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Have you ever wondered why there’s so much hype over hospice CAHPS scores? Even more so, do you struggle to make the connection between your work and these scores? If so, you’ll want to check out these 7 proven ways to improve your CAHPS scores.
To begin, there are several different things that you need to understand about this survey so I’ll start with the basics.
First, CAHPS stands for Consumer Assessment of Healthcare Providers and Systems. (That’s a mouthful!)
This form of hospice reporting was part of a mandate in the Affordable Care Act (ACA) and became active in 2017.
Secondly, the scores from this survey are followed and recorded by Medicare.
Last but not least, the survey results are shared publicly on the internet.
As a hospice nurse, you might not always understand how this relates to your work.
For instance, when someone mentions a top box response, that might not mean much to you.
However, when you consider these top box responses are the ones that count, you might want to reconsider.
Furthermore, if you’re like most hospice nurses, you probably don’t have much time to spend thinking about survey scores.
I get it!
So, for the sake of time, I’ll jump right into the 7 ways you can help improve your CAHPS scores.
Ways You Can Improve CAHPS Scores
1. Understand the Survey
To start, you might want to think of the hospice survey as similar to a star rating.
For instance, as a consumer, if you can pick between a 3 star or a 5 star, which would you choose? Most likely, you’d go for the 5 stars, right?
Now apply that to hospice scores, if a patient has the choice between two agencies in the same area, which do you think they will pick?
Of course, they’d pick the higher-rated agency.
Take a look at the table below and decide which agency you’d want for your loved one.
Who Completes the Survey?
Another important factor that influences survey scores, is the individual that completes the survey.
Long story short, it’s not the patient that completes the survey!
Yep, it goes to the grieving family about 2-3 months after the patient dies. So, when the survey asks about pain control, the “caregiver” is the one answering the question.
Hopefully, you can see how important it is for you to communicate with the caregiver. Ask the caregiver if they feel their loved one’s pain has been was controlled.
Similarly, you should always call the family of your nursing home patients to inform them about their loved one’s pain control.
Simply put, communication is a key strategy in improving your hospice CAHPS scores.
WHAT DOES MEDICARE CAHPS REPORT?
I’ll leave you with just one more thing to ponder on this subject.
Take a moment to think about the last time you completed a survey or left feedback for someone.
Most likely, you were either very pleased, or very pissed. Well, it’s not much different on hospice surveys.
Remember, most people will take to time to complete the survey if you are “top box” or bottom. So, keep this in mind the next time you’re ready to disregard a family member. It’s likely, they’re the ones who are going to rate the care you give.
2. Include the Hospice IDG
First, let me be clear, this is not just a concern for the nurse. If you take a look at the specific questions that are asked on the CAHPS survey, you will find that they touch all areas of care.
For example, your hospice chaplains and spiritual care team are likely to have spiritual care discussions with the patient and family.
For this reason, it’s important to include them in the plan of care and to let them know there are questions related to spirituality on the survey.
Additionally, the hospice nurse aide may be responsible for teaching the family how to transfer and/or care for the patient.
Therefore, they should also be educated on the survey and how the care they provide impacts the hospice CAHPS scores.
Also, nurse supervisors can share survey scores and comments with the hospice IDG. This is a great way to get everyone involved.
PRO-TIP: If your patient is in the nursing home, call the family and invite them to be present during your visit!
3. Learn CAHPS Survey language
Warning: you should not prompt or use exact questions on the survey.
For instance, you should use simple language that the patient and family members can understand.
So instead of shortness of breath, try saying “trouble breathing.”
Another thing to consider is explaining why you are providing care in a certain matter.
For instance, you can talk to your family about your agency’s after-hours policies and how your goal is for them to receive care when they need it most.
These small tweaks can have a positive impact on your hospice CAHPS scores.
You can also ask questions to help you determine if they are satisfied with care without asking the exact CAHPS survey question.
The bottom line: If you don’t know what’s on the survey, you’ll never be able to improve your hospice CAHPS scores.
4. Embrace Negative Feedback
Don’t get me wrong, I’m not saying you have to like negative feedback but you should definitely learn from it.
I used to pull positive and negative comments and share them at staff meetings throughout the year.
Initially, it was uncomfortable but I always treated it as a learning opportunity and not a bashing session.
Eventually, the teams started using the feedback as a way to work through tough patient cases and hash out what went wrong (and right).
The team also discussed what they could do differently in the future.
To be honest, the insight of the chaplains and social workers was always impressive.
Ask yourself these questions:
- What other resources could you have included in the patient’s care?
- Were there red flags or warning signs present?
- What could you have done differently?
- How do you feel about comments?
- What did you get right?
- Imagine it was your loved one, how would you respond or feel?
5. Identify common themes and address them.
Now, this might be a little tough because no one likes to look at their flaws.
I’m not trying to throw stones because I know you are working hard and hospice can be overwhelming.
However, do your patients always run out of supplies?
Do you regularly call the family members of your nursing home patients?
Perhaps you’re the nurse that makes the mistake of not ordering your patient’s comfort kit in a timely manner.
Whatever the case, if your name keeps showing up on patient surveys, then it might be time to re-evaluate your routine.
Sometimes, understanding where you are struggling can get you on the right track.
On the flip side, are you the nurse that always gets high praise on surveys? If so, kudos and keep up the good work. My challenge to you is to get out there and mentor the new nurses in your agency.
If you are a supervisor, then you should monitor the survey comments to identify opportunities for coaching and rewarding your team.
This is a great opportunity to use your hospice CAHPS scores to improve patient care.
Real-life Scenario I Encountered
When pulling our quarterly survey scores, I noticed that we had several comments and negative feedback about patients not receiving enough supplies.
Essentially, hospice was not meeting their needs. When I asked the nurses who cared for the patients, they mentioned that they were ordering but the patients always ran out of supplies early.
Upon further investigation, I found certain par levels had changed for certain supplies. Unfortunately, the corporate office did not notify our branch of this change.
To further complicate things, nurses were only allowed to order every two weeks unless they had supervisor approval. (Another non-communicated change!)
Once we figured this out, we were able to make appropriate adjustments and the survey scores started to improve.
Not to mention the morale of the staff!
So the moral of the story is don’t just accept low scores. Speak up and investigate so that your patients get what they need.
6. Call all family members that provide negative feedback.
In full transparency, I did this as a manager and don’t expect you have time if you’re at the bedside. Personally, I consider this a best practice.
Let’s be real, this won’t change their survey results, right? So why am I recommending it?
First and foremost, it can provide you with valuable insight into the practices and behaviors of the hospice IDG. It can also provide clarity to the responses to the survey.
Most importantly, it provides some closure to the caregiver.
To start, you should offer a sincere thank you for completing the survey.
Also, let them know that their feedback gives you an opportunity to improve care.
Another thing that you should do is ask if it would be ok for you to share the results with the team as a learning opportunity.
I always received positive feedback from this. Mostly because families felt no one was really looking at the results or cared.
This also ensures you are not interpreting the information in a biased manner.
TIP: DON’T ask why they shared a specific response. You don’t want to badger them!
7. Go the Extra Mile
I understand that every agency operates differently so this may be challenging. Also, you have to be careful not to cross professional boundaries.
My point is to build in some extra time in your schedule to do something special for your patient. For example, if you notice they wear nail polish, offer to polish their nails.
Perhaps your patient wants to take a bed bath and not a shower. You can change the care plan to make it happen.
It doesn’t always have to be something big. Remember, the small things count too.
Occasionally, they might need to order a product that is off formulary so that the patient has what is best for them. Approve it and keep it moving.
You can always make up the difference somewhere but you can’t get a do-over on providing quality patient care.
Don’t get hung up on the little things.
Those little touches are the difference between good and great care.
RELATED ARTICLE: Professional Boundaries in Nursing: Are You Crossing the Line?
Summary
Finally, you are an important member of the team and your care directly influences hospice CHAPS scores.
By using these seven strategies, you can guarantee that you’re providing gold standard care.
RECAP 7 TIPS
- Understand the CAHPS survey
- Involve the Hospice IDG
- Learn CAHPS survey language
- Embrace negative feedback
- Identify common themes and address them
- Call the families that provide negative feedback
- Go the extra mile