Designing for Results

DESIGNING FOR RESULTSHOW AN EVIDENCE-BASED BUILT ENVIRONMENT IMPACTS SAFETY AND PATIENT PERCEPTION OF CARE

AUGUST 23, 2012

White PaperTHOUGHT LEADERSHIP

© BSA LifeStructures / Use of reprint not allowed without expressed consent from the author2

W H I T E P A P E R | AUGUST 2012

table of contents

03 Introduction

04Evidence-Based Built Environment

05Value BasedPurchasing

06HCAHPS Survey Questions

07 HCAHPS & the Built Environment

13 Hospital Acquired Conditions & Built Environment

17HCAHPS ImprovementGrid

22Project Team & Acknowledgements

23Appendix

© BSA LifeStructures / Use of reprint not allowed without expressed consent from the author 3

AUGUST 2012 | W H I T E P A P E R

introductionHealthcare executives across the country are facing questions on how their organization can improve patient satisfaction and, as a result, scores on the Hospital Consumer Assessment of Health Care Providers and Systems (HCAHPS) survey. The importance of patient satisfaction results have evolved since the introduction of the Patient Protection and Affordable Care Act—better known as healthcare reform—which affects hospitals’ reimbursement partly based on scores they receive on the HCAHPS. Moreover, improving the patient experience and the environment for those who care for patients is simply the right thing to.

How can you link the design of a patient room and related areas to improved patient satisfaction and patient outcomes? Healthcare facility planners and designers have the responsibility to create a physical environment that enables improved results. After all, creating an atmosphere in hospitals that is safe, clean and quiet makes patients more comfortable and more likely to heal. The ability to identify the design elements that contribute to a healthy and positive patient experience allows hospitals to institute operational plans and design solutions that improve the healing environment. The answer to improving patient satisfaction is a holistic one, encompassing PEOPLE – engaged caregivers; PROCESS – a systematic approach that drives efficiency and quality; and PLACE – a built environment that is an enabler to patient, family and staff satisfaction. Design solutions that respond to all three of the above elements allow the built environment to act as an enabler for positive staff interaction with patients.

Approach

BSA LifeStructures has identified eight questions on the HCAHPS survey that can be impacted by the design of the built environment. Six of the 22 questions relate to the patient’s interaction with the staff, while two are directly associated with the built environment. The questions related to the built environment were analyzed and filtered through an improvement strategy process that identifies the impact of design, the recommendation for improvement and the expected outcome of that design solution. These design recommendations were then charted on the HCAHPS Improvement Grid to evaluate value relative to the capital cost of improvements and the potential for improvement.

There are a number of planning and design processes that improve the components of a patient’s stay, from using noise reducing materials to creating rooms that limit opportunities for dirt and dust collection. Using this improvement process, each design is weighed against evidence-based design principles that evaluate improvement opportunities and related costs. Ultimately all the recommended solutions address the challenge of improving the patient’s experience and healing.



Aligned Goals Aligned Behavior Aligned Process

operational and facility planning driven design

Client Aligned Vision & Guiding Principles

Benchmarks & Metrics Framework Performance

Management Standardization Accelerators

• Shared Vision & Strategy

• Define Customer Experience

• Core Measures• HCAHPS• Project Specific

• Thought Leadership

• Aligned Professionals

• Research & Best Practices

• Process • Room• Unit Design

• Prototypes• Simulation

Modeling• Building

Information Modeling

• Utilize Lean Healthcare Principles

• Function Before Form

The process of implementing design solutions that measure outcomes starts with aligning goals, behaviors and processes. A coordinated approach to collaborative leadership and care will translate to results-driven design that addresses shared goals and objectives.

evidence-based built environment: designing for results



HOSPITAL ACQUIRED CONDITION MEASURES

• Falls• Infections• Readmissions

value based purchasing –aligned goalsUnder Value Based Purchasing Guidelines, total hospital reimbursement will include performance attainment and improvement against specific measures of the perception of care, process of care measures and quality outcomes. This approach to value-based purchasing puts the focus on outcomes and success measures. The built environment’s responsibility is to enable high performance in all the measures that drive success, particularly: patient experience, processes of care, outcomes of care and the prevention of hospital acquired conditions.

11

aligned goals

PEOPLE An Engaged

Caregiver

PLACE Built Environment

that Enables Satisfaction

PROCESS Systematic

Approach for Quality

PATIENT

SAFE EFFECTIVE PATIENT CENTERED

EFFICIENT TIMELY EQUITABLE AFFORDABLE

Patient Experience Measures (HCAHPS)

Outcome Measure (2014)

Core Measures

Hospital Acquired

Condition Measures

30% (+/-)

(+/-) 45%

(-) 25% (+/-)

PATIENT EXPERIENCEMEASURES (HCAHPS)

• % Room Always Clean• % Always quiet around

room at night

OUTCOME MEASURE (2014)

• Mortality for certain diseases within 30 days of discharge

CORE MEASURES• Time to Cardiac Intervention

for Acute MI• Collaborative, quiet

& caregiver enabling environment

25%

30%45%

0%



HCAHPS survey questions

1. During this hospital stay, how often did nurses treat you with courtesy and respect?

2. During this hospital stay, how often did nurses listen carefully to you?

3. During this hospital stay, how often did nurses explain things in a way you could understand?

4. During this hospital stay, after you pressed the call button, how often did you get help as soon as you wanted it?

5. During this hospital stay, how often did doctors treat you with courtesy and respect?

6. During this hospital stay, how often did doctors listen carefully to you?

7. During this hospital stay, how often did doctors explain things in a way you could understand?

8. During this hospital stay, how often were your room and bathroom kept clean?

9. During this hospital stay, how often was the area around your room quiet at night?

10. During this hospital stay, did you need help from nurses or other hospital staff in getting to the bathroom or in using a bedpan?

11. How often did you get help in getting to the bathroom or in using a bedpan as soon as you wanted?

12. During this hospital stay, did you need medicine for pain?

13. During this hospital stay, how often was your pain well controlled?

14. During this hospital stay, how often did the hospital staff do everything they could to help you with your pain?

15. During this hospital stay, were you given any new medicine that you had not taken before?

16. Before giving you any new medicine, how often did hospital staff tell you what the medicine was for?

17. Before giving you any new medicine, how often did hospital staff describe possible side effects in a way you could understand?

18. After you left the hospital, did you go directly to your own home, to someone else’s home, or to another health facility?

19. During this hospital stay, did doctors, nurses or other hospital staff talk with you about whether you would have the help you needed when you left the hospital?

20. During this hospital stay, did you get information in writing about what symptoms or health problems to look out for after you left the hospital?

21. Using any number from 0 to 10, where 0 is the worst hospital possible and 10 is the best hospital possible, what number would you use to rate this hospital during your stay?

Your care from Nurses

The hospital environment

Your experiences in this hospital When you left the hospital

Overall rating of hospital

22. Would you recommend this hospital to your friends and family?

Source:Standard HCAHPS Survey. March 2012. Hospital Care Quality Information from the Consumer Perspective.19 April 2012. <http://www.hcahpsonline.org/surveyinstrument.aspx>



relationship between HCAHPS & the built environmentOf the 22 questions used on the HCAHPS Survey, BSA LifeStructures identified eight questions that could be influenced by the built environment. Furthermore, these eight questions fall into two very distinct categories of influence. First, the hospital environment questions that directly ask about cleanliness and noise in and around the patient room. Second, the care composite questions where the caregiver interacts with the patient.

HOSPITAL ENVIRONMENT QUESTIONS

(QUESTIONS 8 & 9)

During this hospital stay, how often were your room and bathroom kept clean?

During this hospital stay, how often was the area around your room quiet at night?

CARE COMPOSITE QUESTIONS

(QUESTIONS 1-3, 5-7)

Courtesy RespectListen

Explain



Adequate caregiver space at the bedside

Off-stage collaboration areas to facilitate manager rounding and team communication

Caregiver support spaces

1

2

3

QUESTION BUILT ENVIRONMENTIMPACT

THE ENGAGED EMPLOYEE

Respect, Courtesy, Listen, and Explain

design considerations recommendations

adequate caregiver space at the bedside• Computer orientation, staff seating• Supplies at the bedside• Clear of Family Zone & path of travel

to the bathroom• Collaborative areas at bedside

off-stage team collaboration areas• Personal off-stage areas for

manager rounding• Team collaboration areas to support

multi-disciplinary rounding

caregiver support spaces• Staff lounges• Entrance• Respite areas• Natural light• Ergonomics

plan employee spaces with the same considerations as patient spaces• Natural light• Healing environment• Quiet• Ergonomically

provide flexible & adaptable options for caregiver documentation & workspaces• “Immersive” - place for quiet thought• Collaborative• Provide for standing and sitting at bedside and in

caregiver documentation areas

provide storage space at bedside for supplies used most often



QUESTION BUILT ENVIRONMENTIMPACTQUESTION BUILT ENVIRONMENTIMPACT KEEPING THE PATIENT ROOM CLEAN – FINISHES

THE HOSPITAL ENVIRONMENT


A clean room contributes to higher patient satisfaction

Unclean room may contribute to negative perception

Contaminated environment contributes to hospital acquired infections

1

2

3


flooring• Choose products that are

easy to clean• Choose products that look

clean• Choose products with

simple cleaning instructions

walls• Choose easy to clean paint

products• Choose walls coverings that

look clean• Choose products with


ceilings• Choose easy to clean

products• Choose products that look

clean• Choose products with


finishes & products• functionality• product selection

• utilize experience• first cost vs. long

term cost

• maintenance• cleaning products

The Mohawk Group

MDC Wall

Armstrong



PATIENT ROOM RELATED ISSUES – DESIGNQUESTION BUILT ENVIRONMENT

IMPACTQUESTION BUILT ENVIRONMENTIMPACT BUILT ENVIRONMENT RESPONSE TO CARE COMPOSITES



1

2

3

A clean room contributes to higher patient satisfaction

Unclean room may contribute to negative perception

Contaminated environment contributes to hospital acquired infections


floor plan configuration• Avoid acute angles and corners

furniture location & placement• Avoid tight and compact areas which will be

difficult to clean• Anticipate where furniture can be moved

areas that collect dust & dirt• Provide soffits above upper cabinets• Provide soffits for task down lighting• Provide sloped tops as an alternative to soffits

• Floor plan layouts• Furniture locations• Built-in casework locations• Areas to collect dust • Difficult areas to clean

furniture, casework, & built-ins

• Fixed vs. moveable• Snug fit vs. awkward voids• Cleaning products required

furniture location & design



QUESTION BUILT ENVIRONMENTIMPACTQUESTION BUILT ENVIRONMENTIMPACT PATIENT ROOM NOISE – EXTERNAL



1

2

3


Noise contributes to lower patient satisfaction

Noise contributes to slower recovery of the patient

Noise contributes to longer lengths of stay

implement sound attenuation techniques• Sound masking at door• Sound insulation along corridor wall

implement caregivers/visitors “reduce voice volume” program• Quiet zones• Provide sound recording devices in key locations

(green, yellow, red)• Provide signage program

implement mitigation of external noise• Remove moveable items, carts & equipment• Sound insulation added at external sources• Study door locations to avoid door alignment

• Staff/physicians near patient room door

• Caregivers/visitors in corridor• Equipment in corridor alcoves

& storage• Decentralized nurse work

stations

external noise

• Collaboration adds noise to the corridor

• Work station adds noise at patient room entry

• Corridors remain same width despite function change

decentralized nurse work stations



implement sound attenuation techniques• Sound masking in room (white noise)• Sound insulation• Acoustical ceiling tiles

implement wall construction techniques• Increase wall thickness• Improve construction techniques• Sound insulation

implement same-handed patient room floor plan• Adjacent patient room noises reduced• No common headwall separate noise

QUESTION BUILT ENVIRONMENTIMPACTQUESTION BUILT ENVIRONMENTIMPACT PATIENT ROOM NOISE – INTERNAL



1

2

3


Noise contributes to lower patient satisfaction

Noise contributes to slower recovery of the patient

Noise contributes to longer lengths of stay

• Toilet in adjacent patient room• Television in adjacent patient

room• Adjacent mechanical rooms• Caregivers/visitors in adjacent

patient room• Equipment in patient room• Caregivers/visitors in patient

room

internal noise



PATIENT ROOM RELATED ISSUES – DESIGNCONDITION BUILT ENVIRONMENT

IMPACTBUILT ENVIRONMENTIMPACT HOSPITAL ACQUIRED CONDITIONS – PATIENT FALLS


Patient falls in room and bathroom

Patient falls in room & bathroom contribute to increased patient morbidity, mortality, LOS, & cost of care

Travel path to and from the patient bathroom are the most frequent contributors to falls

Unobstructed pathways

1

2

3


preventing patient falls• Unobstructed path from bed to bathroom in few steps• Leafed double bathroom door• Handrails to bathroom and vertically outside bathroom

door• Non-slip flooring• Lighted pathway from bed to bathroom• Visibility from corridor to bed or foot of bed• Toilet in center of bathroom to provide assistance from

two caregiversdistance from bed to toilet using grab bars• Consider that while rooms may be same-handed,

patient will not be, and access to bathroom fro both sides of the bed should be considered.

• Shorter travel distance from bed to toilet as much as possible

• Hand rails are helpful in preventing patient falls, but not the complete solution

21

preventing patient falls travel distance from bed to toilet using grab bars

toilet on footwall toilet on headwall

4’10”

19’5”

9’11” 6’7”

corridor corridor

exterior

exterior

Clemson University Patient Room of the Future



infection prevention• Sink located at entry to patient room

» Features: height, depth, faucets, splash, visibility to patients

• Cubicle curtains: cleanability, hand guards• Enclosed toilet in ICU• Decontamination and disinfection processes before

design• Personal Protective Equipment location

CONDITION BUILT ENVIRONMENTIMPACTBUILT ENVIRONMENTIMPACT HOSPITAL ACQUIRED CONDITIONS – INFECTION PREVENTION


Infection Prevention

1

2

3


Location of sink and hand sanitizers

Personal protective equipment (PPE) location

Cleanability and surfaces

• Sink and hand sanitizers should be immediately available for access upon entry and exit to room

• Sink should be visible to patient to observe staff handwashing

• Provide separate caregiver work surfaces away from sink to avoid splash contamination

• Personal Protective Equipment should be immediately available upon entry to the room

• Limit cubicle curtains to only what is necessary for patient privacy between the door and bed.

» Provide cleanable hand pulls for curtains and keep them secured (tied back) so that they are only used when needed.

© John Durant © Chester County Hospital



PATIENT ROOM RELATED ISSUES – DESIGNCONDITION BUILT ENVIRONMENT

IMPACTBUILT ENVIRONMENTIMPACT HOSPITAL ACQUIRED INFECTIONS - DURING CONSTRUCTION PROJECTS


Hospital acquired infections – during construction projects

Infections lead to hospital readmissions

Infections contribute to lower patient satisfaction

Infections contribute to longer lengths of stay

1

2

3


construction• Stricter enforcement of contractor requirements• Utilize camera and remote technology during

construction• Financial penalties for contractors who do not meet

requirements

negative pressure• Negative pressurization not maintained in construction zones

leads to bad air infiltration in hospital• ICRA standards and requirements not met• Locations of required doors and exits not maintained leads to

bad air infiltration in hospital• ILSM standards and requirements not met• Capping of relevant sheet metal during construction not

completed



maintenance• Develop maintenance protocols involving air handler

maintenance• Utilize cameras and remote technology during air

handler maintenance

CONDITION BUILT ENVIRONMENTIMPACTBUILT ENVIRONMENTIMPACT HOSPITAL ACQUIRED INFECTIONS - DURING SCHEDULED MAINTENANCE


Hospital acquired infections – during scheduled maintenance

1

2

3


Infections lead to hospital readmissions

Infections contribute to lower patient satisfaction

Infections contribute to longer lengths of stay

AHU maintenance• Air handler maintenance (filters) is performed independent of

operational functions and schedules• No specific maintenance protocols in place to coordinate with

operational functions and schedules• Air handler maintenance (cooling coils) is performed

independent of operational functions and schedules• No specific air handler running time protocol in place to

ensure dirty particulates are transferred in hospital rooms and areas



CAPITAL COST OF IMPROVEMENTS

$ $$$ $$$$$

HC

AH

PS

& P

ATIE

NT

SA

FETY

IMP

RO

VE

ME

NT

100%

50%

0%

25%

75% High ImpactLow Cost

Low ImpactHigh Cost

HCAHPSimprovement grid High Impact

High Cost

Low ImpactLow Cost

$$ $$$

Based on the goal of improving HCAHPS Scores through facility modifications and changes, the Risk / Frequency Grid has been modified for this specific process improvement. Included on this page is the HCAHPS Improvement Grid which assists with strategic facility analysis and documentation. The grid includes the relative capital dollars required for an improvement compared to the effectiveness percentage of the improvement. This approach provides four quadrants for all of the proposed physical plant improvements to be categorized. This provides a relative value for the comparison in order to make evidence-based decisions.



• Lean process improvement

• Utilize sound masking devices

• Improve cleaning products

• Remove noise generating equipment

• Insulate noise generating equipment

• Replace ceiling tiles

• Add sloped top caps to exposed top caps

• Modify areas difficult to clean

• Clean cubicle curtains between patients

The High Impact – Low Cost quadrant focuses on those facility improvements which offer a high value and impact at a relative low cost. In addition, these elements can be implemented in short time frames due to their low cost nature.

high impact/ low cost:


$ $$$ $$$$$

HC

AH

PS

& P

ATIE

NT

SA

FETY

IMP

RO

VE

ME

NT

100%

50%

0%

25%


Low ImpactHigh Cost

High ImpactHigh Cost

Low ImpactLow Cost

$$ $$$

how to’s:

HCAHPS improvement grid




$ $$$ $$$$$

HC

AH

PS

& P

ATIE

NT

SA

FETY

IMP

RO

VE

ME

NT

100%

50%

0%

25%


Low ImpactHigh Cost


Low ImpactLow Cost

$$ $$$

how to’s: • Convert to all private rooms

• Change countertops and horizontal surfaces

• Replace tired or broken furniture

• Consider built-in furniture

• Add acoustical features at:

» Areas outside of patient room door

» Nurse work area out of patient room door

• Decentralize collaboration stations away from patient rooms

The High Impact – High Cost quadrant focuses on those facility improvements which offer a high value and impact at a relative high cost. In addition, these elements require longer time frames to be implemented due to their relative high cost nature.

high impact/ high cost:





$ $$$ $$$$$

HC

AH

PS

& P

ATIE

NT

SA

FETY

IMP

RO

VE

ME

NT

100%

50%

0%

25%


Low ImpactHigh Cost


Low ImpactLow Cost

$$ $$$

how to’s: • Eliminate inaccessible corners

• Eliminate acute angles

• Relocate noise generating equipment

• Add sound insulation within toilet/shower walls

• Replace flooring to improve cleaning and appearance

The Low Impact – Low Cost quadrant focuses on those facility elements which offer less value and impact than others yet also requires a relative low cost. In addition, these elements can be implemented in short time frames due to their low cost nature.

low impact/ low cost:





$ $$$ $$$$$

HC

AH

PS

& P

ATIE

NT

SA

FETY

IMP

RO

VE

ME

NT

100%

50%

0%

25%


Low ImpactHigh Cost


Low ImpactLow Cost

$$ $$$

how to’s: • Create same-handed patient rooms

• Add sound insulation within patient room walls

• Improve lighting to simulate natural lighting

• Healing gardens

• Department greeting areas

The Low Impact – High Cost quadrant focuses on those facility improvements which offer less value and impact than others at a relative high cost. In addition, these elements require longer time frames to be implemented due to their relative high cost.

low impact/ high cost:




project team & acknowledgements

white paper co-authors:

Mike Castor

Doug Fick

Monte Hoover

Tara Kempf

Dan Miles

Alex Miser

Shawn Mulholland

Keith Smith

BG PorterChief Operating Officer

Terry Thurston RN, BSN, MBADirector of Healthcare Operations Planningphone | 317.674.2468email | [email protected]

Gary Vance AIA, FACHA, LEED APDirector of National Healthcarephone | 317.753.2819email | [email protected]

BSA LifeStructres project team

members:

special thanks to:

@LifeStructures

@gmanvance

@TerryThurston



appendix

24 HCAHPS: Patients’ Perspectives of Care Survey

27HCAHPS Survey



HCAHPS: Patients’ Perspectives of Care Survey

HCAHPS Overview

The HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey is the first national, standardized, publicly reported survey of patients’ perspectives of hospital care. HCAHPS (pronounced “H-caps”), also known as the CAHPS® Hospital Survey, is a survey instrument and data collection methodology for measuring patients’ perceptions of their hospital experience. While many hospitals have collected information on patient satisfaction for their own internal use, until HCAHPS there was no national standard for collecting and publicly reporting information about patient experience of care that allowed valid comparisons to be made across hospitals locally, regionally and nationally.

Three broad goals have shaped HCAHPS. First, the survey is designed to produce data about patients’ perspectives of care that allow objective and meaningful comparisons of hospitals on topics that are important to consumers. Second, public reporting of the survey results creates new incentives for hospitals to improve quality of care. Third, public reporting serves to enhance accountability in health care by increasing transparency of the quality of hospital care provided in return for the public investment. With these goals in mind, the Centers for Medicare & Medicaid Services (CMS) and the HCAHPS Project Team have taken substantial steps to assure that the survey is credible, useful, and practical.

HCAHPS Content and Administration

The HCAHPS survey asks discharged patients 27 questions about their recent hospital stay. The survey contains 18 core questions about critical aspects of patients’ hospital experiences (communication with nurses and doctors, the responsiveness of hospital staff, the cleanliness and quietness of the hospital environment, pain management, communication about medicines, discharge information, overall rating of hospital, and would they recommend the hospital). The survey also includes four items to direct patients to relevant questions, three items to adjust for the mix of patients across hospitals, and two items that support Congressionally-mandated reports.

The HCAHPS survey is administered to a random sample of adult patients across medical conditions between 48 hours and six weeks after discharge; the survey is not restricted to Medicare beneficiaries. Hospitals may either use an approved survey vendor, or collect their own HCAHPS data (if approved by CMS to do so). HCAHPS can be implemented in four different survey modes: mail, telephone, mail with telephone follow-up, or active interactive voice recognition (IVR). Hospitals can use the HCAHPS survey alone, or include additional questions after the core HCAHPS items. Hospitals must survey patients throughout each month of the year. The survey is available in official English, Spanish, Chinese, Russian and Vietnamese versions. The survey and its protocols for sampling, data collection and coding, and file submission can be found in the current HCAHPS Quality Assurance Guidelines, which is available on the official HCAHPS website, www.hcahpsonline.org.

Source:“HCAHPS: Patients’ Perspectives of Care Survey.” 2012. Centers for Medicare & Medicaid Services. 18 April 2012 <https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/HospitalHCAHPS.html>



HCAHPS Development, Testing and Endorsement

Beginning in 2002, CMS partnered with the Agency for Healthcare Research and Quality (AHRQ), another agency in the federal Department of Health and Human Services, to develop and test the HCAHPS survey. AHRQ carried out a rigorous scientific process, including a public call for measures; review of literature; cognitive interviews; consumer focus groups; stakeholder input; a three-state pilot test; extensive psychometric analyses; consumer testing; and numerous small-scale field tests. During this process, CMS provided three opportunities for the public to comment on HCAHPS, and responded to well over one thousand comments.

In May 2005, the HCAHPS survey was endorsed by the National Quality Forum, a national organization that represents the consensus of many healthcare providers, consumer groups, professional associations, purchasers, federal agencies, and research and quality organizations. In December 2005, the federal Office of Management and Budget gave its final approval for the national implementation of HCAHPS for public reporting purposes. CMS implemented the HCAHPS survey in October 2006, and the first public reporting of HCAHPS results occurred in March 2008. The survey, its methodology and the results it produces are in the public domain.

Hospitals implement HCAHPS under the auspices of the Hospital Quality Alliance (HQA), a private/public partnership that includes major hospital and medical associations, consumer groups, measurement and accrediting bodies, government, and other groups that share an interest in improving hospital quality. The HQA has endorsed HCAHPS.

The enactment of the Deficit Reduction Act of 2005 created an additional incentive for acute care hospitals to participate in HCAHPS. Since July 2007, hospitals subject to the Inpatient Prospective Payment System (IPPS) annual payment update provisions (“subsection (d) hospitals”) must collect and submit HCAHPS data in order to receive their full IPPS annual payment update. IPPS hospitals that fail to publicly report the required quality measures, which include the HCAHPS survey, may receive an annual payment update that is reduced by 2.0 percentage points. Non-IPPS hospitals, such as Critical Access Hospitals, may voluntarily participate in HCAHPS.

The Patient Protection and Affordable Care Act of 2010 (P.L. 111-148) includes HCAHPS among the measures to be used to calculate value-based incentive payments in the Hospital Value-Based Purchasing program, beginning with discharges in October 2012.




HCAHPS and Public Reporting

Publicly reported HCAHPS results are based on four consecutive quarters of patient surveys. CMS publishes participating hospitals’ HCAHPS results on the Hospital Compare website (www.hospitalcompare.hhs.gov) four times a year, with the oldest quarter of patient surveys rolling off as the most recent quarter rolls on. A downloadable version of HCAHPS results is also available through this website. Additional HCAHPS results can be found on HCAHPS On-Line, (www.hcahpsonline.org).

To ensure that publicly reported HCAHPS scores allow fair and accurate comparisons across hospitals, it is necessary to adjust for factors that are not directly related to hospital performance but which affect how patients answer HCAHPS survey items. These adjustments eliminate any advantage or disadvantage in scores that might result from the survey mode employed or from characteristics of patients that are beyond a hospital’s control. In addition, the HCAHPS Project Team engages in a series of quality oversight activities, including inspection of survey administration procedures, statistical analyses of submitted data, and site visits of HCAHPS survey vendors and self-administering hospitals, to assure that the HCAHPS survey is being administered according to the protocols.




March 2012 1

HCAHPS Survey

SURVEY INSTRUCTIONS

You should only fill out this survey if you were the patient during the hospital stay named in the cover letter. Do not fill out this survey if you were not the patient.Answer all the questions by checking the box to the left of your answer.You are sometimes told to skip over some questions in this survey. When this happens you will see an arrow with a note that tells you what question to answer next, like this:

YesNo If No, Go to Question 1

You may notice a number on the survey. This number is used to let us know if you returned your survey so we don't have to send you reminders.Please note: Questions 1-22 in this survey are part of a national initiative to measure the quality of care in hospitals. OMB #0938-0981

Please answer the questions in this survey about your stay at the hospital named on the cover letter. Do not include any other hospital stays in your answers.

YOUR CARE FROM NURSES

1. During this hospital stay, how often did nurses treat you with courtesy and respect?1 Never2 Sometimes 3 Usually4 Always

2. During this hospital stay, how often did nurses listen carefully to you?1 Never2 Sometimes 3 Usually4 Always

3. During this hospital stay, how often did nurses explain things in a way you could understand?1 Never2 Sometimes 3 Usually4 Always

4. During this hospital stay, after you pressed the call button, how often did you get help as soon as you wanted it?1 Never2 Sometimes3 Usually4 Always9 I never pressed the call button

2 March 2012

YOUR CARE FROM DOCTORS

5. During this hospital stay, how often did doctors treat you with courtesy and respect?1 Never2 Sometimes 3 Usually4 Always

6. During this hospital stay, how often did doctors listen carefully to you?1 Never2 Sometimes 3 Usually4 Always

7. During this hospital stay, how often did doctors explain things in a way you could understand?1 Never2 Sometimes 3 Usually4 Always


8. During this hospital stay, how often were your room and bathroom kept clean?1 Never2 Sometimes3 Usually4 Always

9. During this hospital stay, how often was the area around your room quiet at night?1 Never2 Sometimes3 Usually4 Always

YOUR EXPERIENCES IN THIS HOSPITAL

10. During this hospital stay, did you need help from nurses or other hospital staff in getting to the bathroom or in using a bedpan?1 Yes2 No If No, Go to Question 12

11. How often did you get help in getting to the bathroom or in using a bedpan as soon as you wanted?1 Never2 Sometimes 3 Usually4 Always

12. During this hospital stay, did you need medicine for pain?1 Yes2 No If No, Go to Question 15

13. During this hospital stay, how oftenwas your pain well controlled?1 Never2 Sometimes3 Usually4 Always

14. During this hospital stay, how often did the hospital staff do everything they could to help you with your pain?1 Never2 Sometimes3 Usually4 Always

Source: http://www.hcahpsonline.org/surveyinstrument.aspx



March 2012 3

15. During this hospital stay, were you given any medicine that you had not taken before?1 Yes2 No If No, Go to Question 18

16. Before giving you any new medicine, how often did hospital staff tell you what the medicine was for?1 Never2 Sometimes3 Usually4 Always

17. Before giving you any new medicine, how often did hospital staff describe possible side effects in a way you could understand?1 Never2 Sometimes3 Usually4 Always

WHEN YOU LEFT THE HOSPITAL

18. After you left the hospital, did you go directly to your own home, to someone else’s home, or to another health facility?1 Own home2 Someone else’s home3 Another health

facility If Another, Go to Question 21

19. During this hospital stay, did doctors, nurses or other hospital staff talk with you about whether you would have the help you needed when you left the hospital?1 Yes2 No

20. During this hospital stay, did you get information in writing about what symptoms or health problems to look out for after you left the hospital?1 Yes2 No

OVERALL RATING OF HOSPITAL

Please answer the following questions about your stay at the hospital named on the cover letter. Do not include any other hospital stays in your answers.21. Using any number from 0 to 10,

where 0 is the worst hospital possible and 10 is the best hospital possible, what number would you use to rate this hospital during your stay?0 0 Worst hospital possible1 12 23 34 45 56 67 78 89 9

10 10 Best hospital possible

4 March 2012

22. Would you recommend this hospital to your friends and family?1 Definitely no2 Probably no3 Probably yes4 Definitely yes

ABOUT YOUThere are only a few remaining items left.23. In general, how would you rate your

overall health? 1 Excellent2 Very good3 Good4 Fair5 Poor

24. What is the highest grade or level of school that you have completed?1 8th grade or less2 Some high school, but did not

graduate3 High school graduate or GED4 Some college or 2-year degree5 4-year college graduate6 More than 4-year college degree

25. Are you of Spanish, Hispanic or Latino origin or descent?1 No, not Spanish/Hispanic/Latino2 Yes, Puerto Rican3 Yes, Mexican, Mexican American,

Chicano4 Yes, Cuban5 Yes, other Spanish/Hispanic/Latino

26. What is your race? Please choose one or more. 1 White2 Black or African American3 Asian4 Native Hawaiian or other Pacific

Islander5 American Indian or Alaska Native

27. What language do you mainly speakat home?1 English2 Spanish3 Chinese4 Russian5 Vietnamese6 Some other language (please

print): _____________________

THANK YOUPlease return the completed survey in the postage-paid envelope.

[NAME OF SURVEY VENDOR OR SELF-ADMINISTERING HOSPITAL]

[RETURN ADDRESS OF SURVEY VENDOR OR SELF-ADMINISTERING HOSPITAL]

Source: http://www.hcahpsonline.org/surveyinstrument.aspx

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Our multidisciplinary efforts with visionary healthcare, higher education and research clients achieve measurable outcomes through metrics-driven design solutions.

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Designing for Results

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