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December 5, 2014

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Whack-a-Mole (the endless HCAHPS strategy game)

Remember that old game played at the county fair?  You would gain points as you hit a mole with a mallet that popped out of a hole.  The challenge was that there were lots of them and you just couldn’t keep up. It’s illusive, it’s frustrating, and after a while it can be downright tiring! You know what I mean.

 

It’s the strategy most healthcare organizations use to drive performance, metrics and ultimately reimbursement. Here’s the way it works. Let’s say your organization is experiencing lower-than-desired scores in the area of “quiet around the room at night” on the HCAHPS survey. So, what do you do? You immediately devise campaigns around the issue. You oil all the wheels on the carts, implement quiet time between one and three, dim the lights, wear reminder buttons on your scrubs, print posters of nurses shushing visitors and close doors to noisy hallways. Then you wait for your scores to improve. Unfortunately, while you’ve been concentrating your efforts on maintaining quiet, your “clean bathroom” scores have been falling. So, what do you do? You script your environmental employees to say things like, “Is there anything you see that I might have missed?”, check the room for cleanliness on hourly rounds, rid the room of extra linens perceived as “dirty” by the patient, and you wait. BUT BY THEN YOU ARE NOISY AGAIN! And so it goes.

I often wonder if CMS, in its attempt to improve the patient experience and promote transparency, ever thinks about how it sends us healthcare providers into tailspins that leave us exhausted and yearning for a strategy that is effective and makes sense. In order to know what patients want and what they deem important, we need to go to the Patient’s Pyramid of Needs. Based on Maslow’s hierarchy of needs, patients’ needs are identified and are to include all the HCAHPS domains.

All of the things CMS identifies as important to the patient are certainly included, too, but in our search to address the domains in silos, we’ve missed what is most important to the patient. But only the patient can tell us what that is, and we have to ask.

Patients rarely tell us what is most concerning to them for fear that we can’t fix it, that we’re too busy to listen to or address the issue, or that we might judge them. The best strategy for addressing HCAHPS domains is to become truly “patient-centered” and to know what is most important to the patient during the course of their hospitalization.

 

Sweeney Healthcare Enterprises is currently working with organizations that are doing this in a number of ways. Some are using whiteboards to let staff to know during a shift what is most concerning to the patient. Others are incorporating the question into electronic medical records to prompt staff to ask the question every 12 hours and to address at the bedside shift report the patient’s biggest concern.  The issue that is most concerning to the patient should be most concerning to us. To ask the question is what some say is compassion. Others say it’s a way to honor your culture. Either way, patients will love you for it.

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