CMS Measures HCAHPS–What Do You Measure?

The worst part of being a consultant is when your client makes you walk three steps in front of them and requires you to shout ‘Unclean’ as you march down the hall.



This may come as news, but hospital executives do not need satisfied patients.  The term ‘patients’ is a plural, and no patients satisfaction program will satisfy the plural.  The very notion of having a satisfaction program should signify that the organization, in fact has, a patients satisfaction problem, which often means it has an access problem.

Permit me a moment of sacrilege.  Forget the patients, or stated better, forget enhancing the satisfaction of the patients while they are in the hospital.  You are already doing everything you can for them. Your doctors and nurses have your patients covered better than any other country on the planet.  Patients do not complain about the MRI.  Patients do not complain that the hospital replaced the wrong hip. What they complain about is access, but hospitals do not know that because access is not measured, nor is it penalized by CMS.


Worry about your customer, and worry about whether they can access you–stated another way, can they do business with you.  Focus on the business processes that affect a single patient/customer.  At least half of patient satisfaction is comprised of things that have nothing to do with why the individual is at your facility.  Patients know the clinical experience will not be fun.  They know before they get to the hospital, even if they have never been in a hospital, that the clinical experience will likely be painful, intimidating, scary, and somewhat dehumanizing.

Where hospitals seem to miss the point is that hospitals assume that the satisfaction of a patient’s entire stay is tied to whatever clinical procedure they underwent.  That kind of perspective is somewhat akin to the Ritz Carlton assuming that the satisfaction of a hotel guest’s entire stay has to do with the success of the presentation they delivered at the Xena Warrior Princess Lookalike Convention.  It does not.  Their satisfaction depends on the cumulative of all of the other experiences they had at the hotel.


Something to file away.  Every Ritz Carlton employee, down to the lowest person on the org chart, is authorized up to two thousand dollars to do whatever is required to satisfy a customer, even a customer whose bill will only be five hundred dollars–a breakfast charge.

Patients view their medical procedure and their medical tests as the clinical part of their stay, a part that in their mind occupies far less than half of the hours they spend at the hospital.  That is the patient part.  It is during those processes that people see themselves as patients.

During their other waking hours, and for most of their non-waking hours, people see themselves as customers.  People paying a lot of money for a service.  Their satisfaction includes how much effort it took prior to coming to the hospital and it includes how responsive the hospital was to them after they were discharged.  

Hospital employees do not see these people as customers.  And why should they?  Nothing in their DNA, nothing in their training told them that the warm body in room 207 is a customer of a large organization.  And these same people base a large portion of their customer satisfaction on their experiences during those nonclinical hours. 

I realize this notion of the customer-patient/patient-customer flies in the face of everything of which hospital executives have focused.  It certainly flies in the face of the business processes that have been designed to support a patient-only model.

Here is one way to view the distinction.  Patients get better or they do not.  Getting better, fixing their problem is what the patient expects; anything else is failure.  How that happens is the concern of the hospital.  Getting better is a black hole in the mind of the patient.  For the most part patients expect it will not be pleasant.  Patient satisfaction in not all wrapped up with whether the procedures the patient underwent were painful. It can be argued that a patient’s satisfaction of their clinical treatment is somewhat binary.  Came in sick.  Walked out better. Cubs win.



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