The was at night. If patients are loud and









The HCAHPS Survey; Not the Best Way to Measure Quality Care

Jennifer Rodriguez

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Keiser University
















HCAHPS Survey;

the Best Way to Measure Quality Care

The HCAHPS (Hospital Consumer
Assessment of Healthcare Providers and Systems) Survey, also known as the
CAHPS® Hospital Survey or Hospital CAHPS®, is a standardized survey and data
that has been implemented since 2006 to measure patients view of their hospital
care during their recent hospital stay.

There are three goals of the
HCAHPS Survey. First, the survey gets comparable data on patients’ view of
their care that allows for objective and meaningful comparisons to other
hospitals on issues that are important to patients, including how well
healthcare providers communicate with patients, pain management, how clean the patients’
rooms were, and if the patients would recommend the hospital to family and
friends. Also, by reporting the results publicly it provides the hospitals
incentive for hospitals to improve care to their patients. It also gives the
hospital transparency by allowing the public to see the results of the surveys.

I have mixed feelings about the
survey. I understand quality care is hard to measure accurately. Usually people
will fill out surveys when they had a bad experience, so I do not think it
would reflect the full truth of the quality of patient care.  Also, there are questions that are beyond the
staff’s control, like how quiet the area was at night. If patients are loud and
uncontrollable, or watching TV in a shared room, it would be an unfair
assessment to judge the patient’s hospital stay based on uncontrollable
situations. Furthermore, by having patients fill out the surveys, we are giving
them a lot of responsibility to fill out truthfully. If the patients do not
fill out the survey truthfully, or just fills out any answers to complete the
survey, it could have an unfair detrimental effect on the hospital. I think a
more accurate way to measure would be to hire a team of unbiased doctors and
nurses, and have them visit each hospital personally, and physically go to the
patient’s rooms of patients that are about to be discharged and have them ask a
set of standardized questions that reflect quality care. Sending a survey in
the mail to the patients gives the patient too much control over a situation
they may not care about and are not aware of the consequences it holds. Also,
how do we know that the patient is the one who fills out the survey. Perhaps
another family member fills out the survey about a visit they had a few years
prior. There are many things that can taint the quality of the survey, so I feel
it is not a good way to measure quality care, yet I understand hiring a team to
audit a hospital requires funding that may not be available.

My feelings while filling out
the survey was disappointed. I just do not feel it is a fair assessment. The
survey is subjective, so one person may think bad care is not receiving
medication when they wanted it because the nurse couldn’t give it to them
because it would be unsafe because they can only get it every four hours and
only two hours passed since they last received the medication.  Another example is a patient who has a high
tolerance to pain medication, maybe from an addiction, and the nurse would
never be able to safely give them enough medication to make them pain free. I
do not think that is considered poor patient care, but I am certain the patient
would think that it is because they were in pain. Some patients may think a 2
on the pain scale after surgery is unreasonable, yet it would be next to
impossible to safely have a pain level of 0 on the pain scale after surgery.
Some patients would consider they had a bad experience because they weren’t
allowed to eat before surgery. Some patients would claim they had a bad
experience because they did not like the diagnosis they received. The survey is
too subjective, and it is unreasonable to think that it is an accurate
reflection of the quality of care they received.

A couple more important issues
about the survey is time and generality.  In article “Patient Satisfaction Surveys Not
Accurate Measure of Hospitalists’ Performance,” the author makes the point that
the survey generally rates its care by all doctors, so if they have a bad
experience by one doctor, the patient taking the survey will state that all
their care by the doctor was unfavorable, even though they may have received
great care by other doctors. It is an unfair assessment of their care by the
doctors, which holds true for the nurse’s part of the survey as well. Also, the
surveys do not come out in a timely manner. In the same article the author states,
“If a hospitalist receives a low score on the “Doctor Communication” domain,
the scores are likely to be three to nine months old. How can we legitimately
assign (and then modify) behaviors based on those scores?” (Winthrop Whitcomb,
MD, MHM, 2013).

do not think knowing this survey exists will affect how I practice as a nurse.
I am confident that I will always provide the best care possible to my
patients, so I will not have to think how to act to get a good score on the

In conclusion, although I am
disappointed in the HCAHPS survey, I understand the need to do something to
improve the quality of care the patients receive. There is a direct correlation
with low HCAHPS scores and patient readmissions (Tannas, M., n.d.). I just feel
there are many flaws in the survey and would like to see a better way to judge
the quality care that the patients receive.  Some flaws include the timeliness of the
survey and the patient sending it back, the surveys are very subjective and may
not truthfully reflect the quality of care that they received, and how general
the survey is, which makes it hard to implement specific changes at the
hospital. The least the survey can do is put a fire under the staff to make
them “care.”  I believe it is a good idea
for the hospital to show transparency with the survey outcomes, because it
holds them accountable. The survey has a lack of control, so I don’t believe it
is fair to have incentives tied to it.


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