Health care is a vast ocean of ebbs and flows. The sand and the waves will never look the same from one minute to the next.

The Centers for Medicare and Medicaid Services have implemented the Consumer Assessment of Healthcare Providers and Systems [CAHPS] survey to measure the patient care experience. For hospice, this entails a primarily qualitative collection of data that will later affect annual payment structures.

As regulations change and hospices are now utilizing the CAHPS Hospice Survey process and forming their own star ratings in the industry, is your staff prepared for these waves? How are you teaching your employees to perform quality work?

What’s next?

Before you get seasick, stop and reflect on your staff. The language of CAHPS must be taught and reinforced, not just to your employees but also to your patients and caregivers. If you have received negative surveys, what have you done about it? Further, have you taken the time to show your employees the CAHPS survey and gone over every question?

What you can learn from a 2/10 CAHPS survey rating.

Mary was an amazing hospice nurse case manager who worked in the field for over 10 years, and every patient and family loved her. Until they didn’t.

I received a CAHPS survey with the worst rating our agency had seen in my several years as a manager there, along with a comment from the patient’s wife; “I will never recommend your agency and am insulted by how your hospice, and especially the nurse, treated me.” I recall these words because they stung, and particularly because the patient’s wife was herself a nurse.

She gave our agency a 2 out of 10 only because her husband liked our aide. She thought us worthy of a zero.

The patient had terminal agitation, and was only on service at home for a short time. There were a lot of phone calls from his wife to the office, as well as extra visits and time spent with her and the patient from every member of my team. For this caregiver to give a negative survey, and particularly call out one of our best nurses, left me dumbfounded. Not my staff, and especially not Mary – she was near perfect!

Create teaching opportunities – for staff and families.

Grief sways feelings and intensifies emotional responses. Maybe the wife “didn’t really mean it,” but maybe she did. I decided to use this survey as an opportunity to really dig into our CAHPS surveys and take a better look at how our caregivers may be viewing the efforts of the team.

Mary cried about the survey and beat herself up, even asking for a copy of it. Together with Mary and my team, I talked over how the entire case was managed. We combed through the old electronic medical record and tried to figure out what went so wrong or could have been done better. I even went as far as to call the wife, as I felt she was owed an apology for anything we may have done that made her feel so insulted. She answered the phone but hung up on me as soon as I spoke.

I decided not to give Mary a copy of the survey just to dwell on the response. In the end, the team truly couldn’t identify what may have gone wrong, and the patient had ultimately passed peacefully with the wife seemingly thankful for our efforts. I told Mary and the rest of the team that cared for this patient, “We just need to learn from this, and teach our families differently.”

Perception is everything.

Every hospice employee operates in a world where the patients and caregivers are at their breaking points; they are drowning in that health care ocean. Educating in hospice is unlike any other arena of healthcare, and your employees must be ever mindful of those perceptions and emotions and how to teach and keep caregivers afloat.

One survey does not break an agency and one person’s reviews are not necessarily representative of an entire organization. However, CAHPS surveys can provide a valuable opportunity to examine your team. Perception is everything. Maybe Mary used the wrong words to educate and forgot that the wife was herself a nurse. My team ultimately changed the way we worked with patients and caregivers for the better as a result of the wife’s responses, even if we couldn’t identify the specific issues in her case.

Your employees’ interactions with patients and caregivers will define the quality of your agency, so it’s critical they be mindful of that. Review the contents of the CAHPS survey with your team, and use our Survey Focused Teaching Tips handout to ensure your survey results will reflect the high standards you set.

The CAHPS survey is a tool, and we want our caregivers to answer the questions truthfully but positively. The rest of this blog mini-series will help you keep your head above water and train the trainer in a much more effective way.

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