Katie Owens - Healthcare Speaker and Executive Coach

Lead Author, The HCAHPS Imperative for Patient-Centered Excellence

Tag: HCAHPS

HCAHPS: An Asset or Liability for Recruiting and Retaining the Best Workforce?

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?

chart-hcahps-an-asset-or-liability-for-recruiting-and-retaining

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 Interviewing

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

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.

Orientation

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.

30/60/90-Day Meetings
• 30 days: establish the relationship
• 60 days: ensure things are going well
• 90 days: get feedback from the 30/60-day discussions


References

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

http://www.healthstream.com/resources/px-advisor

Hospital 5 star rating system set to roll out in April: CMS

by John W. Mitchell , Senior Correspondent

The Center for Medicare & Medicaid Services (CMS) is ratcheting up accountability for hospitals with the rollout of a consumer overall 5- star single rating system in April.

CMS spokesperson Alper Ozinal told DOTmed News there is good reason to emphasize hospital scores through a single star rating in addition to category-by-category ratings.

“HCAHPS scores have been found to be positively related to other quality indicators, including process of care, outcomes, safety and readmissions.” He added that HCAHPS scores have been improving in hospitals since introduced in 2006.

“This is a big change,” said Katie Owens, Vice President of HealthStream Engagement Institute, a company that both surveys nearly 1.7 million patients a year about their hospital experience and coaches hospitals on how to improve scores by creating patient-centered service. “With consumers now so active on social media the use of 5 star ratings on such sites as Yelp, Trip Advisor and Consumer Report, it seems CMS is looking to follow suit to simplify things in the eyes of the consumer,” she told DOTmed News.

The American Hospital Association (AHA), which represents nearly 5,000 hospitals and health care systems, has concerns about this new single star rating system, officially titled HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) Star Ratings.

“The current hospital compare site [which was developed with help from American hospitals] was not designed for single star system rating from multiple scores for patient experience,” Akin Demehin, Senior Associate Director for Policy at the AHA explained to DOTmed News.

“Hospitals are committed to sharing quality data but we’re concerned the single star rating (for patient satisfaction) will not be particularly useful to consumers in making health care decisions. We think it might be more understandable for single star ratings planned in the future for clinical outcomes, such as heart attack.”

Owens, with HealthStream, noted that improving patient satisfaction requires a systemic effort to create a patient-centered culture.

“The Star System does not change anything as far as our work with hospitals. We work to place patients at the center of health care through a hospital leadership commitment to cultural change,” she said.

She noted the biggest barriers to improving hospital ratings are: lack of accountability; lack of skills to consistently deliver patient-centered staff behavior; and lack of buy-in from staff and physicians.

To Access Article:

http://www.dotmed.com/news/story/25325/

Common Sense for Improving the Patient Experience

Three proven techniques — “personnel” attention, setting expectations and accountability — can transform your hospital’s culture.

At the risk of stating the obvious, all health care begins and ends with the patient. Yet, we are falling short on instilling behaviors and systems centered on the patient. In fact, hospitals have a dismal disappointment rate of 29 percent: According to the most recent Centers for Medicare & Medicaid Services HCAHPS survey, American patients believe they were treated at the best possible hospital a mere 71 percent of the time.

If you consider how hospitals, physicians and the industry as a whole are judged, the patient experience can make or break your reputation as well as the bottom line. My challenge to you is simple: Use common sense to create a solvable scenario for our leaders, employees and physicians who care deeply about being successful.

Critical Questions
Patient surveys and the potential financial impact of value-based purchasing have elevated the patient experience to one of the most pressing issues currently facing health care organizations. The Beryl Institute’s 2013 benchmark study, “The State of Patient Experience in American Hospitals,” revealed that patients rank their care experience as one of their top priorities. Yet, a 2013 HealthLeaders Media study revealed that 58 percent of health care leaders have not made specific patient-experience investments.
In this time of unprecedented change, financial pressures and competing priorities, how will your hospital meet or exceed quality measures? How can you avoid the financial penalties associated with underperformance? How can you create systems of accountability and recognition to ensure that your culture achieves results?

Patient-centered excellence is the commonsense answer to these questions and more. Each patient is your hospital’s core responsibility, but are you committed to providing service excellence? Is your staff taking the time to remember that “the gall bladder in 205” is really a retiree named Miss Peggy who volunteers as a crossing guard in her neighborhood? Does Mrs. Jones know without a doubt that her care and needs are your priority on any given day, despite emergency department volumes greater than 100,000 visits per year? If not, patient-centered excellence is not a priority at your hospital.

I am going to outline three proven techniques that can put your hospital on the right track to improving the patient experience.

Cultural Transformation through “Personnel” Attention
HealthStream Engagement Institute poll given to 250 health care leaders ranked “people” last in their list of priorities. How can we ask our team to create exceptional quality, financial or experience outcomes if we are not developing and engaging the people who achieve our results?

What does it take to transform a culture? Unfortunately, it does not happen overnight. Cultural transformation is a journey that begins with “personnel” attention. It involves learning new skills and creating opportunities to mentor staff and leaders.

To put this into perspective, I have yet to find a hospital that excels in patient-centered excellence that does not value and nurture its own personnel. From senior leaders to physicians, and the environmental team to valet drivers, your personnel must take ownership in your hospital. They must feel heard and respected and ultimately be a part of the conversation.
Take a moment to rate your hospital’s commitment to patient-centered excellence. Answer the three challenge questions listed below.

patient-centered excellence

If you cannot rate your teams predominantly between fours and fives, chances are you are encountering one or more of nine common barriers to cultural transformation:

1. failure to set clear direction and mission;
2. lack of staff ownership and buy-in;
3. fragmented communication;
4. lack of recognition and rewards;
5. failure to hold staff accountable for performance;
6. inadequate data-collection and measurement process;
7. satisfaction with the status quo;
8. insufficient leadership commitment and visibility;
9. lack of an open and trusting environment.

I encourage you to review these barriers and then do the exact opposite.

Great Expectations
An easy-to-remember but tough-to-implement mantra is “every patient, every time, every interaction.”

Just as it is your leaders’ job to set expectations with your personnel, your personnel must strive to set proper expectations with patients. The first step for staff is to try to understand the patient experience from the patient’s perspective. The second step is to deliver a consistent experience to every patient, every time. Unless we understand the patient’s perspective, we will be unable to deliver the best experience possible.

Another key factor for staff is knowing that there’s a big difference between what’s important to the patient and what’s important to us as health care providers. Human beings are not used to being patients, so we have to help them know what to expect during their hospital stay. After all, they spend most of their lives outside the hospital. It is our role and privilege to understand and manage what the patient sees, feels and experiences.

An example of properly setting expectations is explaining what kind of noise a patient will hear at night, going so far as to illustrate that the patient might hear noises different from those in his or her home. Additionally, we need to tell the patient that “ultimately our job is to make you feel secure. We’ll respond 24/7 and take care of you during your stay.”

Accountability and the Patient Experience

Accountabilities predict the outcome. This is a fact that I have witnessed countless times. The challenge lies in properly evaluating behaviors and setting accountability measures. We are astute at holding people accountable for financial and quality measures, but the patient experience can be tricky. We need to establish, clarify and champion specific accountabilities for the patient experience.

Evaluation with consequence sustains results. The best way to illustrate this claim is to imagine the best nurse, physician and technician in your hospital. Now imagine the ones whom you would not want within 20 feet of your loved one. If you pulled annual performance evaluations from both, would there be a difference? If not, there is a lack of accountability and consequences. We need to remove this deficit to transform the patient experience.

Tools and tactics work best one at a time. The three I have outlined here — “personnel” attention, setting expectations and accountability — will get you on the right track. I guarantee that recognizing patient-centered behaviors will elevate your market position and financial performance. Patient-centered behaviors cost nothing, but they earn dividends. Are you prepared?

Katie Owens is the Vice President of HealthStream Engagement Institute based in Pensacola, Fla. She is the lead author of “The HCAHPS Imperative for Creating a Patient-Centered Experience.”

To Access Article:
http://www.hhnmag.com/display/HHN-news-article.dhtml?dcrPath=/templatedata/HF_Common/NewsArticle/data/HHN/Daily/2014/Sep/090414-owens-patientexperience