Did you know that an HCAHPS survey is sent to all inpatients who are discharged from a hospital, while the OAS CAHPS is sent to patients who received care at an outpatient clinic or ambulatory surgery center? In all cases, the cleanliness of the facility is rated by that patient and has a significant impact on the facility’s overall score.
So, how does cleanliness actually impact scores?
Well, in a hospital, cleanliness contributes 5% of the score while in clinics and ASCs, it contributes 10% to that score.
The questions are …
In a hospital; “During this hospital stay, how often were your room and bathroom kept clean?”
Response Options: Never, Sometimes, Usually, Always.
If they visited a clinic, the question is “During your visit, was the facility as clean as you thought it should be?” Response Options: Yes definitely, Yes somewhat, No.
Any response, other than the highest rating, is worth 0%. This means that any doubt on the part of the patient will result in a 0! So, think about that, the smallest mistake can cost you all your hard-earned points.
How are surveys completed?
Only 25% to 30% of surveys are actually completed and returned, while patients with a negative experience are 2 to 3 times more likely to respond. HCAHPS and OAS CAHPS data indicate that “extremely dissatisfied” patients drive a disproportionate number of responses.
Studies estimate that family members complete 10% – 15% of surveys on behalf of the patient and tend to give lower or more neutral scores.
Furthermore, patients who have a negative experience with doctors or nurses (or something else) are more likely to rate cleanliness poorly, even if the actual cleanliness of the facility is not the issue. This is due to the “reverse halo effect” when patients have a bad experience with one service and then rate unrelated aspects of care more negatively. For example, studies show that patients who rate “Nurse Communication” poorly are up to 40% more likely to give low cleanliness scores.
What can you do to prevent unfairly low cleanliness scores?
- Train staff on patient communication – A polite, respectful interaction can prevent retaliatory scoring, as well as show the patient that your staff cares about cleanliness and their experience.
- Encourage your front-line housekeeping staff to interact with patients, “Is there anything I can do for you before I leave?” This can sometimes be the only social interaction that the patient has that day and helps to give them a positive impression of your staff.
- Require your Supervisors and Managers to interact with patients during inspections and rounds. Our clients will often explain how and why they are using iPads and the Walsh QA Inspector program to carry out inspections, reassuring the patient that the hospital is professional and really does care about cleanliness.
- Carry out patient experience surveys independent of HCAHPS and OAS CAHPS surveys, giving you a fresh view of how patients really experience cleanliness.
- Carry out regular inspections of patient rooms and public areas. Walsh’s clients’ results have shown that HCAHPS scores rise in concert with the number of publicly visible cleaning inspections; the more you are seen to inspect, the cleaner the patient and family feels the hospital is.
So, let’s re-cap:
1. HCAHPS and OAS CAHPS surveys ask a patient to rate their perception of how clean a facility is. In addition to actually being clean, we must ensure that patients “believe” that the facility is clean. This means that we must effectively manage their perception.
2. Fifteen percent of surveys are completed by family members, who tend to be more critical than patients. This means that your score will be disproportionately impacted by those areas where family members frequent or transit through, such as hallways, elevators, lobbies, public restrooms, etc. Think about it, when you are in an elevator, you have nothing better to do than look at the floor. If it is dirty or there is trash, you might perceive that the entire facility is dirty.
3. Only about 1 in 4 surveys are actually returned, and those with any negative experience are more likely to respond. Cleanliness scores can be negatively impacted by a bad experience in some unrelated service. Therefore, you should carry out your own patient surveys. This gives you an opportunity to fix issues before they become problems, creates a positive relationship with a patient, and gives you data to share with management showing that your team is really doing a good job.
In the end, the perception of cleanliness has a major impact on your HCAHPS and OAS CAHPS scores. Thorough cleaning, patient communication, and being seen to care will all contribute to your higher scores.