Overcoming 5 Obstacles to Better Home Health CAHPS ScoresCreating

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Karen Utterback By Karen Utterback 
Former Vice President, Product Marketing and Strategy, Change Healthcare (Retired)
Creating a Culture of Quality More Than Home Health CAHPS

As an executive of a home health or hospice organization, the way you view measurement systems like the Home Health Consumer Assessment of Healthcare Providers and Systems (HH CAHPS) sets the tone for everything that follows. But living up to someone else’s idea of customer service can feel strange—after all, this is a topic constantly on your mind and something you’ve worked hard to achieve.

Eileen Freitag, director of strategic and marketing consulting at home care consultancy Fazzi Associates, suggests an interesting litmus test. Imagine the president of the local hospital has requested your agency to provide care for him following his stroke. Do you (a) let the referral go through the normal process (you have all the confidence in the world that any of your staff will give this patient the best care possible) or (b) call the supervisor for the care team and together hand-pick the nurse and therapist who will do the best job?

Freitag says achieving scenario A requires creating a culture of service in which your entire agency values patients and families and is committed to creating a positive experience for all, at all times.

To that end, here are a few obstacles organizations face in their quest toward top-notch customer service, along with solutions offered by Freitag.

Also See: Top 5 HHCAHPS Questions that Drive Recommendations of Care

#1. Agencies and patients have different ideas about excellent service.

Staff tend to overestimate patients’ satisfaction, Freitag says. It’s often a rude awakening to see how the patients rate the staff and the service they received.

Fazzi’s previous patient satisfaction survey (prior to Home Health CAHPS) found that when patients commented on excellent service, no clinical items made the list. They talked about things like clinicians and receptionists being professional, understanding, polite, caring, efficient, prompt, helpful and friendly. Three most important trends emerged: Let the patient know when you’re going to arrive, arrive when you said you said you would, and don’t send so many people.

What to do:

First, share this information with your staff. Show them comments (positive and negative) from patients regarding how they were spoken to, and provide training on what to say in a variety of situations (specifics below).

#2. Patient questions are not what they seem.

Freitag says nurses tend to take questions at face value and answer as honestly as possible. For example, if a patient asks how many patients they will visit that day, the nurse might answer “Six.”

What to do:

Train nurses to understand what’s really being asked (“Do you have time for me?”) and answer that question. They might say, “I have a few patients to see today, but right now, you’re the most important person.”

#3. The person completing the Home Health CAHPS survey was not very involved with the patient’s care.

In some cases, says Freitag, the person filling out the survey never even met the nurse who provided care.

What to do:

If this happens frequently in your organization (check for it in your HH CAHPS results), consider requiring a clinician or other staff member to contact a family member every week or every other week to provide an update. This will not only help the family member fill out the survey more accurately, it will provide important information on the patient on a regular basis.

#4. Patients complain about a lack of thoroughness.

Freitag says patients often don’t realize everything being done in a visit and are extremely sensitive to feeling rushed during a visit.

What to do:

Patients need to feel that we are not hurried, that we are giving them our full attention, says Freitag. Even though nurses are indeed busy, they should ask, “Is there anything else I can do for you? I have time.” Similarly, make sure patients know their needs are being addressed by using the words from the survey like, “I checked your home to be sure you can move around safely and checked the side effects of your medications. Is there anything else I can do for you? I have time.”

#5. Patients complain about a lack of response/timeliness.

Note that this relates to both visits and responses to queries.

What to do:

Set agencies standards for returning phone calls (e.g., within 24 hours), require that patients be called the night before or by 9 a.m. with information on when the nurse will arrive, and train all staff to answer “I’ll find out” if they don’t have the answer to a question, rather than “I don’t know.”

Freitag, who says organizations should aim to be in the top 20% of Home Health CAHPS scores for patient satisfaction, points out that although outside measurements can be burdensome, they also represent a tremendous opportunity to improve interactions between patients and staff and—potentially—to discover process issues within your organization.

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