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Can Narratives Provide Greater Insight Into The Patient Experience?

In 2018, the American Hospital Association published a joint report, in collaboration with four other hospital associations, calling for an update to the HCAHPS survey.

They recognized the importance of feedback, but believed that key issues needed to be addressed to consider whether patient narratives can provide greater insight into the patient experience.

Their key findings included the following: [1]

  • HCAHPS response rates have fallen to 26%. Furthermore, there is a delayed response following the patient’s discharge and the time surveys are completed. This exacerbates the low response rates and may not be representative of the views of the overall patient population.
  • A recommendation to shorten the survey and reevaluate its health literacy levels. The concern is that some segments of the patient population may be under represented due to the higher level of health literacy utilized.
  • Technology has evolved considerably since 2008 when HCAHPS was first implemented. The report suggests that digital format responses, obtained online via smartphone or computer, would be the most desirable.
  • Topics included on the HCAHPS are “incomplete” and omit vital questions related to process efficiency and teamwork among employees. It is important to identify those items which are most important to the patient. The report also noted the need “to gain more clarity of the patient’s perceptions” as expectations continually evolve.
  • Supplemental questions were also suggested for the HCAHP. These suggestions include open ended text narratives where patients can furnish specific “patient stories” of their hospital experience. In addition, social factors that influence the patient perspective may not easily be captured, and a structured survey format is not ideal under these circumstances. Free text information, which reveals details of the hospital stay, can easily be shared with management and frontline teams. This data can be utilized to further understand the patient population and assist with training efforts and process improvement.

In a comparative study of Yelp reviews and HCAHPS survey data [2]:

  • Four of the top five topics most strongly associated with positive Yelp reviews were not covered by HCAHPS domains. These include topics relating to personal relationships with doctors, nurses and staff (i.e. how caring or comforting they were) and topics relating to specific service lines (i.e. surgery/procedures/peri-op and labor/delivery).
  • Two of the top five topics most strongly associated with negative Yelp reviews were not covered on the HCAHPS domains, namely insurance and billing and cost of the hospital visit.

Is there a better way to capture information from the patient perspective?

Is a narrative approach more suitable to gain insight into specific areas for improvement?

Studies show that a narrative approach into patient feedback enhances data quality and provides greater insight into the patient experience. Share on X

Multiple studies show that a narrative approach into patient feedback enhances the quality of the data obtained and provides greater insight for hospitals to improve the patient experience. 

One study, authored by Hubberts and Smith, entitled “The value of patients’ handwritten comments on HCAHPS surveys” [3], explains the advantages of obtaining patient feedback in a narrative format.

 “Some patients write comments on their Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys, but survey vendors do not record them, and the value of this anecdotal information is not well understood. 

However, many rating websites contain both numerical ratings and anecdotal comments from consumers who wish to share their experiences, and the option to write comments enhances the appeal of these survey forums.

Recent research shows that numerical ratings do not sufficiently capture the range of consumer experiences and that comments contain additional information that complements survey responses.”

Similarly, a study published in the Patient Experience Journal regarding the benefits of adopting a narrative format to capture details of the patient experience explains that: [4]

“’Narrative’ information refers to the retelling of something that happened, presented via written or spoken words.”…“Narrative information such as patient comments can be elicited and organized in reliable and valid ways to present meaningful information about a patient’s experience with a provider, the patient’s decision process, and the consequences of a healthcare choice.”

“Coherent patient narratives are multifaceted, with several characteristics making them engaging and meaningful. As storied expressions that reflect rich experiences, patient narratives convey emotions, provide the logic or an explanation underlying a perspective, express relational information, and capture naturalistic experiences.”

“Patient narratives also often have strong face validity because they portray experiences in a more holistic, engaging, and memorable manner than do quantitative survey measures.”

The Agency for Healthcare Research and Quality (AHRQ), the federal agency that provides the HCAHPS survey, has identified the need to enhance the data acquired with a patient survey instrument.

At the time of writing a narrative version of a survey to measure physician practice performance is in the beta testing stage. The CAHPS® Narrative Elicitation Protocol [5] is a set of open-ended questions that prompt survey respondents to provide a clear and comprehensive story about their experience with a health care provider.

 “Patients’ stories about their experiences with healthcare are an important complement to the information derived from closed ended questions in the CAHPS Clinician & Group Survey and other CAHPS surveys. Reading what patients say can help doctors and their staff better understand what is happening when their patients seek and receive care and what they can do to provide a better experience.”

This research points to the value of obtaining patient feedback in a narrative format.

The key findings cited in the AHA report highlight the need to obtain timely and more complete data to “gain more clarity from the patient’s perspective” regarding their hospital stay.

Gaining clarity from the patient’s perspective

A leader in hospital cost savings strategies, VIE Healthcare has developed an innovative tool to meet that objective, prior to patient discharge.

The iSUGEZT app can be provided to patients and families upon admission, to be used throughout the patient journey. The ability to offer suggestions, praise staff members, and voice concerns in free text format has the potential to transform hospital leadership.

iSUGEZT demonstrates to patients and their families that the hospital values their opinions and will respond proactively to suggestions, taking steps to improve the patient experience based on their feedback.

iSUGEZT provides a straightforward way for hospital leadership to share vital information and details with management and frontline staff.

iSUGEZT tells the patient story prior to discharge and prior to patients receiving the HCAHPS survey. It enables the patient narrative to provide greater insight into the patient experience in your hospital in real-time.

Download the iSUGEZT app here.

References

[1] Modernizing the HCAHPS Survey: Recommendation from Patient Experience Leaders; 2019. Accessed online at:  https://www.aha.org/system/files/media/file/2019/07/FAH-White-Paper-Report-v18-FINAL.pdf

[2] Benjamin L. Ranard, Rachel M. Werner, Tadas Antanavicius, H. Andrew Schwartz, Robert J. Smith, Zachary F. Meisel, David A. Asch, Lyle H. Ungar, Raina M. Merchant; Health Aff (Millwood). 2016 April 1; 35(4): 697–705.  doi:10.1377/hlthaff.2015.1030.

[3] Huppertz JW, Smith R. The value of patients’ handwritten comments on HCAHPS surveys. J Healthc Manag. 2014; 59(1):31–47.

[4] Finucane, Melissa L.; Martino, Steven C.; Parker, Andrew M.; Schlesinger, Mark; Grob, Rachel; Cerully, Jennifer L.; Rybowski, Lise; and Shaller, Dale (2018) “A framework for conceptualizing how narratives from health-care consumers might improve or impede the use of information about provider quality,” Patient Experience Journal: Vol. 5 : Iss. 1, Article 5. Accessed online at: https://pxjournal.org/journal/vol5/iss1/5

[5] AHRQ- CAHPS Patient Narrative Elicitation Protocol Document. No. 2315. Last reviewed February 2019. Agency for Healthcare Research and Quality, Rockville, MD. Accessed online at: https://www.ahrq.gov/cahps/surveys-guidance/item-sets/elicitation/index.html