Patient Experience Week: How to Improve HCAHPS Scores

Improving physician and nurse communication in the hospital setting is pivotal in achieving a good patient experience.

HealthLeaders is helping to celebrate Patient Experience Week! In honor of Patient Experience Week, please enjoy this video educational session with top health system executives about patient clinical experience.

The video educational session, How to Improve HCAHPS Scores, features Ghazala Sharieff MD, MBA, corporate senior vice president of hospital operations and chief medical officer at Scripps Health as well as Brooke Horne, MPH, executive director of patient experience at Providence.

Sharieff and Horne discuss a range of issues related to improving HCAHPS scores. Two of the top topics are improving physician and nurse communication scores.

Improving physician communication scores

A primary element of encouraging physicians to improve their communication scores is sharing their HCAHPS data with them, Sharieff says. "Anybody who was less than 50^th percentile was in red, so it was clear who was underperforming. Doctors do not want to be in that low percentile range, so they started asking for help."

At Scripps, underperforming physicians receive tips to improve their communication with patients, she says. "There are three questions on the inpatient score—are physicians listening carefully, are physicians explaining in a way that the patient can understand, and are physicians communicating with courtesy and respect? My tips mirror those questions. 'Are you explaining the care plan? Are you explaining any new medications?' I always end with the same question, 'Are you asking the patient whether there is anything you can explain further?' Sometimes, we use a lot of medical jargon that the patients do not understand. I will ask doctors whether they are asking their patients, 'Are there any questions that I can answer?' Or, 'What is your greatest concern today?' We want to show that we are listening to the patients' concerns."

Providence urges physicians to focus on listening carefully, courtesy and respect, and making sure patients understand their care, Horne says. "We ask patients to write down their top two or three priorities, so we can make sure our physicians are answering those questions and the patients feel heard. A provider can really make or break a patient experience. The relationship between a patient and a provider is critical."

Providence also uses physician champions to improve physician communication, she says. "Physician champions can help do peer-to-peer coaching. They can conduct peer-to-peer conversations around provider experience with our patients."

Key qualities of physician champions are for them to be engaged and well-known, Horne says. "It matters that physician champions are respected and known within the organization."

Improving nurse communication scores

The coronavirus pandemic put strain on nurse communication, and Providence has been working to make up ground, Horne says. "Over the past couple of years, we have been focusing on engaging our nurses. We want to have staff engagement because we cannot improve the patient experience if we are not engaging our nurses. We create an environment so our bedside nurses can help design improvement in patient experience. We are seeing things from their perspective. We are ensuring that they have the tools and the resources as well as the education to be successful."

At Providence, understanding what nurses lack to be successful is crucial, she says. "Oftentimes, it is the feeling of being understaffed. Other times, they do not have the equipment they need or the time. So, we are trying to make sure they have the time to round on the patients, and we are streamlining their work to make it more efficient. We want nurses to have the opportunity to be in the room with the patient, so they can ensure that the patient is heard and understood. We want them to be able to build relationships with patients, so they can treat our patients with courtesy and respect."

At Scripps, one of the ways the health system is promoting nurse communication is ensuring that they can work to the top of their license, Sharieff says. "We have hired what we call patient care assistants, and that relieves the burden of things somebody else can do. For example, the assistants can help a patient get up and go to the bathroom. We want our nurses to spend more time at the bedside doing things only they can do—communication about medications, going over discharge instructions, and connecting with the patients."

Scripps is also encouraging nurses to engage with patients at the bedside, she says. "Sitting at the bedside sounds really simple, but it is amazing to me what a difference that makes. We are enforcing a 'two-minute sit time.' The nurses like it because they are eye-to-eye with their patients. We are tackling nurse communication from multiple directions."