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Identify and Address Your Top HCAHPS Challenges: White Paper


This blog post is an excerpt from our white paper, Consistency, Communication, & Understanding—Addressing Top HCAHPS Challenges

HealthStream has used various surveys to collect information from healthcare leaders and employees on their organizations’ top HCAHPS challenges. Our analysis of 1,800 responses has shown that the top three challenges in regard to improving HCAHPS performance lie with:

  • Communication (18%)
  • Consistency and sustainability (14%)
  • Understanding the survey and reports (9%)


One in every seven respondents to HealthStream’s survey expressed difficulties in ensuring consistent and effective communication both among employees and between employees and patients. While three domains from the HCAHPS survey specifically mention communication (Nurse Communication, Doctor Communication, and Medication Communication) HealthStream’s experience in working with organizations to improve performance across all measures has shown that communication is integral to impacting every survey item. As we discussed above, the HCAHPS survey sets a new minimum standard for what is expected during a hospital visit—that patients will be treated with courtesy and respect, that help will be provided as soon as it is needed, and that the area around the room will be kept quiet at night. However, we still have the opportunity to help the patient define what each of those mean.

To understand the importance of communicating clearly with patients, it is helpful to look at the hospital experience from their perspectives. Many patients think that hospitals are a sterile environment; when they are asked if their room was kept clean, their expectation is that it was sterilized on a regular basis. By informing patients of what to expect from housekeeping staff and other staff who will be in their room, we can set their expectation of what “Always” means in reality.

Consistency and Sustainability

With the transition from traditional patient satisfaction surveys to HCAHPS, many hospitals are challenged by meeting the expectations of consistency set by the HCAHPS survey. So, it is not surprising that one in every five healthcare employees indicated that they struggle with consistency and/or sustainability.

Two thirds (14 of 21) of the core questions on the HCAHPS survey are rated on a scale of “Always” to “Never,” and “Always” responses are the only ones that count when it comes to Value-Based Purchasing, thus consistency in behaviors has never been more important. This consistency must exist not only from one caregiver’s encounter with a patient to the next, but also among all caregivers, support personnel, hospital employees, vendors, and contractors. The behaviors and words used by everyone that a patient meets in the hospital must be in alignment with the culture, standards, and attitude of the organization in order to portray the image of “Always.”

Working to ensure consistent communication and developing standards of behavior for all employees and contractors can yield tremendous improvements in perceptions of consistency. However, processes must be put in place by which all are held accountable to those standards. Behavioral standards should be integrated into annual evaluations for employees, as well as vendor and contractor agreements.

Understanding the Survey and Reports

In school, we always wanted to know what chapters were going to be covered on a test, right? Work is not that much different. Do your staff members know the test they are being graded on (i.e., the HCAHPS survey)? As part of our coaching engagements, HealthStream coaches ask that all leaders and staff take the HCAHPS survey (or the patient survey most applicable to their department) as if they were patients in their hospital. This helps to increase awareness of the test on which the staff is being graded, and it also creates an understanding of the behaviors they might need to change to improve scores. Once staff members have taken the survey, ask them to identify areas where they feel their unit or department is falling short of “Always” or achieving Top Box scores, and work together come up with ideas on how to improve those scores. Even leaders and staff in non-patient care areas should participate in this exercise and brainstorm ways that they can impact the patient experience and HCAHPS scores despite not being at the bedside. Every employee, no matter where he/she works in the hospital, has an opportunity to impact a patient’s experience.

Click here to download the entire white paper.