Survey says: Pharmacists affect patient satisfaction
HCAHPS survey evaluates patients’ inpatient experience during their hospital stay.
In recent years, writing a Yelp review about a favorite restaurant or chronicling a hotel stay on TripAdvisor has become a common practice. In fact, rating your experience with a service provider, doctor, or airline has become fairly routine in today’s technology-driven world.
Hospitals are also interested in what patients have to say about their inpatient experience, especially now that surveying is required by CMS. The pressure is on hospitals to achieve high survey scores because reimbursement is tied to how satisfied patients are with their care. Patients’ positive interaction with hospital pharmacists during medication review and discharge counseling can significantly impact HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey scores.
Communication about medications is one of several key areas covered by the HCAHPS survey. That’s good news, because health-system pharmacists are in a great position to improve survey scores during face-to-face interactions. “Patients feel like they have someone they can talk to and ask questions and this increases their sense of satisfaction,” said Kathy Chase, PharmD, Director of Provider Services for Cardinal Health.
Historically, hospitals have surveyed patients to varying degrees about care, but there wasn’t a national standard for collecting or reporting information that would allow for the comparison of hospital care across the board. The HCAHPS survey program was officially endorsed by the National Quality Forum in 2005, and starting in October 2012, CMS began tying HCAHPS survey scores to hospital reimbursement.
The intent of the HCAHPS survey is to provide a standardized way to measure patients’ perspectives on hospital care. If a hospital doesn’t meet certain score levels, it will be penalized. “In the face of decreasing reimbursement, everyone is looking for help to improve patient satisfaction, and if there was ever a time for hospital pharmacists and pharmacy services to step up and evolve with health care reform going on around us, it’s now. Actually, it was yesterday,” said L. David Harlow III, PharmD, Chief Pharmacy Officer at Martin Health System in Stuart, FL.
The HCAHPS survey includes 27 questions that target certain aspects of the hospital experience. The surveys are typically administered to a random sample of patients with varying medical conditions via mail, telephone, or both, up to 6 weeks after discharge.
Survey questions in which pharmacists can play a role in improving patient satisfaction include the following:
- During this hospital stay, were you given any medicine that you had not taken before?
- Before giving you any new medicine, how often did hospital staff tell you what the medicine was for?
- When I left the hospital, I clearly understood the purpose for taking each of my medications (rated on a scale of 1 to 5).
- Before giving you any new medicine, how often did hospital staff describe possible side effects in a way you could understand?
- During this hospital stay, how often was your pain well controlled?
- During this hospital stay, how often did the hospital staff do everything they could to help you with your pain?
Path to satisfaction
Often, patients who feel the strongest about their hospital stay tend to be those who have had the most negative experiences. When a hospital pharmacist is involved with the medication reconciliation process and talks to patients about their medications, they can improve patient satisfaction about their medications. “If a pharmacist takes the time to listen to a patient and help them understand their disease state and their medications, they are usually much more satisfied with the care they get at the hospital,” said Chase.
Regarding the HCAHPS survey question about whether patients understood their medications at the time of discharge, Chase noted that this is a natural opportunity for pharmacists to increase patient satisfaction. In some organizations, a pharmacist brings the patient’s medications right to the bedside prior to discharge so patients don’t have to stop at a community pharmacy on the way home. “It makes it easier for the patient because they don’t have to stop [at a pharmacy]. The pharmacist can take this opportunity to sit down with a patient and educate them about how important their medications are,” said Chase.
Face time with patients
According to Harlow, patients at Martin Health System appreciate a visit from a hospital pharmacist to discuss medications. “In our experience, once a patient has a visit [from] a pharmacist, which was traditionally an uncommon experience, it [puts] a very positive spin on their stay,” said Harlow. “The patient is very enthusiastic about their interaction with a pharmacist, and it goes a long way toward helping them have a depth of understanding of what is happening to them in the acute arena and how that translates to their self care at home.”
At Martin Health System, hospital pharmacists are involved with patients from admission through their entire stay. “We make sure pharmacists spend face time with complex patients who have the most opportunity for a poor experience and a poor outcome,” said Harlow. “These are the patients who need the most help.”
Although the HCAHPS survey questions are designed to assess patients’ satisfaction with their hospital stay, the only disease state or ailment that is mentioned on the survey is pain and pain control. “Intuitively, there is a perfect opportunity for pharmacists to get involved with a pain management or a pain stewardship program, because pain control easily lends itself to evidence-based algorithms,” said Harlow.
Having a medication expert involved with pain control protocol creation to monitor pain control “is a fantastic place to [improve] patient satisfaction because there is no quicker way to create poor HCAHPS scores than to have someone remain in excess pain during their hospital stay,” said Harlow. “Pain is something that is absolutely avoidable.”
Although there are countless opportunities for pharmacists to improve patient satisfaction, one challenge is the time it takes to perform medication reconciliation and face-to-face interactions. “Pharmacists will spent about 30 minutes with each patient, so during an 8-hour day, seeing 16 patients doesn’t seem like a lot,” said Chase. “Many hospitals use student pharmacists to expand that reach.”
Student pharmacists and pharmacy technicians can assist hospital pharmacists with educating patients about their medications. “Students are great at doing this, and they are very good at talking to patients and capturing information,” said Chase.
In her experience, some health systems will have student pharmacists give patients a business card so a patient can call if they have additional questions about their medication, adverse effects, or disease state. “This creates a huge amount of patient satisfaction because they feel like they have someone they can call, almost a ‘personal pharmacist’ to help them with any questions they have about their medications,” said Chase.
Pharmacists as assets
Chase is already seeing a trend in better HCAHPS scores when pharmacists are involved with medication reconciliation and discharge counseling. “Even after just 3 months [of pharmacist interventions], we are seeing as much as a 10% improvement in HCAHPS scores, and we know satisfaction is occurring because we’re seeing improvement,” she said.
As we enter an era in which patient satisfaction affects quality metrics and hospital reimbursement, pharmacists should be viewed as a “system asset” in both the inpatient arena and integrated networks, noted Harlow.
“I know there are a lot of challenges with decreasing reimbursement for organizations, but the level and magnitude of opportunities for evolving hospital pharmacy practice is like nothing we’ve ever experienced because of all the pressures on health care organizations to become more efficient,” said Harlow. “We can’t do things the way we used to, so for creative pharmacists, there are all kinds of ways we can be plugged in and create a presence with patients.”
For more information
There are numerous resources online about the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. To view the HCAHPS survey instruments, visit www.hcahpsonline.org/surveyinstrument.aspx. Survey results are posted on the Hospital Compare website on a rolling basis. To compare Medicare-certified hospitals and the quality of care provided to patients in the United States, visit www.medicare.gov/hospitalcompare/.