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Are your physicians feeling 'HCAHPS fatigue'? Here's how to rethink your strategy.

April 26, 2019

    The national data speaks for itself: As measured by HCAHPS, CMOs are doing pretty well when it comes to patient experience. Hospitals at the national median receive top-box scores on physician communication measures 80% of the time, with minimal spread between low- and high-performers. Organizations at the 10th percentile of performance receive top-box scores 74% of the time, while hospitals at the 90th percentile receive top-box scores 86% of the time. (If you're curious where your hospitals stand, use The Hospital Benchmark Generator to compare performance.)

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    Closing the remaining HCAHPS gap is a worthy ambition, but CMOs are starting to ask: What else could we be doing to improve patient experience? To win patient loyalty, the majority of health systems have expanded their definition of experience to include factors well beyond HCAHPS, such as care access and patient activation. And many CMOs find it increasingly challenging to maintain physician engagement around HCAHPS, especially amid competing quality improvement initiatives that are often better aligned with physicians' intrinsic motivators—and more easily win their attention.

    A new approach

    That's why some organizations are fundamentally shifting their strategy to formally pursue patient experience as part of their quality improvement efforts—not as a separate or "additive" initiative. In practice, that approach requires two shifts:

    1. Identify and prioritize initiatives that are correlated with both improved quality (such as readmissions and length of stay) and improved patient experience (inclusive of HCHAPS, but also loyalty and other measures).

    2. Implement those initiatives among patient populations who have the biggest gaps in care quality and experience, so physician efforts are concentrated on the biggest opportunities.

    Based on more than 100 interviews with CMOs we conducted as part of this year's national meeting research, here are the three patient groups we recommend focusing physician efforts on in particular:

    Cheat sheet: How to talk to physicians about patient experience data

    1. Elective surgical patients

      A key revenue driver for most organizations, this group is arguably the one that should have impeccable quality and patient experience outcomes, since providers have the most information and time to plan. But many CMOs tell us that outcomes still miss the mark—especially when it comes to managing and meeting patient expectations. By one estimate, half of hip and knee replacement patients have unmet expectations after surgery when it comes to their independence and range of motion. That disparity alone represents a significant opportunity to clarify expected clinical outcomes and improve patients' surgical experience.

    2. Polychronic medical patients

      Polychronic patients are defined as having three or more chronic conditions, at least one of which significantly affects quality of life. These patients often have high readmission rates and lackluster patient experience, especially when they feel that their care team is uncoordinated or struggling to keep track of their multiple clinical- and non-clinical needs. There is real urgency to scale both quality and experience improvements for this group: The number of polychronic patients is expected to more than double over the next 10 years. Creating processes to uncover unmet risk factors and improve access to care for this group today will help providers manage growing volumes in the future.

    3. High-need ED patients

      Geriatric and behavioral health patients are two unique "frequent flier" groups to the ED who require specialized support that many EDs are not equipped to provide. Delays to appropriate care for these populations undermine quality and experience from the outset—and are difficult to rectify later in the care episode, if they are admitted. By creating channels to specialized psychiatric and geriatric services from within the ED, CMOs have an opportunity to improve quality for each of these groups respectively, while also improving patients' first impressions of the system.


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