As the calendar turns to 2025, the biggest changes are coming to the HCAHPS survey since the advent of the national patient experience measurement system in 2006.
After years of study and testing, CMS will require hospitals to administer a new, updated version of the survey beginning in January. The new survey also comes with some important changes in how it can be administered. These include allowing electronic administration of the survey (email) and other changes designed to increase response rates and elicit a wider range of responses from diverse communities.
The new HCAHPS survey sunsets some domains and adds others. For example, the Care Transitions Domain – which asked questions about post-hospital care – is being removed. A new question on managing symptoms during recovery is being added. The Responsiveness Domain – which focused on the answering of call bells – is being adjusted and expanded. The question on quietness will be expanded into a domain focused on getting rest during a hospital stay. Perhaps most significantly, a new domain that focuses on team care and communication will be added.
The survey changes themselves were tested before inclusion in the survey. For those of us on the ground who deal with HCAHPS every day, these changes are a step in the right direction. For example, the new domain on teamwork touches on one of the most challenging aspects of patient experience – communicating a coherent care plan to our patients. This is harder than it may sound. Patients are cared for by diverse teams and disciplines. It can be a challenge to keep the entire team on the same page as care plans are developed and evolve. Our teams feel this as we constantly work to use technology and other tools to stay aligned. Patients tell us this is a challenge, as well. That is why so many patients bring notebooks to the hospital or keep loved ones nearby. They do this because information sometimes comes fast, and it takes effort to keep track of all the details. The addition of this domain is not only timely but highlights an area where most hospitals still have room to improve.
Some of the other changes are a bit puzzling. For example, I believe that expanding the domain on quietness and restfulness is problematic. I think we could all agree that being able to rest while in the hospital is conducive to wellness and healing. From a pure patient experience standpoint, it makes sense. At NewYork-Presbyterian, we have daily unit quiet times and schedule our bedside interventions to try and give our patients an opportunity to rest. However, this domain does not take into account the realities at many hospitals across our country – especially safety-net hospitals. Many hospitals still have double bedded rooms. The most frequent noise complaint we hear on surveys is noise created by roommates and their visitors. By including this domain on the HCAHPS survey, which has reimbursement implications for hospitals, we put hospitals that do not have all private rooms at a disadvantage. Converting all rooms in American hospitals into private rooms would cost untold billions of dollars. Including these questions on a regulatory survey is not fair, in my view. They should be removed, or at least held separate from any reimbursement implications.
The ability to survey patients beyond paper surveys is long overdue. Response rates to HCAHPS have been declining precipitously in recent years, and this is due, at least in part, to this limited mode of administration. At NewYork-Presbyterian, we piloted the new "e-survey" this year and saw our response rates rise. The e-surveys also allow us to see responses more in real time. This helps us improve in an even more timely fashion. While we welcome this change, we will have to watch how it influences the demographics of survey respondents. The hope behind this change was to make the survey more equitable and expand the diversity of responses from all parts of the communities we serve. We need to monitor this very closely as the next year unfolds to ensure that is the case.
A new survey requires adjustments to our strategic plan and education in our organizations. At NewYork-Presbyterian, we are actively planning for the conversion to this new survey and new mode of administration. Of course, our planning includes the logistical changes needed to field the new survey with our vendor partner. We are also educating every level of our organization, especially our caregivers, about the new survey components. Our patient experience approach has always included implementation of an array of evidence-based best practices to address our patients' and family members' needs. As we think about the new survey and the new year, we are enhancing some of our practices and approaches to address the coming changes. Every organization should have such a plan to assure that all stakeholders are informed and prepared for this change.
It's probably worth saying that, although the HCAHPS survey is required for all hospitals, it will never be the only way that we should measure and improve the patient experience. It is, however, an important tool for us to benchmark key issues for patients across all healthcare organizations. I would also point out that many of the issues covered by HCAHPS are still foundational. The survey asks about how well we listen, show respect and explain things to patients. It asks about how well we educate our patients about their care. The survey probes how well we prepare patients for the next step in their health journey. All of these issues are important. Very few hospitals can say they have "topped out" on these measures. Although HCAHPS isn't all the work to be done, it remains an important part of the work.
Thus, we face the new year with a new opportunity to learn more about what our patients want and need. My team and I are very curious how these new questions and modes will play out. We will be looking closely for new insights and lessons to help us care even more compassionately and effectively for those we serve.