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HCAHPS: What "Always" Looks Like as a Patient


By Bonnie Lowry, Consultant (HCAHPS and other Surveys), HealthStream

HealthStream HCAHPS Consultant Bonnie LowryI’ve worked in healthcare market research and consulting for the last 23 years of my career. I consider my job a privilege and I look forward to learning something new from my customers every working day of my life. I’ve always operated under the assumption that whenever I visited a client, it would be to take care of whatever they needed from me and from HealthStream. I had made it 23 years without going into a client hospital “toes first.”  I broke that streak at about 1:30 a.m. on August 6th when a medical emergency sent me from a hotel room to my client hospital.


The HCAHPS Consultant Becomes a Patient

I was less-than-enthusiastic about my circumstances. I had a terrible travel day and had gotten to my hotel at 1:00 a.m. I had instantly started feeling unwell. As my condition worsened, I realized that it was unlikely that I was going to make the 8:00 a.m. meeting that was the real reason for my visit. In other words, it was difficult for me to see the advantages that this type of “primary research” might have for me and for my client.

My client was Vidant Medical Center in Greenville, North Carolina. I should have been worried. After all, Vidant Medical Center has every single demographic characteristic of a medical center that should perform poorly on HCAHPS measures. They are large – nearly 900 beds. They are an academic medical center – affiliated with East Carolina University. They are busy – operating at roughly 95% of capacity the majority of the time. They are undergoing a major construction project – the addition of a new pediatric tower. Lastly, I was admitted though their Emergency Department – generally not the path to a top-box rating.

Using the HCAHPS Survey to Assess Her Experience

So how would a crabby market research consultant rate her experience at Vidant Medical Center?  I actually pulled up a copy of the HCAHPS survey when I got home just to see if I could find a single instance where I would not be able to give them a top box rating. Despite their size, their teaching status, their construction and their capacity, I could not find a single question where I could not give them an unqualified top box rating.

I would rate the overall hospital experience a 10 and here are some (but not all) of the things that most surprised and delighted me. By the way, I shouldn’t have been surprised by any of this. Vidant Medical Center and Vidant Health perform extremely well on the HCAHPS measures.  

Doctor Ratings

HCAHPS doctorsMost of my clients went into apoplexy when they saw the physician questions on the HCAHPS survey. Many felt that they could not have an impact on physician behaviors and I heard from many of them that they didn’t believe that physicians saw value in a strong performance on these metrics. Vidant Medical Center doesn’t need to share that concern. Here are some of the behaviors that their doctors exhibited every time at every encounter - “always.” 

  • Not one of them ever left the bedside without first asking if I had any questions. The ED physician did it. A specialist did it. Two different hospitalists did it and so did a resident. When a behavior is that consistent, we can be quite sure that it is not by accident.
  • My hospitalist did a perfect hand-off. He was going to be off the day after I was admitted. He made sure that I knew the name of the next physician that I was seeing and told me that he was a great doctor. He did this right after he gave me a thorough update on my condition and right before he asked me if I had any more questions.

Nurse Ratings

Honestly, they were supernaturally good. I have always felt (and know that many of my customers agree) that the HCAHPS scale was a bit daunting. Always means always. Can a busy nurse on a busy unit really execute every one of those behaviors every time for every patient at every encounter?  I now have proof that the answer is yes.

  • My nurses always came quickly on the very few occasions when I rang my call bell. Of course, I didn’t need to ring more than a couple of times because when nurses and patient care staff are regularly rounding, even someone like me will have difficulty thinking of something else that I need.
  • The nurses and patient care staff at Vidant Medical Center always asked if there was anything else that they could do for me before they even made a move towards the door. Because they always adjusted blankets, bedside table, phone, call button, etc. I usually couldn’t think of a thing.

Cleanliness and Quietness

Vidant Medical Center is a lot of things, but most of it is not brand, spanking new. So how do they make it well into the top half of the database for cleanliness and how is it that such a large hospital also seems to have cracked the code on quietness?

  • In case you were wondering, the housekeeper who took care of my room was pretty terrific too. She introduced herself, let me know what she was there to do and asked me if there was anything that needed special attention.
  • Before she left, she made sure to leave a card with information on how to reach her department if my room needed additional attention. She also got every nook and cranny of my room and bathroom perfectly clean. I am a terrible housekeeper, but always feel free to criticize someone else’s. I looked and couldn’t find anything to criticize here.
  • Vidant Medical Center has a great CNO. Her name is Linda Hofler, PhD. She is smart and deeply committed to creating an excellent patient experience and it shows everywhere along the continuum of care. However, and I could be wrong, I thought she looked nervous when she asked me about whether or not it was quiet outside of my room at night. She shouldn’t have been. Despite the very busy floor full of people who were very ill and the patient care staff who were busy taking care of them, I really didn’t hear much of anything at night. Staff always remembered to shut my door and kept hallway conversations very quiet.

So – what’s the difference here?  Why can Vidant Medical Center make it to always despite what would appear to be some rather daunting barriers?  Because I work with Vidant Health, I know the answer to this question – great leadership at every level of the organization.

Great Leadership Makes a Difference

I’ve worked with Sue Collier, their Vice President of Service Excellence and Patient and Family Experience for about three years now. She is a fierce and well-known advocate for Patient and Family Centered Care and her “maniacal focus” on these values have brought and kept this large system to the top of HCAHPS performance. Her colleague, Amy Jones shares her passion. Both Amy and Sue have taught me a lot about how to treat customers both internal and external. Their unwavering commitment to finishing strong on these metrics has shown me that a strong HCAHPS performance is possible for any hospital regardless of their size and orientation. Their gentle, good humor makes me glad that I get to work with Vidant Health.

Linda Walter is the manager of the unit on which I was treated. If she worked in an environment that would tolerate excuses, I could think of plenty of reasons why her staff might not perform well on the HCAHPS metrics. She manages a large unit. (She actually manages two – a surgical step-down unit and a critical care unit.)  Her patients are sick. Her unit is usually full to capacity. They’re all great reasons why there should have been at least a few “usuallys” in my HCAHPS ratings. Something tells me that Linda embraces a no-excuses culture too. Her unit runs like a case study in HCAHPS excellence even when she is not physically on the unit.

How about your organization?  Are you tolerating excuses that wouldn’t fly at Vidant Medical Center?  Are you sufficiently “maniacally-focused” to insure that staff are meeting or exceeding the behavioral standards that have been set?

Thanks Vidant Medical Center – I learned a lot from you and I feel a lot better too!

Learn About HealthStream’s Patient Insights/HCAHPS Survey.

Learn About the HealthStream HCAHPS Improvement Library.

Learn About Vidant Medical Center.



As a trustee of Vidant, I am not surprised about these comments; however, I am very pleased that someone who works with many hospitals takes the time to let others know about our great patient focus and quality and safety emphasis. Eastern North Carolina is so fortunate to have world class care right here in our local communities and Greenville!! Our people care and they show it! Thomasine Kennedy
Posted @ Tuesday, November 06, 2012 7:06 AM by Thomasine Kennedy
Reading this article made me feel proud to work for such an outstanding organization. We strive hard to exceed our customers expectations. It's great to be recognized for our efforts.
Posted @ Thursday, December 06, 2012 10:09 AM by Denise Voncannon
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