HCAHPS scores are a recruitment issue, as well as a clinical issue.
At the heart of many healthcare organizations’ mission statements is an imperative to place the patient at the center of our work. Either directly or indirectly stated, the quality of the patient experience (both clinical quality and patient’s perceptions of care and service) is paramount to why many organizations exist. The Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS) has become the standard by which we evaluate excellence in the patient experience.
At face value, the HCAHPS survey is 32 questions measuring patient perceptions of care across seven dimensions, two individual items and two overall items (of which all are publicly reported on HospitalCompare.hss.gov). Each day, more than 8,400 patients complete the HCAHPS survey and give feedback on the quality of their experience (Lehrman & Goldstein, 2013). Our health systems and workforce are currently in the second year of accountability for performance, based on Value-based Purchasing where HCAHPS represents 30% of the Total Performance Score.
In April 2015, Centers for Medicare and Medicaid (CMS) will be adding a five-star rating to simplify consumer understanding of performance and “spotlight excellence in healthcare quality”(HCAHPS, 2015).
With growing simplicity in transparency, there is a heightened need for constant vigilance on HCAHPS as a magnet to attract and retain the very best. Our coaches work with hospitals and health systems to create cultures of excellence where everyone in the workforce is mission critical, from the boardroom to the bedside. This article will help you leverage HCAHPS to support attracting, selecting, and retaining talent.
FIRST IMPRESSIONS: ATTRACTING THE BEST POSSIBLE CANDIDATES
In a world where our patient experience scores are readily available and our applicant pools have myriad means to research our organizations to make their employment decisions, some key questions emerge, such as: Why should a candidate choose your organization over a competitor? And, do your HCAHPS scores tell a positive story about your commitment to patient-centered excellence or a negative one?
According to a 2013 CareerBuilders survey, reputation is incredibly important to job-seeking candidates. This study found that candidates would be willing to accept a lower salary if the employer made a great impression during the hiring process and that the employer’s brand plays an integral role in their decision (CareerBuilder, 2013).
It is important to evaluate your organization’s unique proposition of excellence, and HCAHPS data can be an incredibly valuable validation of your accomplishments. As a resource, how well are your recruitment assets aligned to tout your HCAHPS commitment?
SELECTING THE RIGHT PLAYERS
While most would agree it is critical to select individuals that reflect the organization’s commitment to patient-centered excellence, all too often selection is rushed to fill vacancies. Anyone who has ever made a bad hire knows that the impact can be damaging on so many levels.
Selection should be rigorous, so each employee can be engaged and empowered to make a difference (and ultimately be set up for success in the organization). Your selection process determines the candidates and, ultimately, hires that will be entrusted to care for your patients. The goal should be to narrow your organizational “front door” so that only those who embody your values and commitment to excellence can walk through. The following are proven strategies to elevate your selection process:
Standards of Performance
Standards are the behavioral expectations for all leaders, staff, and physicians that demonstrate your organizational values in action. Creating emphasis on your standards is an integral link to the “Always” experience HCAHPS requires. Many of our clients require all applicants to sign a commitment statement to their Standards of Performance as a component of the job application.
Behavioral-based interview (BBI) questions are a powerful inquiry tool to allow the hiring manager to evaluate past behavior (successes and failures) of the interviewee. Our experience is that BBIs can be a powerful lever to ensure that new employees already possess the behaviors necessary to achieve HCAHPS goals, particularly the communication skills that are part of most of the HCAHPS dimensions. These examples from our HealthStream Coaching Library can be used to elevate selection techniques:
• Tell me how you help your patients understand your responsiveness to their needs (e.g., call-light response, bathroom, personal needs).
• Tell me about a time when you had to work with a team to improve your HCAHPS scores.
• Describe a challenge you have had to overcome with physician communication.
• Tell me how you have engaged your staff to improve nurse communication.
• Give me an example of how you have involved non-clinical teams in the patient experience.
It is so important for hiring managers to practice active listening during the interview process. BBIs will reveal rich background information on each candidate; however, the onus is on the interviewer to ask probing follow-up questions. Some commonly asked follow-up questions include:
• What was the first key thing that you did?
• How did you determine the strengths and weaknesses of that approach?
• What was the outcome of the situation?
Peer Interviewing is a selection process where high-performing team members are allowed to evaluate job candidates and assist the manager in the candidate selection process. Involving peers creates further validation for the hiring manager, builds early rapport with candidates, and creates peer investment for a new hire’s success.
The most successful peer interviewing programs are planned and launched to equip the peer interviewers to successfully recommend the best candidates to hire. Peer interviewing can create an integral link to hiring those most aligned with your HCAHPS expectations and aspirations. Preparing peer interviewers to ask HCAHPS-related questions and to share the organization’s commitment to patient-centered excellence creates clear expectations to the job applicants.
ONBOARDING AND RETAINING YOUR TALENT
Now that they are hired, how do we garner their full engagement and get these employees to stay? Retention needs to be a constant focus that begins on day one. Every employee needs to know their contributions to the patient experience and how they can impact HCAHPS.
Bringing new leaders, staff, and physicians up to speed on the organization’s commitment to service, HCAHPS, and the patient experience sets clear expectations and accountabilities from day one at orientation. Organizational and departmental orientation should include:
• education on the importance of HCAHPS,
• the survey tools used to measure the patient experience,
• how to access patient experience results and key reports,
• organizational and departmental goals for HCAHPS improvement, and
• tools and resources to improve HCAHPS scores.
The First 90 Days
Our coaching teams recommend adopting 30-, 60- and 90-day meetings as an integral onboarding process to engage new team members and validate their progress.
During 30/60/90-day meetings, leaders can engage their new hires to assure the promise of the job equated to the reality, solicit ideas for improvement, and further engagement and enthusiasm for the organization’s success. Maintaining congruency with HCAHPS is important during these discussions. The leader can (and should) reinforce commitment to the patient experience, maintain accountability for “Always,” share recognition, and ask for the employee’s fresh perspective to improve service and operations.
Equally important to layering learning for new team members is the team that will support successful onboarding. HCAHPS performance and patient comments can be a valuable lens to identify employees that can be role models and/or preceptors for other new leaders, employees, and physicians.
There are endless reasons to make HCAHPS a priority in your organization. In this churning and evolving healthcare environment, leaders are more challenged than ever before. We’re responsible for more lives at a time when the healthcare industry faces soaring costs, falling reimbursement rates, rigorous standards of quality, workforce shortages, and more informed patients.
HCAHPS as an enabler to your selection, onboarding, and retention systems is not a matter of luck, it is the intersection of process, expectations, and engagement.
• 30 days: establish the relationship
• 60 days: ensure things are going well
• 90 days: get feedback from the 30/60-day discussions
CareerBuilder. (2013). New CareerBuilder study reveals nine lessons for job seekers and recruiters that may surprise you. Retrieved from http://www.careerbuilder.com/share/aboutus/ pressreleasesdetail. aspxsd=10%2F17%2F2013&id=pr785&ed=12%2F31%2F2013
HCAHPS. (2015). HCAHPS Star Ratings. Retrieved from http://www.hcahps.org/StarRatings.aspx
Lehrman, B., Goldstein, L. (Autumn, 2013). HCAHPS Executive Insight Letter. Centers for Medicare & Medicaid Services, Baltimore, MD. Accessed January, 2015. Retrieved from http://www.hcahps.org/executive_insight/default.aspx
Printed Winter 2015 Healthcare Workforce Advisor