In This Section      

HCAHPS Scores Measure Patients’ Perspectives on Care

See more in:

HCAHPS Scores Measure Patients’ Perspectives on Care

HCAHPS Scores Measure Patients’ Perspectives on Care

Date: 05/01/2016

How often do you want other drivers to stop at a red light? Choose an answer:

  • Never
  • Sometimes
  • Often
  • Always

Always, of course.

By the same token, says Lisa Allen, chief patient experience officer for Johns Hopkins Medicine, “always” should be the answer patients give when asked how frequently they experienced great care during their hospital stay, as they are on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) questionnaire. The survey asks questions such as: “During this hospital stay, how often did nurses treat you with courtesy and respect?” and “During this hospital stay, how often did doctors listen carefully to you?”

“The ‘always’ experience is what we are striving for. It’s what our patients and their families deserve,” Allen says.


The HCAHPS questionnaire is a national, standardized survey mailed to a random sample of people who recently had a hospital stay. To capture their perception of the care they received, the survey asks 32 questions. Based on patients’ responses, the Centers for Medicare and Medicaid Services (CMS), which receives the survey results from our Press Ganey vendor, assigns hospitals a rating of one to five stars in nine aspects of care — nurse communication, physician communication, responsiveness of hospital staff, pain management, communication about medicines, discharge information, care transition, cleanliness of hospital environment and quietness of hospital environment.

Additional star ratings are assigned that reflect a patient’s willingness to recommend the hospital and the patient’s assessment of the hospital’s delivery of care.

Based on these category ratings, CMS assigns an overall star rating to the hospital. Quarterly reports are published on the Hospital Compare website to help consumers make decisions about inpatient care. Hospitals in the Johns Hopkins Health System received three stars, with the exception of Sibley Memorial Hospital, which received two, for the second quarter of fiscal year 2016.

Emergency Department Admissions

In crunching the numbers, Allen noticed that patients admitted through the Emergency Department (ED) rated their experience lower than patients with a planned admission. For example, at The Johns Hopkins Hospital, 63 percent of patients with a planned admission said staff members were responsive versus 55 percent for those admitted through the ED. The gap is even wider at Howard County General Hospital: 72 percent versus 53 percent.

A hospital’s overall score can be disproportionately affected by the percentage of patients completing the survey who came through the ED, says Allen. In response, The Johns Hopkins Hospital has launched a pilot that places a coach and three concierges in the ED. The ED coach helps train staff members in communication skills and problem-solving using Lean and other performance improvement tools — good communication and information about delays improves patients’ perception of their care. The ED concierges talk with boarding patients, provide information and comfort items, and see them again after admission. Good communication improves patients’ experiences and their subsequent rating on HCAHPS.