Understanding HCAHPS Scores and How To Improve Them

Hospitals worldwide see millions of patients from all walks of life for different medical reasons. In the U.S. alone, over 7,000 active hospitals provide medical care to those who need it. If there’s one crucial question we have to answer regarding the quality of care these hospitals offer, it’s this: how effective are they? This is where HCAHPS scores come in.


The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is the first national standard survey on patients’ perspectives of hospital care. The publicly reported survey is a data collection method to measure patient satisfaction, reflecting the importance of hospital effectiveness through hospital consumer assessment.

In 2002, the Centers for Medicare and Medicaid Services (CMS) partnered with the Agency for Healthcare Research and Quality (AHRQ) to develop and test the HCAHPS survey. It was in May 2005 that the National Quality Forum (NQF) established this standardized method of healthcare quality measurement and reporting.

Many healthcare facilities have initiated efforts to learn patient satisfaction for internal use, but the HCAHPS survey encourages hospitals to bring a more standardized approach that allows easy comparison. With the HCAHPS, the public gets valid, objective, and meaningful comparisons between hospitals locally, regionally, and nationally.

Measuring Patient Satisfactions Scores | CHCM

Administration of the HCAHPS Survey

The HCAHPS Survey comprises 29 items, of which 19 encompass critical aspects of the hospital experience, such as communication with hospital staff, cleanliness, overall rating, and more. A random sample of adult discharged patients with different medical conditions receive the survey between 48 hours and six weeks after their hospital stay.

The four approved modes of HCAHPS administration are mail, telephone, mixed (mail and then telephone follow-up), and Active Interactive Voice Response (IVR). The survey is empowering as it allows the expression of a patient’s experiences. At the same time, hospitals use the survey as a tool for improving their patient experience.

HCAHPS Sections and Questions

The HCAHPS survey has different sections to evaluate various clinical care aspects. Through these questions and the adult patients’ answers, hospitals learn how they do in different areas and determine the need for improvement. The sections include the following:

  • Nurse Care
  • Doctor Care
  • Hospital Environment
  • Discharge Experience
  • Overall Rating
  • Aftercare and Home Recovery
  • Patient Self-Assessment

Some of the HCAHPS questions include how often the nurses treat the discharged patient with courtesy and respect during their stay in the hospital and how often doctors explain things in ways the patients understand. There are also demographic and screening questions for additional HCAHPS data.

HCAHPS Scoring

Now, let’s use figures to understand how the HCAHPS helps hospitals ensure they provide the best care to their patients. The HCAHPS summary score has a 5-star rating scale, with 5-star as the highest. This summary score is the average of the hospital’s ratings on the 19 main items.

The public can view HCAHPS scores through the HCAHPS website, with the reports divided into three “HCAHPS Boxes:”

  1. Top-Box: The most positive response to the survey items.
  2. Middle-Box: Intermediate responses to the survey items.
  3. Bottom-Box: The least positive response category for survey items.

Hospitals can get into the top-box through a combination of factors, including the following:

  • Excellent communication between healthcare providers and patients
  • Responsiveness of hospital staff
  • Pain management
  • Effective communication on medication and discharge information
  • Care transition

When a hospital gets numerous “Always'” ratings on the survey from patients, this helps them get high patient satisfaction scores. On the other hand, hospitals that receive more “Sometimes” or “Never” responses are likely to get less favorable outcomes.

HCAHPS Scores Calculation

Here’s a preview of how HCAHPS results are calculated from the Maryland Health Care Commission’s Quality Measures Data Center (QMDC):

  • Step 1: Calculate Unadjusted HCAHPS Scores
  • Step 2: Calculate Patient Mix Adjustment
  • Step 3: Apply Patient Mix Adjustment (PMA)
  • Step 4: Mode Adjustment

HCAHPS scores undergo a process of adjustment based on factors such as the number of patients and features like age, gender, race, and language. After these adjustments, scores are calculated to determine the overall hospital performance.

In the country, South Dakota is the only state with an average HCAHPS score over 4-stars (4.21), followed by Wisconsin (3.99) and Nebraska (3.97).

Improves Patient Outcomes | CHCM

How To Improve HCAHPS Scores

In school, students take a test to measure their knowledge of a topic. The higher their score, the better they comprehend the material. Similarly, hospitals can use the HCAHPS survey to measure how well they serve patients, but through the eyes of patients themselves. You’re taking a practical exam, and the patients are your examiners. Here are four tips to help you ace that exam:

Foster a Culture of Quality

Every employee plays a vital role. From the doctors and nurses down to housekeeping and food service, create a culture of quality throughout your hospital! Everyone must commit to providing the best care possible.

An excellent way to foster a culture of quality is to ensure that your health care providers and employees have the necessary resources and support to help them excel. Provide regular training opportunities so all healthcare providers and employees understand the importance of good patient care. The more you develop your core competencies, the better equipped you will be to help your patients.

Investing in healthcare IT and other tools that will help streamline patient care processes is also essential. Provide the technology to make it easier for staff to review patient data, access medical records, and track performance.

Promote a Patient-Centered Hospital Environment

Focus on creating an atmosphere that makes patients feel valued and respected. All staff must know the importance of patient-centricity from when a patient arrives until discharge. Prioritize patient engagement, and emphasize patient experience.

A patient-centered hospital looks at operations from the patient perspective. Everything you do, every system you implement, and every service you offer must be designed to meet the patient’s needs. It involves communicating frequently and providing excellent patient education.

Fostering this hospital environment helps improve patient engagement, which leads to better HCAHPS scores. Another important thing to remember: You don’t want higher HCAHPS scores just for the sake of higher scores. You aim for them to guarantee the best possible patient experience.

Look at HCAHPS Scores the Right Way

Speaking of HCAHPS scores, it’s easy to lose focus on what they do for hospitals and patients. HCAHPS scores aren’t only a measure of how well a hospital is doing; they are ultimately about improving the quality of patient care.

Try to remember that they are a tool to enhance public accountability. The best way to use patient satisfaction scores is to analyze them and use the insights to change your operations.

In which aspects does your team excel? Which areas need improvement? Use the answers to build on your successes and address areas that need attention. By taking an analytical approach, you can pinpoint what to do.

Enlist Creative Health Care Management

Creative Health Care Management (CHCM) transforms healthcare into an advanced evidence-based, patient-centered high-quality care practice. When you partner with us, you improve your relationships in the hospital, which, in turn, improves your overall service quality, safety, and patient experience.

CHCM has care models and operational frameworks that maximize efficiency, increase patient satisfaction, and reduce costs. We share our knowledge in various ways, such as through strategic planning and tactical implementation, clinical practices, data-driven decision-making, and innovative technologies.

Our services are designed to help you optimize your hospital’s performance while enhancing patient experience. After all, when you focus on the people who provide care and work to improve your hospital’s performance, you’re more likely to get higher patient satisfaction scores.

Improve HCAHPS Scores with CHCM | CHCM

Improve HCAHPS Scores with CHCM

CHCM helps organizations enhance and deepen their positive patient experience culture by conducting Re-Igniting the Spirit of Caring (RSC) and See Me as a Person (See Me) workshops. Both these CHCM legacy programs support the significant improvement in HCAHPS data as compared to the National average.

Are you ready to take the first step in improving your HCAHPS scores? Contact CHCM today!

Contact CHCM Today! | CHCM



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