New Solutions

3 Ways to Improve CG-CAHPS Survey Scores

Posted by Greg Hyman on Apr 17, 2014 8:39:00 AM

More and more, healthcare organizations are opting to implement CG-CAHPS surveys in advance of a CMS mandate, yet many remain uncertain about how to improve CG-CAHPS scores prior to the launch of public reporting.

As early adopters understand, improving scores before public reporting begins can make a difference in how the public ultimately views an organization’s quality of service and care. While achieving significant improvement is usually not easy, with the right support and resources in place, early adopters can attain robust scores on their CG-CAHPS surveys before they become a metric upon which the public will rely in making care decisions.

When clients ask us how they can improve their CG-CAHPS survey scores, we first work with them to identify their key opportunities, and then we make evidence-based recommendations on how to address their specific areas for improvement.  The following are three areas that often challenge healthcare organizations, as well as practices we recommend for beginning to address them:

1. Physician Communication – This CG-CAHPS survey composite assesses the patient’s experience regarding communication with the physician who provided care, encompassing the adequacy of the time spent with the patient, coverage of important topics, and the patient’s ability to understand what has been said.  Several best practices for improving Physician Communication scores include:

  • Involving patients in a Patient Experience Steering Team
  • Collaborating with patients to identify the five most important behaviors contributing to a positive impression of physician communication
  • Providing “teach back” communication training or coaching to physicians

2. Access to Care – This CG-CAHPS survey composite measures patients’ perspectives regarding their ability to make appointments and receive care when it is needed, a particular challenge for groups with large patient panels.   One prominent Avatar client has improved their performance in this area by:

  • Removing variability by standardizing appointment types and slots
  • Committing to returning all patient messages the same day
  • Implementing a Team Care Model
  • Using Third Next Available Appointment (TNAA) as a key success indicator

For more information on the steps our client took to improve their Access to Care scores, click on the link at the end of this article.

3. Courtesy & Respect – In the fast-paced practice environment, staff members may understandably forget to place particular emphasis on the courtesy and respect they extend to patients.  However, this area naturally has a powerful impact on the overall satisfaction of consumers, and proven strategies for supporting a culture of courtesy and respect should be leveraged.  Recommended practices include:

  • The 10-4 Rule: If the person is within 10 feet, make eye contact with them; if they are less than 4 feet away, speak with them.
  • Constructing an internal scorecard emphasizing key focus areas
  • Immediately greeting/acknowledging the patient and family.  If you can’t immediately serve them, let them know you will be with them soon.

By utilizing these and other recommended methods as a starting point for supporting a positive patient experience, early adopters of CG-CAHPS surveys can begin approaching their improvement goals before the launch of public reporting.

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Topics: CAHPS, Patient Surveys, cg-cahps

For the Best CAHPS Survey, Partner with a Survey Vendor

Posted by Kelli Killian on Apr 15, 2014 4:48:00 PM

As a part of the HCAPHS family of surveys, CAHPS Clinician & Group Surveys (CG-CAHPS) ask patients about their recent experiences with clinicians and their staff. CAHPS surveys are mandated by the government and not only have strict compliance requirements but also cannot be altered, limiting the amount of data that can be collected. Due to this, a growing number of organizations are choosing to partner with a survey vendor who can help facilitate CAHPS compliance and combine CAHPS as well as custom questions into a truly customized patient survey. Read on to learn three benefits of partnering with a survey vendor for your CAHPS survey.


1. Helps Facilitate CAHPS Compliance

To ensure your organization meets all of its compliance requirements, partner with a CMS approved survey vendor to help facilitate the process. A best-in-class vendor will be able to work as an extension of your organization, managing the data submission process so that your staff is free to focus on their day-to-day work. Ensuring you are in the best position to meet all of CMS's requirements for the CAHPS program should be priority number one for your organization, and an experienced survey vendor can expertly manage that process for you.

2. Add Custom Items to CAHPS Survey

Because CAHPS surveys were designed to gain general knowledge, questions can certainly skim over important subject areas where more insight is needed. For example, if your organization has low scores in a particular area, survey vendors can work with you to develop more questions that delve deeper to learn the “why” behind CAHPS questions and help inform accurate action planning.

3. Follow the Individual Patient Experience

By creating a fully customizable patient survey for your organization, a survey vendor can actually track an individual patient’s journey. By asking questions about the departments they were exposed to and what services they had, organizations can capture granular information on patient satisfaction at the department, unit, and service level empowering organizations with the data they need to make improvement initiatives in the right areas.

By partnering with a survey vendor your organization can not only ensure best-in-class CAHPS compliance, but also gather valuable insight into the granular factors affecting the patient experience at your organization. Click here to learn about Avatar’s current range of CAHPS products that continue to grow with the market. Contact us today for more information regarding Avatar's ability to seamlessly incorporate CAHPS surveys into our Intelligent Patient Surveys.

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Topics: Best CAHPS Survey

How to Improve Physician Engagement

Posted by Melissa Herrett on Apr 10, 2014 9:14:22 AM


According to a recent study, the number of physicians employed by hospitals rose 6 percent from 2012 to 2013. As physician employment continues to increase, understanding how to engage this unique population should become a priority in any organization hoping to improve the patient experience.


To improve physician engagement, organizations must first measure initial engagement levels at their hospital or within their health system. While there is some overlap between what drives engagement among employees and physicians, physicians often face unique challenges and are motivated by different factors than other employees. To measure physician engagement, then, you must use a survey tailored to the distinct drivers of physician engagement. More information about what to measure on a physician engagement survey can be found in our past blog post, The First Step to Improve Physician Satisfaction: Measure It.


Avatar recommends launching physician surveys during a hosted event such as a breakfast or luncheon when physicians can be considered a “captive audience”. You should also stress the availability of mobile administration of the survey (through a smartphone or iPad), if applicable, in order to highlight the fact that physicians can complete the survey quickly and easily when they have the time. Finally, you can encourage physicians to participate by stressing the importance of the survey as a method to maximize communication and partnerships between physicians and administration.


Once you have an initial understanding of physician engagement levels at your organization, you will be able to easily identify the areas that require the most focus. You can then create action plans around these areas to improve physician engagement. Avatar recommends the following general tips when asked how to improve physician engagement.


  • Highlight how physicians are directly impacting and contributing to organizational outcomes.
  • Showcase positive patient comments, to help physicians understand the results of their actions and recognize them for their hard work.
  • Regularly communicate the organization’s standards for quality, so physicians are on the same page and understand what efforts are being made to provide high quality care.
  • Listen closely to physician ideas. Establish an easy way for physicians to submit their suggestions to improve the patient care experience.


These tips are useful on a general basis when organizations are trying to figure out how to improve physician engagement, but it’s vital to recognize that each hospital or health system has unique challenges and circumstances. Understanding your physicians’ specific feelings and needs will help you engage your team and provide a better patient experience for every individual.


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Topics: Improve Physician Engagement

Different Ways to Conduct CAHPS Surveys

Posted by Kristina Anderson on Apr 3, 2014 11:26:00 AM

Did you know that CMS only allows specific administration modes for each CAHPS survey? While HCAHPS can be conducted via telephone or through the mail, HH-CAHPS can only be administered via mail. CG-CAHPS gives the option for mail or online surveys. It’s important to know which surveys can be administered via each mode. To learn more about the different modes allowed for each CAHPS survey type, download our free CAHPS Fact Sheet by clicking here.


Avatar conducts surveys through a variety of different modes, including mail, live telephone, email:

Mail - Avatar’s primary format and distribution process for patient surveys is hardcopy surveys distributed by US mail. Mail surveys consist of a cover letter, comments section, and the body of the survey itself. The cover letter is customized to maximize the visual cues to the patient, encouraging completion of the survey as well as assessment of the correct visit/experience in the event that the patient has had multiple recent patient visits. Customizations include logo, identification of the provider to be evaluated, visit date, facility/provider-specific images, the letter text, and the signature block.
Online/Email - Avatar also offers online survey completion and email-pushed surveys, which we have found to be an effective supplement to mailing hard-copy surveys. For online survey administration, we would either email patients a direct link to the survey (provided their email addresses are available in the patient data file), or include a link to the survey on the cover letter of the mailed survey. It has been our experience that a hybrid mail/electronic survey provides the most comprehensive data collection methodology in the most financially responsible way.
Telephone - Telephone surveys begin with scripted instructions given by the interviewer, followed by the survey and additional time for open-ended comments from the patients. Interviewers will make multiple attempts to reach respondents. During survey design we will help you determine the number of call-backs necessary to achieve your goals. We will also ensure each sample is programmed for calling such that the time of day and day of week are varied to allow for valid completion of surveys. Each completed phone survey will be tracked via a unique identifier.

If your organization would really benefit from utilizing a different mode than what is required by CMS, Avatar can meet that need through split mode administration. Split mode administration is when a certain number of surveys are conducted in a specific mode to satisfy CAHPS requirements, with the remainder of the surveys sent via the mode your organization prefers.

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Are happy employees engaged employees?

Posted by Kelli Killian on Apr 2, 2014 6:20:00 PM

This is the question on many senior leaders’ minds. Happiness and engagement often go hand and hand but are not one in the same. Happy employees are less likely to feel excess stress at work, and their general mood is more upbeat. According to research conducted by the Wall Street Journal and iOpener Institute, happy workers help their colleagues 33% more often than unhappy employees and are 36% more motivated in their work.

While happiness does not ensure employee engagement; happy employees do encourage positive reinforcement in the workplace which helps sustain their level of engagement and satisfaction. On the other hand, an actively disengaged employee may be happy about a raise or catered office lunch, yet still fail to contribute at the level of an engaged employee.

Since productivity is key, focus first on employee engagement and satisfaction, and employee happiness will follow.  The reverse is not always the case.


Here are three helpful tips to foster employee engagement in the workplace.

  1. Encourage supervisors to coach with passion

It is important for employees to have a direct supervisor who cares about their professional development. They can support their direct reports’ desired career path with questions like “Where do you see yourself in five years?” and “What projects or tasks would you ultimately like to work on at this organization?” Supervisors should also have regular meetings with their direct reports to share any news or events that affect them. By keeping the lines of communication open, supervisors can work to effective engage their direct reports.

  1. Provide Meaning and Alignment

For employees to become fully engaged, it is imperative that they understand and support their organization’s mission and how their role contributes to its success.Some employees need to feel aligned with the company’s stance on the environment or social responsibility. Others are content to be a valued team member who understands and supports the company vision and mission. Once the strategy and mission are clearly defined, employees can align themselves with the organization’s ideals.

  1. Build Trust

One of the single biggest contributors to employee happiness is a culture of trust: feeling trusted and being able to trust the people we work with and the organizations we work for. To earn employees’ trust, Avatar Solutions found that actions speak louder than words. Our recent study focusing on the relationship between perceived visibility of senior leaders and perceived concern showed that the more senior leadership engages with employees in person, the more employees feel that senior leadership is concerned about them. Face time between employees and senior leaders is essential to building trust.

To learn more about building employee engagement, follow us on Twitter @EngageEmployees and join the conversation in our LinkedIn group the Employee Engagement Emporium.

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Topics: employee engagement, happy employees vs. engaged employees

3 Advantages Of Offering Customizable Patient Surveys

Posted by James Oscar Williams on Apr 1, 2014 9:26:37 AM


Patient surveys are intended to help you measure your strengths, acknowledge areas of opportunity, and find new ways to deliver value. Customizable patient surveys do this by examining three key areas that will help your organization gain a better understanding of the patient journey. Read on to learn three distinct advantages of offering customizable patient surveys. 

  1. Understand Expectations

     Offering customizable patient surveys allows your organization to gain insight into what patients expect from a visit to your facility. Patients’ expectations are formed in a variety of ways, including interactions with family and friends, the media, and past experiences. Capturing this data will provide an opportunity for those responsible for improvement to understand what your patients’ expected in specific areas such as quality, reliability, and customization. Meeting patient expectations can be seen as the foundation of measuring care. An example of a customizable patient expectation question is… “Before I came to ABC Medical Services, my expectations of the overall quality of the hospital were extremely high.”


  1. Drive Processes

     Each interaction a patient has with people, processes, and policies within of your healthcare facility has an effect on how they measure their experience. By focusing questions around service, care, and business operations your organization has an opportunity to take an introspective view of the patient journey. Though the care provided by nurses, physicians, and other clinical staff is important, other operations like nutrition, environment, registration and billing have an effect on perceived value as well. An example of a useful customized process question is… “My need was taken care of promptly and to my satisfaction if there was a problem.”


  1. Improve Outcomes

     Customizable patient surveys offer additional insight into the outcomes of patient visits that standard surveys don’t capture. By combining expectations and understanding experiences, customizable surveys address key results like loyalty, endorsement, and differentiation. In today’s competitive healthcare market increasing the likeliness to recommend and understanding the value customers place on your services are instrumental to capturing market share. An example of a question to measure outcomes on a customizable patient survey is… “I would recommend ABC Medical Services without hesitation to others.”


These are just a few of the benefits to customizable patient surveys. To learn more about our survey methodology please view our archived blog post.

Interested in learning about what makes Avatar Solutions different from other survey vendors?  Please visit our website.

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Topics: customizable patient satisfaction survey

Why CAHPS Survey Programs Are Not Enough (And What to Do About It)

Posted by Greg Hyman on Mar 27, 2014 8:49:00 AM

With the emergence of value based purchasing, hospitals and health systems are under increasing demands to use their patient experience data to drive meaningful improvement in performance. But while most healthcare organizations have long made a practice of surveying patients, the newer pressures of regulatory compliance, data transparency, and pay for performance have resulted in a push for hospitals to adopt novel approaches to their survey programs. While this can be painful for some organizations initially, when implemented correctly, these approaches can yield profound, positive changes for hospitals and our nation’s healthcare system.

One profound and too-often overlooked challenge for hospitals in tackling value based purchasing (VBP) is that the very instruments we are required to use to measure performance – HCAHPS, and in the future similar tools like CG-CAHPS – don’t provide a robust framework for driving improvement in scores. Meanwhile, VBP is predicated on meeting performance thresholds and/or improving over time.  This is precisely why CAHPS Survey programs are not enough. 

In our experience, we have found that hospitals benefit most from an integrated approach to their survey programs – using CAHPS instruments to meet VBP participation requirements and more in-depth, targeted patient surveys to obtain fine-grained data for informing performance improvement initiatives.  Many Avatar clients utilize this approach with great success.  In fact, our HCAHPS clients improve at a faster rate than the national HCAHPS database in 9 out of 10 composite areas, and perform better in VBP payment in 7 out of 8 composites.  While their success is due in large part to a commendable dedication to improvement, our clients take advantage of a supportive framework incorporating several key resources as additional drivers.

We typically recommend leaders consider incorporating the following drivers into their CAHPS survey programs:

  • Integrated CAHPS and targeted survey programs, for capturing comprehensive, granular data on their patients’ experiences
  • Powerful reporting technologies, for performing targeted analyses and informing improvement initiatives
  • Dynamic action planning solutions, for building evidence-based goals and interventions, tracking progress, and ensuring accountability
  • Performance improvement support, including best practice literature or media, targeted suggestions based on areas of opportunity, guidance on data analysis, and/or additional consultation as needed

The needs of every hospital or health system necessarily vary with their circumstances, but with an integrated approach to CAHPS and the right collateral resources, healthcare organizations are well positioned to achieve strong VBP performance.  We have experienced this with our clients and anticipate that the trend toward novel, further integrated approaches to VBP will continue as more organizations become aware of the benefits of this strategy.



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Types of CG-CAHPS Surveys

Posted by Melissa Herrett on Mar 21, 2014 9:36:20 AM


The Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) Survey is the first nationally standardized survey measuring patients’ experiences with providers and staff in a physician office setting. While the survey itself is not yet publicly mandated, organizations do currently have the opportunity to publicly report data through the Physician Quality Reporting System (PQRS).

It is important to understand the different versions of the CG-CAHPS survey and how each one is intended to be used. With this information, your organization will have the necessary data to improve the patient experience of care.

The types of CG-CAHPS Surveys include:

CG-CAHPS Visit Version 2.0
This instrument is VISIT SPECIFIC and asks respondents about experiences during their most recent visit with a provider (physician or other) as opposed to all visits over a certain period of time. Access to care questions refer to care over the past 12 months. In discussions with CAHPS experts it is likely to become the “de facto” specialist survey, due to its visit specific focus. The instrument refers to “provider” so is appropriate for physicians and other individuals who provide clinical care.
CG-CAHPS Clinician and Group 12 Month
This survey asks patients to report on their experiences with providers in the last 12 months. It therefore could encompass various visits over the 12 months prior to receiving the survey.
CG-CAHPS Patient Centered Medical Home (PCMH)
This instrument combines the CG-CAHPS 12 month survey with the PCMH item set to address the domains of the medical home. This instrument is specific to medical home and would therefore not be recommended for evaluation of specialist care. This instrument has been selected as the survey for use in NCQA’s PCMH Recognition program, of which Avatar Solutions is an approved vendor. This instrument is also “provider” focused, and is appropriate for physicians and other individuals who provide clinical care.
CG-CAHPS Clinician and Group 6 Month – COMING SOON
This version asks patients to report on their experiences in the last six months, and is intended to standardize the time periods various surveys measure. The pilot version of the survey has been completed, and it will be available through Avatar in Q3 2014.    

A survey vendor such as Avatar can help you select the appropriate version for your organization. Once you select the right CG-CAHPS version, analyzing the data to determine opportunities for improvement is vital to truly making a difference. Contact Avatar today for more information about the appropriate survey version for your organization, as well as to see how our online reporting system has been enhanced to provide more detailed analyses and reporting features to help you improve.  

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Topics: cg-cahps

How Companies Can Gain from March Madness

Posted by Melissa Herrett on Mar 19, 2014 9:41:21 AM

The following post is a guest post provided by David W. Miller, Senior Consultant at Avatar Solutions. 

March Madness may have a reputation for distracting the workforce, but organizations can actually learn a lot about employee engagement and workforce productivity from the competition. March Madness is about upsets, last second shots, Cinderella stories, and teammates defying all odds. While these are all great stories to be told in and of themselves, there is one common theme to tie them together: momentum.

When I played college basketball, I clearly remember one game where we were playing a nationally ranked team. It was close to the end of the game and my team was down by ten points. My coach called a timeout and gave a speech I will never forget. He told us that while we had some plays that did not go our way, whether through poor execution or variables out of our control, the game of basketball is won or lost by momentum. It is how you respond after adversity occurs. It is about making those final pushes and drives at the right time to beat the competition. Then my coach advised a plan and strategy to win. By following that strategy, my college basketball team defied the odds to win the game and become nationally ranked.

According to the Webster Dictionary, momentum is defined as the strength or force that allows something to continue or to grow stronger or faster as time passes. As March Madness kicks into full swing, consider meeting with your team to discuss the tournament and momentum in particular. Take time to do a situational appraisal of where your organization is in relation to the competition when it comes to productivity, employee engagement, and other organizational outcomes. Devise a plan or strategy to build momentum to achieve your goals.

Consider, for example, one Avatar client that had a significant decrease in engagement scores from their first survey to their second. They ranked above the 95th percentile in our Employee Engagement Database on their first survey, but following their second survey, they came in just above the 65th percentile. While this ranking was still well above our national norm, the company was not content simply beating the norm; they wanted their scores to be award-winning.

To achieve this goal, the organization began by first identifying the internal and external factors affecting engagement levels. If you are at all familiar with sports, you are aware that both internal factors (lack of teamwork) and external factors (referee calls) can impact the outcome of any game. The same can be said for businesses. Internal and external variables alike can impact revenue, company growth, and, ultimately, overall engagement scores.

Senior leadership then devised a strategy to address these internal and external variables, re-build momentum, and increase employee engagement. They conducted feedback sessions and included employees in the process, to help ensure full disclosure and involvement across the company. Using the information they gathered, the organization crafted a plan to rebound from uncontrollable external variables and internal “dropped balls,” with the overarching, game-winning goal to become Best-In-Class again in our database. Time will tell if they are successful, but in the meantime, they are currently in the process of building momentum to get back to the top.

Creating momentum and pushing your team of employees forward will result in positive organizational outcomes. Start building the momentum now, and who knows? By next year’s March Madness tournament, you may be leading the bracket in employee engagement.


Follow David on Twitter @DavidMiller3436

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Topics: employee engagement

Communicating to Improve Employee Survey Confidentiality

Posted by Kristina Anderson on Mar 13, 2014 9:25:15 AM

When it comes to getting accurate data and high response rates on employee surveys, confidentiality is a key issue. If employees don’t think the employee survey is confidential, they may feel uncomfortable sharing their real feelings for fear that they will face repercussions. This may lead to employees answering items untruthfully, or may cause them not to participate at all.


Developing an effective communication plan can help to alleviate employee fears about confidentiality. Below are three tips for creating a communication plan based around confidentiality.

  1. Give a trusted leader’s guarantee. When communication goes out to employees generically from the company as a whole about confidentiality, employees may not trust it or take it seriously. However, when communication comes directly from a trusted senior leader and includes his or her personal guarantee that the survey will be fully confidential, employees will sit up and notice. A guarantee is a powerful thing when it comes from the right person, and will give employees confidence that they can respond truthfully to the survey, no matter what their opinions may be.
  1. Include measures taken to ensure confidentiality. Just saying that the survey will be confidential is not enough. Employees need to know exactly how their responses will be protected. Is there a threshold for reporting responses? Will open-ended questions be checked for things that might reduce confidentiality? Is there a third party in charge of collecting and reporting responses? All of the steps you’re taking to ensure confidentially are important to the employees, so they should be shared with employees.
  1. Optimize your communication modes. All of the communication in the world won’t help your cause if employees never see it. Emailing employees is a quick and easy option, but if employees never check their email or if not all employees have access to computers at work it may not make sense for your organization. Posters, announcements via intercom or television, memos, or table tents in the cafeteria/break room are all other options. Think about where your employees go and what they see on a daily basis, and develop a communication plan that fits with them.

Interested in learning more about improving perceptions of confidentiality with your employee survey? Check out our blog post, Five Best Practices for Supporting Employee Survey Confidentiality to learn more.

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Topics: Employee Survey Confidentiality

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