I think that the federal “Hospital
Consumer Assessment of Healthcare Providers and Systems” (or HCAHPS) provides
what is possibly the most accurate and actionable quality-of-care data at our
disposal.
Those who believe that HCAHPS is a
“patient satisfaction” survey will be surprised by this assertion. But HCAHPS isn’t a patient satisfaction tool. Unlike Press Ganey, which our Health System
also administers, HCAHPS never asks whether the patient is satisfied with
anything. It asks whether a thing happened. Or didn’t. Here are some of the items:
- During this stay, how often did doctors listen carefully to you?*
- During this stay, how often did doctors explain things in a way you could understand?*
- Before giving you a new medication, how often did hospital staff tell you what the medicine was for?*
- Before giving you a new medication, how often did hospital staff describe possible side effects in a way you could understand?*
(*Possible answers:
Always, Often, Sometimes, Never)
I have never met a skilled
diagnostician who didn’t listen carefully.
I will preempt an objection here: there is no such thing as listening carefully without conveying to the
patient that one is offering one’s full attention. Even if it could be done, it wouldn’t matter,
because whenever we don’t seem to be
listening, the patient stops sharing. As Osler said, “Listen to the patient and he
will tell you the diagnosis.”
And what about doctors “explaining
things in a way [the patient] can understand”?
Certainly, the only one who can assess our success at this is the
patient. The result matters. In private practice, it matters -- because
without this skill, the physician may have talents, degrees, and lots of
knowledge, but he wont have any patients.
From a quality of care perspective, communication drives adherence to
the treatment plan, limits medication errors and improves a range of important outcomes. Communication skill is a core quality issue
for physicians.
HCAHPS also asks about how we manage medications –
did the “staff” tell the patient what the new medication was for and what side
effects to look for? For the most part,
hospital leaders rely on our Nursing and Pharmacy colleagues to ensure that
this communication occurs. This isn’t wrong
– educating patients should be a team effort.
However, the member of the team who knows first that a new medication
is being given, and knows best why, is the person who prescribed it. Communicating with patients about the
medications we order is first and foremost a physician responsibility.
A review of our HCAHPS results makes it clear that we have "room for improvement" and the solution
must involve each and every one of us.
For those who want them, we have improvement tools that can help. But why expend the effort? One reason is that HCAHPS results
now influence hospital reimbursement under the federal Value Based Purchasing
program. Another is that the results are
publicly reported in hospital report cards.
But there are other, maybe better reasons.
As noted above, important patient
outcomes emerge from effective physician communication. Strong communication begets trust. Trust, in turn, drives adherence to
prescribed medications, physician follow-up and other aspects of the plan of
care. It also alleviates anxiety, and
promotes the sense that whatever the patient’s medical situation, he is “in
good hands.” Finally, the physician who
communicates skillfully can experience the kind of professional pride and sense of meaning in work that makes the practice of Medicine a uniquely rewarding
endeavor, one that stimulates the analytical mind and nourishes the feeling
heart. Maybe HCAHPS has something to do with satisfaction after all.
