Title: The influence of positive feedback on provider views and the correlation between positive feedback and HCAHPS.
The objective of this study is to analyze the impact/influence that positive patient feedback has on providers. Also, to study the correlation between positive feedback and hospital HCAHPS scores.
This study researched the influence/impact of positive feedback on advance practice clinicians (APCs). APCs include PA-Cs, CRNPs, and DCs. The study also researched the correlation between positive feedback and hospital HCAHPS scores, specifically rate of hospital and communication with doctors. All research was performed using comments and data from Lehigh Valley Hospital. The research was conducted using informal surveys and found that notifying APCs of positive feedback pertaining to them increases confidence as well as it encourages them to improve their levels of care. The comment data was collected using Press Ganey and HCAHPS scores were provided by HCAHPS Program Manager, E.J. Rovella, MBA, MHA, FACHE. Positive feedback was organized by units and correlation coefficients were calculated. The results found that there was a moderately positive relationship between positive patient feedback and HCAHPS scores for both rate of hospital and communication with doctors. The results imply that by notifying APCs and other providers about positive patient feedback, it will improve their levels of care and increase rates of more positive feedback. This increase in positive feedback will reciprocate in increased HCAHPS scores, thus improving overall hospital quality on a standardized basis. Mentorship throughout this study was provided by Brian J. Damweber, MPAS, PA-C and E.J. Rovella, MBA, MHA, FACHE.
Feedback is an integral part of the communication that occurs between a healthcare provider and the patient. It allows the provider to hear what he/she is doing right or wrong from the perspective of the patient. A challenge in regards to feedback is that people respond to it differently. Some may prefer negative feedback, through which they can correct mistakes in order to accomplish goals. Others may prefer positive feedback, which builds confidence and allows one to reassure his/herself about their positive performance and what they should continue to do in order to provide the optimal care for the patient. HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) is “the first national, standardized, publicly reported survey of patients’ perspectives of hospital care.” (“HCAHPS Fact Sheet,” 2013). This survey provides an effective system of scoring that can be compared on a national basis and can be utilized by prospective and current patients. An HCAHPS score represents the percentage of surveys that answered the highest possible positive selection for that particular question. The standardization characteristic of HCAHPS makes it very effective; however one problem with HCAHPS is that it does not factor patient comments into its scores. This puts a limitation on the survey’s effectiveness in that scores do not take into account what patients write in the comments section. Instead they must rate their care within the constraints of the questions asked.
There is not extensive literature addressing the exact goals of this study, but there is research about related topics. A British study titled “Associations between internet-based patient ratings and conventional surveys of patient experience in the English NHS: an observational study” found that there was an association between web-based ratings of patient experience and paper-based patient surveys (Millet, 2012). This relates to concepts of the HCAHPS and patient feedback comments discussed in this study, however, the problem with this study is that it comes out of England, which operates under a very different healthcare system than in the U.S. thus possessing the potential to have different results than if the study were performed in the U.S. In another study titled “The value of patients’ handwritten comments on HCAHPS surveys,” Huppertz (2014) found that “coefficients for negative comments were significant for both the overall hospital rating and intent to recommend” (p. 39-40). Analysis concludes that the reason for the relationship is that people who write negative comments possess an overall negative opinion of the hospital and will, therefore, rate the hospital consistently with these views. This information is very valuable to the study as it deals with the same topics of patient comments and HCAHPS. This study looks to add to Huppertz’s by focusing more on the effects of positive patient comments and their relationship to HCAHPS.
This study looks to examine the influence that positive feedback has on advance practice clinicians (APCs) and the impact it has on the level of care that they provide. In addition, the study analyzes the correlation between positive patient feedback and hospital HCAHPS scores, particularly rate of hospital and communication with doctors. The hypothesis is that the survey will show that positive feedback has encouraging effects on APCs and that it encourages them to not only maintain, but increase the level of care provided to patients. It is also hypothesized that there will be a positive correlation between positive patient feedback and HCAHPS scores.
An informal survey was used to assess the impact of positive patient feedback on APCs. These surveys were sent in the form of an email. Comments, between the time periods of 7-1-2013 and 6-30-2014, were collected using the Press Ganey application. Positive comments specifying APCs were used. The surveys were sent individually to APCs. A total of 31 surveys were distributed. They included a comment(s) about the particular provider it was addressed to and asked four questions that were to be answered with yes, no, or not sure. The questions were as follows; does this comment change the way you would provide care to future patients, does this comment make you feel more confident in your performance, does this comment encourage you to improve your level of care, and this comment does not influence your job performance. There was also an optional section for any additional comments. Only APCs having specific positive comments within the noted time frame were used. Some surveys included more than one comment if it applied.
To determine if there is a correlation between positive feedback and HCAHPS, the study collected data over the same time period between 7-1-2013 and 6-30-2014. All positive, negative, and mixed comments were collected from Press Ganey for Lehigh Valley Hospital-Cedar Crest. The comments were organized by the units within the hospital. Percentages were calculated for each unit to determine the weight of positive, negative, and mixed comments for that particular unit. This was repeated for each unit. Only the positive comment percentages were used in the study. An average was calculated using the positive comment percentages for each unit of the hospital. Next, each unit’s positive comment percentage was subtracted from the average to determine its deviation from the average. The HCAHPS score for rate of hospital for the entire Lehigh Valley Hospital- Cedar Crest campus was collected. This same HCAHPS score was then collected for each individual unit. Similarly to the comments percentages, the HCAHPS for each unit were subtracted from the overall hospital score to determine their deviations from the average. The correlation between the positive comments deviations and the HCAHPS deviations was calculated. Instances of the same positive or negative deviation for each unit were also taken note of. For supporting data, the HCAHPS score for communication with doctors for the entire hospital was then collected. This score was then collected for each unit. The steps above were repeated and the deviations between the units HCAHPS scores for communication with doctors and the hospital’s HCAHPS score for communication with doctors were calculated. Again, the correlation coefficient between positive comments deviations and HCAHPS deviations was calculated and instances of the same trend were taken note of.
To eliminate the influence of extreme outliers, the study excluded any units that provided less than five HCAHPS surveys and less than 15 comments. A total of 26 units were used in calculating the data. Three were excluded from the study because there were no available HCAHPS scores for them. An additional unit was also excluded because it fit the criteria having less than five HCAHPS surveys and less than 15 comments.
The survey was presented to 31 subjects. Of these 31 subjects, 21 responded giving the survey a 68% response rate. The results can be found in Appendix 1-a. For the question “Does this comment change the way you would provide care to future patients?” 24% responded yes, 71% responded no, and 5% responded not sure. For question two “Does this comment make you feel more confident in your performance?” 100% of respondents answered yes. For question three “Does this comment encourage you to improve your level of care?” 76% of respondents answered yes and 24% answered no. For the fourth statement, “This comment does not influence your job performance,” 10% agreed, 67% disagreed, and 24% were unsure. A graphic representation of the results can be seen in Appendix 1-b.
The data in Appendix 2 displays the weighted comment breakdown within each unit used in the Lehigh Valley Hospital- Cedar Crest study. The average of positive patient feedback among all of these units was found to be 56% positive. The deviations for each unit can be seen in Appendix 3. Appendix 3 displays each unit’s HCAHPS data for rate of hospital. The HCAHPS score for rate of hospital for the entire hospital is 74.3. The deviations were calculated and listed in Appendix 3. Feedback data and HCAHPS rate of hospital data were compared and found that 22 out of the 26 units (85%) used in the study had the same positive or negative deviation trend. A correlation coefficient was calculated for these two data sets and determined to be 0.62. Appendix 4 displays each unit’s HCAHPS data for communication with doctors. The HCAHPS score for communication with doctors for the entire hospital is 78.3. The deviations were calculated and listed in Appendix 4. Feedback data and HCAHPS communication with doctors data were compared and found that 17 out of 26 units (65%) used in the study had the same positive or negative deviation trend. A correlation coefficient was calculated for these two data sets and determined to be 0.42.
The hypothesis proved to be correct for both aspects of this study. The results of the survey show that every single participant experiences a boost in confidence when they receive positive feedback about his/herself. In addition to this, 76% answered that receiving positive feedback about themselves encourages them to improve their level of care. The consensus of the optional additional comments was mainly that providers hear only about the negative feedback and not enough about the positive. Focusing on informing providers about positive feedback will make them more confident in their performance and motivate them to not only keep performing well, but increase their overall performance. This will directly benefit patients’ health and care and lead to an overall improvement in hospital quality, patient satisfaction, and patient experience.
The correlation coefficient between positive patient feedback and HCAHPS rate of hospital scores was 0.62. This shows that there is a moderately positive relationship between these two factors and when one increases, it will influence the other to increase as well. In addition, the correlation coefficient between positive patient feedback and HCAHPS communication with doctors scores was 0.42, also displaying a moderately positive relationship. Knowing this data can help to greatly improve the hospital network. Positive patient feedback is very impactful and influential to providers. This same positive feedback is positively correlated to two of the most important HCAHPS scores, rate of hospital and communication with doctors. Regularly notifying providers of positive feedback from patients will encourage them to improve their level of care. Due to the correlation, improving their level of care will generate a greater weight of positive comments among the different units. If a greater weight of positive comments is achieved, it will likely improve HCAHPS scores for the entire hospital, which will increase hospital rank in the nationally standardized HCAHPS system, thus attracting more potential patients.
One limitation of this study is the small sample size for the survey, due to its exclusivity to just APCs. Future studies could extend the survey to physicians as well and see if views are consistent with APCs, which they would be expected to be. Another limitation is that the response rate was not fully optimized. The entire sample size did not respond to the survey, whereas if they had it would give the study more data to rely upon. One final limitation is that the program which this study was performed under prohibited patient interaction, eliminating the possibility of studying the impact of comments on patients’ confidence and perspectives. This provides an opportunity for future research. Another suggestion for future research would be to analyze the feedback and HCAHPS data beyond that of the fiscal year used in this study to determine if the correlation still holds true. Another suggestion for long term research would be to begin regularly distributing positive feedback to providers and study the factors used in this study to see if performing this action does indeed lift HCAHPS scores for rate of hospital and communication with doctors.
Finkelstein, S. R. How Positive and Negative Feedback Motivate Goal Pursuit. Social and Personality Psychology Compass, 517-530. Retrieved July 16, 2014, from http://faculty.chicagobooth.edu/ayelet.fishbach/research/FEF%20Compass%202010.pdf.
HCAHPS Fact Sheet. (2013, August 1). . Retrieved July 16, 2014, from http://www.hcahpsonline.org/files/August_2013_HCAHPS_Fact_Sheet3.pdf
Millett, C. Associations between internet-based patient ratings and conventional surveys of patient experience in the English NHS: an observational study. BMJ Quality & Safety, 600-605. Retrieved July 16, 2014, from http://qualitysafety.bmj.com/content/21/7/600.full.pdf.
Huppertz, J., & Smith, R. The value of patients’ handwritten comments on HCAHPS surveys. Journal of Healthcare Management, 59, 31. Retrieved July 16, 2014, from http://connection.ebscohost.com/c/articles/94059273/value-patients-handwritten-comments-hcahps-surveys.
Published In/Presented At
Fritz, N., (2014, July, 25) The influence of positive feedback on provider views and the correlation between positive feedback and HCAHPS. Poster presented at LVHN Research Scholar Program Poster Session, Lehigh Valley Health Network, Allentown, PA.
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