A patient’s experience of hospital care is shaped by countless interaction, including whether team members listen carefully, explain information clearly, respond when help is needed, coordinate care effectively, and prepare the patient and family for what comes next.
The Hospital Consumer Assessment of Healthcare Providers and Systems, commonly known as HCAHPS, gives hospitals a standardized way to understand these experiences from the patient’s perspective. HCAHPS scores offer valuable insight and improving them requires more than focusing on a number. Sustainable improvement happens when healthcare organizations use patient feedback to strengthen communication, relationships, teamwork, leadership, and the systems surrounding care.
What Is HCAHPS?
The Hospital Consumer Assessment of Healthcare Providers and Systems Survey is the first national, standardized, publicly reported survey of patients’ perspectives of hospital care. The Centers for Medicare & Medicaid Services (CMS) partnered with the Agency for Healthcare Research and Quality (AHRQ) to develop and test the survey beginning in 2002. CMS implemented HCAHPS in 2006, and the first public results were reported in 2008.
HCAHPS has three primary goals:
- Produce standardized data that allow meaningful comparisons among hospitals.
- Create incentives for hospitals to improve the quality of care.
- Increase transparency and accountability through public reporting.
Unlike a general patient satisfaction survey, HCAHPS asks patients whether specific, observable aspects of care occurred during their hospital stay. It measures patients’ perspectives of their experience rather than whether every personal expectation was met. That distinction matters. HCAHPS scores are most useful when leaders treat them as evidence about how consistently patients experience essential care behaviors.
Why HCAHPS Scores Matter?
HCAHPS scores matter because they tell us how patients and families experienced our care. While clinical quality measures what we did, HCAHPS reveals how people experienced us during some of the most vulnerable moments of their lives. More than a patient satisfaction survey, it reflects the strength of communication, trust, compassion, and teamwork throughout the care experience. Ultimately, HCAHPS is not simply a measure of performance; it is a reflection of organizational culture and the extent to which people feel seen, heard, respected, and cared for.
What Changed in the Updated HCAHPS Survey?
CMS introduced an updated HCAHPS survey for patients discharged on or after January 1, 2025. The updated survey contains 32 items, including 22 questions about critical aspects of the hospital experience.
Several important changes were made:
- Eight new survey questions were added.
- Five previous questions were removed.
- Care Transition was removed as an HCAHPS measure.
- New measures were added for Care Coordination, Restfulness of the Hospital Environment, and Information About Symptoms.
- The Responsiveness of Hospital Staff measure was updated.
- Web-first survey administration options were introduced.
- A question about whether the hospital stay was planned was added for patient-mix adjustment.
The new and updated measures begin appearing in public reporting with the October 2026 Care Compare refresh. Hospitals should plan to evaluate their patient experience strategies against the updated survey, and the measures included in older HCAHPS reports.
What Does the HCAHPS Survey Measure?
The updated HCAHPS survey produces 11 publicly reported measures. Seven are composite measures based on multiple questions, and four are based on individual survey questions.
Composite HCAHPS Measures
- Communication with Nurses
- Communication with Doctors
- Restfulness of the Hospital Environment
- Care Coordination
- Responsiveness of Hospital Staff
- Communication About Medicines
- Discharge Information
Individual HCAHPS Measures
- Cleanliness of the Hospital Environment
- Information About Symptoms
- Overall Hospital Rating
- Willingness to Recommend the Hospital
These measures reflect different parts of the patient’s experience, but they are deeply connected. A patient’s perception of care coordination, for example, may be influenced by whether nurses and physicians appear informed, whether team members communicate consistent information, and whether the patient and family are included as partners in planning care.
Hospitals cannot improve these experiences effectively when each measure is addressed in isolation. The results should be examined as interconnected signals of culture, communication, relationships, and care delivery.
How is the HCAHPS Survey Administered
HCAHPS is administered to a random sample of adult inpatients between 48 hours and 42 calendar days after discharge. Eligible patients come from medical, surgical, and maternity care service lines. Participation is not restricted to Medicare patients.
As of 2025, hospitals can administer the survey using six approved modes:
- Mail only
- Telephone only
- Mail with telephone follow-up
- Web with mail follow-up
- Web with telephone follow-up
- Web with mail and then telephone follow-up
Hospitals may use an approved survey vendor or receive CMS approval to administer the survey themselves. Surveys must be conducted throughout every month of the year.
How Are HCAHPS Scores Calculated?
HCAHPS results are more complex than a simple average of patients’ answers. Survey responses are adjusted to support fairer comparisons among hospitals that are similar in size, location, and services offered. CMS accounts for factors that can influence how patients respond but are not directly related to hospital performance, including the mode used to administer the survey and characteristics included in the patient-mix adjustment model.
Results are commonly reported using three response categories:
- Top-box: The most positive response, such as “Always” or “Definitely Yes”
- Middle-box: An intermediate response, such as “Usually” or “Probably Yes”
- Bottom-box: The least positive responses, such as “Sometimes,” “Never,” or “Definitely No,” depending on the question
HCAHPS Star Ratings use a different calculation than standard survey scores. CMS adjusts survey responses to account for factors such as patient characteristics and survey method, then groups the results into categories ranging from one to five stars. Reports typically present percentile rankings rather than raw scores, helping organizations understand how their performance compares with others. CMS also calculates an HCAHPS Summary Star Rating that combines the individual HCAHPS Star Ratings. A five-star rating represents the highest performance category. CMS does not assign a predetermined percentage of hospitals to each category. The thresholds are recalculated for each reporting period.
How To Improve HCAHPS Scores
Organizations searching for how to improve HCAHPS scores may be tempted to focus on scripts, reminders, or individual survey questions. These tactics may support improvement, but they cannot compensate for a culture in which communication, relationships, and teamwork are inconsistent. A patient’s willingness to recommend a hospital is shaped by the total experience of care, not by a single interaction or survey question. Communication with nurses and physicians, responsiveness, coordination among team members, and the healing environment all contribute to whether patients feel confident recommending the hospital to family and friends. Although the relative influence of each measure varies by organization and patient population, the pattern is clear: patients are more likely to recommend a hospital when they feel respected, heard, informed, supported, and confident that their care team is working together.
Meaningful improvement begins by strengthening the experiences behind the scores.
1. Interpret the Story Behind the Data
A score can reveal that patients are not consistently experiencing clear communication or timely responsiveness. It cannot explain why. Leaders should examine quantitative results alongside the qualitative feedback they receive. This includes:
- Patient comments
- Complaints and compliments
- Rounding observations
- Unit-level performance
- Workforce engagement data
- Safety and quality outcomes
- Staffing and workflow patterns
- Feedback from point-of-care team members
This helps teams move beyond asking, “Why is our score low?” and toward asking, “What are patients and team members experiencing, and what conditions are producing that experience?” Looking at HCAHPS scores in isolation can result in superficial solutions. Looking for the story behind the data helps organizations identify the processes, behaviors, and cultural barriers that are working well for them as well as those that need attention.
2. Strengthen Communication with Patients and Families
Many HCAHPS measures are directly or indirectly influenced by communication. Patients need more than information. They need communication delivered in a way they can understand, retain, and use.
Healthcare teams can strengthen communication by:
- Listening without appearing rushed
- Using plain, accessible language
- Checking for understanding instead of asking only, “Do you understand?”
- Explaining medications and possible side effects, while ensuring the patients understand by asking them to describe it in return
- Keeping patients informed about delays and next steps
- Including family members and caregivers when appropriate
- Using interpreter services and other communication resources
- Inviting questions and concerns
- Exploring with patients and families to find out what we are doing well that they would like us to do more of
- Closing the loop after a patient asks for help
Consistency is essential. One excellent interaction cannot fully overcome a stay characterized by unclear, conflicting, or incomplete communication.
3. Build a Relational, Patient-Centered Culture
Patients experience organizational culture through the behaviors of the people caring for them.
They notice whether team members introduce themselves, listen attentively, preserve dignity, demonstrate compassion, and treat and see them as a person rather than a diagnoses or tasks. They also notice when employees appear disconnected, overwhelmed, or unable to communicate with one another.
A patient-centered culture cannot be sustained through isolated customer service expectations. Leaders must create an environment in which team members have the skills, support, resources, and psychological safety needed to form meaningful connections with one another and patients.
When caregivers feel that they matter and are valued and supported, they are better positioned to create experiences in which patients feel they matter and are valued and supported.
4. Improve Care Coordination Across the Team
The addition of Care Coordination to the updated HCAHPS survey reinforces an essential truth: patients experience the healthcare organization as one system. Patients should not have to reconcile conflicting instructions, repeatedly provide the same information, or determine which team member has the most current care plan.
Stronger care coordination requires:
- Reliable interprofessional collaboration
- Clear roles and responsibilities
- Effective handoffs – including the patient and who the family designates
- Collaborative care planning with an identified clinical lead
- Consistent information across point-of-care team members
- Inclusion of patients, families, and caregivers
- Alignment between inpatient care and discharge planning
Improving collaboration and coordination is not simply about asking individual employees to communicate more. Organizations must examine whether their processes and workflows make coordinated care possible.
5. Support Responsiveness Without Sacrificing Relationships
Responsiveness is influenced by staffing, workflow design, role clarity, communication, and teamwork. Leaders should avoid interpreting a low responsiveness score as proof that employees do not care.
Instead, ask:
- What prevents team members from responding promptly?
- Are patient requests reaching the right person?
- Are responsibilities clear?
- Can another team member safely address the need?
- Do patients know what to expect?
- Are delays acknowledged and reassured?
- Are recurring requests revealing unmet clinical or comfort needs?
Purposeful rounding and clearer team communication can help anticipate patient needs, but these practices must remain consistent and meaningful. When rounding becomes a checklist alone, patients can recognize the difference.
6. Improve Discharge Communication and Preparation
A patient’s experience does not end when they leave the hospital. Patients and caregivers need to understand medications, follow-up care, warning signs, and what to do if concerns arise.
Effective discharge preparation should begin early and continue throughout the stay. The interprofessional team should:
- Involve patients and caregivers in planning
- Explain information in manageable portions
- Use teach-back to confirm understanding
- Provide consistent verbal and written instructions
- Explain symptoms or health problems to monitor
- Clarify who to contact with questions
- Address barriers that could make the plan difficult to follow
The updated “Information About Symptoms” measure makes this work especially important. Patients and caregivers must leave with the knowledge and confidence to recognize when additional help may be needed.
7. Engage Point-of-Care Team Members in Improvement
Team members often understand the barriers behind HCAHPS results better than anyone else. They see where communication breaks down, which processes create delays, and what patients repeatedly ask or misunderstand.
Invite team members to examine patient feedback, identify root causes, test improvements, and evaluate results. Shared ownership creates stronger solutions than top-down directives developed without insight from the people delivering care. This approach also reinforces professional accountability. Improving the patient experience becomes part of how the team practices, learns, and makes decisions together.
8. Treat HCAHPS Improvement as Ongoing Culture Work
A short-term initiative may temporarily raise awareness, but sustainable improvement requires leadership attention, accountability, learning, and reinforcement. Leaders must consistently model the behaviors expected from others. They should recognize meaningful improvement, remove barriers, provide development opportunities, and connect HCAHPS results to the organization’s broader commitments to quality, safety, workforce well-being, and person-centered care.
The goal is not to teach employees how to generate a more favorable survey response. The goal is to create an environment in which excellent patient experiences occur reliably.
Moving Beyond the HCAHPS Score
HCAHPS scores create visibility. They help hospitals see where patients are consistently experiencing excellent care and where the experience may be breaking down. But the score itself does not create improvement.
People, relationships, processes, leadership, and culture turn patient feedback into meaningful change. Organizations that approach HCAHPS improvement as culture transformation, rather than survey management, are better positioned to create lasting improvements for patients, families, and team members.
Strengthen Patient Experience With CHCM
Creative Health Care Management (CHCM) helps healthcare organizations create cultures grounded in caring, connection, accountability, and person-centered practice. Programs such as Re-Igniting the Spirit of Caring and See Me as a Person® help healthcare professionals reconnect with purpose, strengthen therapeutic relationships, and develop practical skills for communicating with patients, families, and colleagues.
We know the patient experience is not shaped by patient-facing interactions alone. It is also influenced by whether employees feel supported, whether leaders’ model relational and accountable practices, and whether the broader culture enables teams to provide compassionate, coordinated care. CHCM’s Employee Engagement Workshops help organizations strengthen connection, ownership, and pride among team members. Our Leadership Development Workshops equip leaders to create the clarity, trust, and accountability teams need to deliver excellent care consistently. For organizations seeking broader, sustainable change, Cultural Transformation Workshops address the workplace conditions, behaviors, and systems that shape both employee and patient experiences.
Through these solutions, CHCM partners with organizations to connect patient experience improvement with employee engagement, leadership development, professional practice, and culture transformation. Because when healthcare professionals feel valued, prepared, connected, and empowered, they are better positioned to create those same experiences for patients and families.
If your organization is ready to move beyond monitoring HCAHPS scores and strengthen the experiences behind them, contact Creative Health Care Management to begin the conversation.
Frequently Asked Questions About HCAHPS Scores
HCAHPS stands for Hospital Consumer Assessment of Healthcare Providers and Systems. It is a national, standardized survey that measures patients’ perspectives of hospital care.
Not exactly. Patient satisfaction can be influenced by whether an experience met an individual’s expectations. HCAHPS asks patients to report whether specific aspects of care occurred, such as whether nurses listened carefully or staff explained medications clearly. It is more accurately described as a patient experience survey.
The updated HCAHPS survey contains 32 items. These include 22 substantive patient experience questions, three screening items, five patient-mix adjustment items, and two items supporting congressionally mandated reports.
The updated survey adds measures for Care Coordination, Restfulness of the Hospital Environment, and Information About Symptoms. The Responsiveness of Hospital Staff measure was also revised.
The updated survey took effect for patients discharged on or after January 1, 2025. The new and updated measures begin appearing publicly with the October 2026 Care Compare refresh.
A good result depends on the measure, comparison group, reporting period, and organization’s goals. Hospitals should evaluate their performance against national benchmarks and peer organizations while also monitoring improvement over time and variation across units and patient populations.
Hospitals can improve HCAHPS scores by strengthening communication, care coordination, responsiveness, discharge preparation, interdisciplinary teamwork, and patient-centered culture. Sustainable improvement requires addressing the systems and workplace conditions that shape patient care, not simply coaching employees to pursue higher survey ratings.
Publicly reported HCAHPS results and Patient Survey Star Ratings are available through Medicare Care Compare.
Sources
- Updated HCAHPS Survey
- hcahps_fact_sheet_december_2024.pdf
- HCAHPS Star Ratings
- Find Healthcare Providers: Compare Care Near You | Medicare
We look forward to the opportunity to bring the CHCM solutions to your organization.
