Which patient experience initiatives have the biggest effect on readmission rates? Two management associate professors write in Harvard Business Review that while many hospitals are investing heavily in improving their responsiveness to patients, they may be missing out on a simpler solution.
Hospitals are increasingly on the hook for their performance on the Hospital Consumer Assessment of Health Providers and Systems (HCAHPS), readmissions rates, and other quality metrics. And providers are increasingly spending money on fancy amenities and high-tech patient monitoring, write Tulane University's Claire Senot and Ohio State University's Aravind Chandrasekaran.
But while those investments in "material assets" may provide hospitals with "immediate gratification," Senot and Chandrasekaran argue that the most important thing hospitals can do to reduce readmissions is invest in their own people—specifically, in improving communication between patients and caregivers.
Details of their research
In a research paper published in Management Science, Senot, Chandrasekaran, and colleagues analyzed six years of CMS data on readmission rates, HCAHPS scores, quality measures, and other factors from nearly 3,000 acute-care hospitals. In addition, the researchers conducted five case studies on individual hospitals and about 50 interviews with 50 administrators, nurses, and physicians.
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By examining individual questions on HCAHPS surveys, the researchers differentiated between the communication-focused and response-focused dimensions of the patient experience.
The communication dimension corresponds to caregivers' ability to engage in meaningful conversation and is bolstered by a patient-centered culture and training. Meanwhile, the response dimension describes clinicians' ability to quickly respond to a patient's explicit needs and is usually improved by investments in monitoring technology and infrastructure.
Overall, the researchers found that when process-of-care measures were already strong, improving the communication of staff has a larger effect on reducing readmission rates compared with investing in responsiveness. A strong focus on communication resulted in a 5-percentage-point reduction in 30-day readmission rates, while emphasizing responsiveness decreased readmission rates by less than 3 percentage points
The 2-percentage-point advantage from investing in communication is a "powerful" result, Senot and Chandrasekaran write. And they say it is a "conservative estimate," as it comes from comparing the results of only a 1% increase in either the responsiveness or communication dimension of the patient experience.
What's more, the researchers say that investing in improved communication is about $14 cheaper per patient compared with investing in improving responsiveness when care quality is already high.
"These results," Senot and Chandrasekaran conclude, "have important implications for where hospital administrators should invest to improve the overall health-care-delivery system in the United States," (Senot/Chandrasekaran, Harvard Business Review, 9/23; Budryk, FierceHealthcare, 9/24).
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