate individuals at the facility. Depending on the issue, these are the people to whom I would address the letter:
- President or CEO of the Hospital
- Head of the Department of Quality
- If appropriate, Director of Nursing
- If appropriate, Head of Clinical Services or Chief of Medicine
I would also send a copy to your physician as well as to the Quality Department of your health insurer. I think notifying the insurer makes sense especially when issues result in unnecessary tests and procedures for which they will be asked to pay on your behalf. (Remember the chest x-ray & blood tests my friend had due to that erroneous fever? If not, check her experience here.) Since these titles vary among institutions, you will need to contact the specific facility to get the correct title and the names of the individuals in these positions.
Present your experience and, if possible, what you hoped would have been a better outcome. Then ask for a response that you wish to include what they will do in the future to prevent a recurrence to another patient.
If you experience exemplary service, also send a letter citing the high points of your experience and the staff that deserve credit.
What About Satisfaction Surveys?
Satisfaction surveys are commonly used by organizations to learn how they are doing from the perspective of their customers. Starting in 2002, Centers for Medicare & Medicaid Services (CMS) partnered with the Agency for Healthcare Research and Quality (AHRQ), another agency in the federal Department of Health and Human Services, to develop and test the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey. In fact, since 2008 hospitals have been using the standardized HCAHPS Survey to get feedback from patients. In July 2013, 3,928 hospitals publicly reported HCAHPS scores based on 3.1 million completed surveys.
You can check out a hospital’s results by going to the Hospital Compare Web site, www.medicare.gov/hospitalcompare.
Linking Quality to Payment
Since July 2007, hospitals subject to the Inpatient Prospective Payment System (IPPS) annual payment update provisions (“subsection (d) hospitals”) must collect and submit HCAHPS data in order to receive their full annual payment update. The incentive for IPPS hospitals to improve patient experience of care was further strengthened by the Patient Protection and Affordable Care Act of 2010 (P.L. 111-148), which specifically included HCAHPS performance in the calculation of the value-based incentive payment in the Hospital Value-Based Purchasing (VBP) program. This began with October 2012 discharges.
HCAHPS and Hospital VBP Scoring
Eight HCAHPS measures, or “dimensions,” are included in Hospital VBP: the six HCAHPS composites (Communication with Nurses, Communication with Doctors, Staff Responsiveness, Pain Management, Communication about Medicines, and Discharge Information); a composite that combines the Cleanliness and Quietness items; and one global item (Overall Rating of Hospital). The percentage of a hospital’s patients who chose the most positive survey response is used to calculate the Patient Experience of Care Domain score.
How Surveys Are Used To Improve Quality
While satisfaction surveys identify areas that should be improved, those areas are often not very specific. The satisfaction survey can be considered the first step in the quality improvement process. Once the general area that needs improvement is identified, then an analysis is done to find the specific issues that need to be addressed. To draw an analogy from medicine, the survey determines if there is a fever, but doesn’t readily point to the cause. Your letter of complaint can help the institution more quickly identify the issues they must address to improve their quality.
So, by all means respond to satisfaction surveys after your inpatient experience, but also take the time to share constructive criticism with the hospital or outpatient facility.
By the way, the information I provided about HCAHPS was taken from http://www.hcahpsonline.org/files/August_2013_HCAHPS_Fact_Sheet3.pdf.
As always, your comments are welcome.
For Your Health – Dr. Bob