New Solutions

Why CAHPS Survey Selection is So Complicated – And What to Do About It

Posted by Greg Hyman on Sep 10, 2014 6:01:00 PM

At first glance, it might seem that the glory days of patient experience measurement occurred a decade ago, when surveying patients often meant sending them a page of home-spun questions, hoping for a handful of responses, and tackling the obvious service issues when time allowed. A laissez faire approach, maybe, but simple!

Today, simple is perhaps not the first word one would choose to qualify patient experience measurement, which, with the growing influence of value-based purchasing, often entails instrument selection from among an array of complex, overlapping surveys; compliance considerations; vendor relationship management; dedicated internal roles; and weighty financial implications.

But one need not condemn what is complicated or inconvenient. In fact, approached correctly, participation in CAHPS initiatives can have a meaningful impact on revenue and your mission – whether explicit or otherwise – to deliver outstanding care and a positive patient experience.  The process takes time, yes, but it begins with a single first step – selecting the right instrument(s).

To help you get started, the following presents an overview of the complications to selecting a CAHPS instrument, as well as how to address them. (For more ideas, click the link at the end of the article to download Avatar’s free CG-CAHPS Preparedness Guide, which presents an approach applying to CG-CAHPS and other CAHPS surveys.) 

Selection Consideration 1: Multiple Obligations

There are a number of reasons why CAHPS survey selection is complicated. First, many healthcare organizations are obligated not only to meet CMS’ requirements for value-based purchasing, but also the patient survey requirements of numerous other third parties, whether for accreditation, federal and local designations, or other drivers.

  • Step 1: Map out all measurement obligations and any competing or overlapping instrument specifications. Does it make sense to select the survey that meets the greatest number of high-priority demands? Yes, though a supplementary survey may be needed for competing requirements.

Selection Consideration 2: Multiple Instruments

In addition to the instrument requirements posed by CMS, PQRS, and others, some regulatory-driven surveys such as CG-CAHPS have multiple instrument versions addressing different timeframes or care settings. Based on the environment in which your patients are treated, your compliance requirements, and your plans for internal use of the survey data, you should be able to narrow down your version selection options to a manageable few.

  • Step 2: Identify the salient characteristics of each instrument, including appropriate settings, stage in survey lifecycle (is it likely to be used in future pay-for-performance?), and alignment with your internal measurement drivers. Narrow down your list!

Selection Consideration 3: Performance Improvement

For all their complexity, CAHPS Surveys have already had a powerful impact on healthcare, but used alone they are typically not adequate tools for guiding performance improvement efforts. Proprietary, driver-focused patient experience surveys are ideal as a foundation for performance improvement. It is important to keep in mind that different programs have different guidelines as to whether and how supplemental survey items can be utilized.

  • Step 3: Assess how the CAHPS instrument options you’ve identified will incorporate with your performance improvement efforts and supplemental surveying. If you’re already surveying patients, can the items be integrated with your CAHPS surveys? Do your existing surveys provide an adequate foundation for improving CAHPS scores over time? How will you establish and coordinate sampling and administration plans to meet your compliance and performance improvement needs?

These are just a few of the reasons why CAHPS survey selection can be challenging, as well as some steps for addressing the challenge. For many, the ultimate objective is to meet all compliance and performance improvement needs while minimizing redundancy and maximizing cost efficiency. While these recommended steps can serve as a starting point to achieving that objective, the path to an optimal, cost-effective program remains somewhat complex. When in doubt, grab your draft roadmap and pencil and call up a trusted expert. A good vendor will be happy to help you navigate your selection process.

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Topics: HCAHPS, Patient Surveys, CG-CAHPS, HH-CAHPS, ED-CAHPS, Choosing a CAHPS Survey

Why Improving Patient Satisfaction … Doesn’t

Posted by Greg Hyman on Aug 21, 2014 1:23:45 PM

Once upon a time, people talked about improving patient satisfaction as a way for health systems, hospitals, and independent practices to maintain and build their share of the market. A common analogy to the hospitality industry seemed fitting – if I’m a consumer with a choice of hotels for the annual family getaway, aren’t I going to select the hotel with the best amenities, the most wow factors, the familiar, reassuring brand name?

Of course I am, and the same often holds true for healthcare. After all, healthcare organizations are businesses. The growing preponderance of immediate care chains offering free coffee and snacks, bottled water, and flat screen televisions in every exam room is testimony to healthcare’s potential for overlap with hospitality, at least where customer service and marketing practices are concerned.

But healthcare is not the hospitality industry. Improving patient satisfaction as one would improve the satisfaction of hotel guests is a worthy goal, but it is not enough to truly do right by patients. In fact, studies have shown that focusing on patient satisfaction may have an ambiguous or even deleterious impact on patient health outcomes. 

Why? To boil down a very complex issue, look for example to the patient with borderline high cholesterol, who has researched the risk factors online and determined that intervention with statins is the answer. When his physician declines to write a prescription, instead recommending lifestyle changes as a first-line approach to lowering borderline high cholesterol, the patient may leave feeling ambivalent about the visit. Yet the doctor made a medical decision she felt was in the best interest of the patient.

In the admittedly simplistic example above, neither of the implied outcomes is truly “satisfactory.” Either the patient receives a prescription for a medication he may not yet need, or he leaves dissatisfied and less likely to adhere to the clinician’s recommendations. Whereas a focus on improving patient satisfaction does nothing to suggest a better scenario, seeking to improve the patient experience offers a multi-dimensional approach in which the patient, clinician, and staff are all active participants.

At the hospital or practice with a strong focus on patient experience, the scenario may look very different indeed. Utilizing a patient experience survey and sophisticated analytics, patient experience leaders may have previously uncovered a perceived need for better listening and communication between physicians and patients, as well as better post-visit follow up. Now, with the right coaching, training, and processes in place, the clinician and staff are prepared to work in collaboration with the patient to improve outcomes.

As a result of attending to the care experience, rather than focusing on improving patient satisfaction, the practice has done right by the patient. The physician demonstrates that she understands the patient’s concerns and responds with sensitivity. Post-visit follow-up further supports adherence to the physician’s advice. Now the patient is not only more likely to feel satisfied; he’s more likely to do his part to improve or maintain his health. 

So, in healthcare, we can place secondary importance on the amenities, wow factors, and satisfaction for satisfaction’s sake. At the end of the day, supporting patients’ engagement with their own health is the critical success factor here. Attending to the patient experience is how we can achieve this. 

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Topics: patient satisfaction, CAHPS, CAHPS Survey, CAHPS Surveys, patient experience, patient satisfaction survey, CG-CAHPS, patient experience surveys

Three Reasons Employee Engagement is a Challenge… and What to Do About It!

Posted by Melissa Herrett on Aug 14, 2014 9:51:20 AM

Research into employee engagement highlights the fact that engaging employees is often a challenging feat. Despite the increased attention many organizations are paying to engaging their workers, recent statistics show that almost 60 percent of employees are only partially engaged in their jobs, and 12 percent are actively disengaged. With the dedication and commitment toward engaging employees, why is it still so hard to achieve full employee engagement?
Here are 3 reasons why engaging employees can be difficult, as well as some techniques to address these challenges.
  1. Tough Economic Times – Often, an organization’s budget can lead to employees who are forced to do more with less. Whether it’s a matter of time or materials, when budget cuts are implemented, employees may simply not have the resources to do their jobs as effectively as they can. As a result, their engagements levels may experience a dip.

    To continue to engage employees despite a leaner approach to business, it’s important to ensure open and honest communication with each employee. Managers should be frank about why budgets and resources are slim. Following that conversation, managers and employees should work together to brainstorm ways to approach projects with limited time and resources. These conversations will also allow leaders to understand employees’ current workloads and help staff members re-prioritize projects as needed.

  2. Coworker Dynamics – Interacting with other people can at times be challenging. Every individual has a unique personality, mannerisms, and ways of approaching projects, and it can be hard to find common ground. In the workplace, this is especially true because you often don’t have the benefit of being able to select your coworkers. The fact of the matter is that people may simply not get along.

    In order to mitigate this issue, encourage employees to get to know coworkers outside of their projects and work. Sometimes, encouraging employees to connect on a more personal level will help them find common ground and understand where coworkers are coming from. These relationships may then positively impact the way individuals work together on projects and tasks. Managers should also discuss effective team building strategies and team dynamics, so that employees understand ways to cope when in a group that doesn’t necessarily see eye to eye.

  3. Work is, well… work – There’s no way around this one. Work is defined as “exertion or effort directed to produce or accomplish something,” according to The inherent nature of work can be exhausting and overwhelming. Add in the structure of today’s work environment, where employees are often accessible late into the evening hours through text messages, cell phones, and email, and the chances of mental exhaustion, extra stress, and overall burnout increase.

    To combat this issue, encourage employees to take time away from work to relax and reenergize. Get them to completely disconnect from work for a while, and they will likely come back feeling rejuvenated and ready to contribute. By showing employees that you realize their mental health is just as important as the work at hand, employees will likely become more engaged in their jobs.    

It’s no secret to anyone in the workplace that engaging employees can be a challenge. However, by recognizing the challenges, keeping them front of mind, and taking small steps in the right direction, the obstacles that seem momentous today can and will be overcome.

For more information about how work/life flexibility positively impacts engagement, download our Free White Paper. 

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Topics: employee engagement

3 Tips for Getting Employees Excited about an Employee Engagement Survey

Posted by Kelli Killian on Aug 6, 2014 10:22:00 AM

 Today organizations are treating employee engagement as much more than a trendy buzzword. Companies realize the very real impact engaged and disengaged employees have on their business, and they are looking for ways to keep employees engaged. Many of these organizations have found the value in administering an employee engagement survey and action planning around survey results to improve.

While surveys can be a powerful tool for increasing employee engagement, their benefits can really only be realized when the proper practices are set in place to support your survey initiative. An important step in survey administration is promoting the survey to employees to help them understand why you’re administering the survey in the first place. If employees do not understand, then they are less likely to participate in the survey or to respond thoughtfully, which could result in incomplete or inaccurate data. If you can’t help employees buy into the survey process, then the point of conducting the survey is lost. 

So how can you get your employees eager and enthused about the survey?  Read on for three tips to help build excitement about your employee engagement survey.



  1. Be an open book.  Let employees know why you’re conducting a survey and why it’s important. Share important dates. Let them know the steps you’re taking to ensure survey confidentiality. Tell them why the survey will be beneficial to them and the organization overall. Knowing the “how” and “why” will help to build enthusiasm among employees.
  2. Involve employees.  Including employees in the planning process can help increase their enthusiasm for the survey and show that this really is a team effort for the entire organization. Involving employees could be as simple as asking for volunteers to be survey captains, who champion the survey and encourage participation. 
  3. Consider an incentive.  A little extra reason to get excited about the employee survey can come in the form of an incentive. Prize examples could be a popular gift card, a catered department lunch or even an extra vacation day. Individuals should be entered to win only if they complete the survey. An incentive is an easy way to get employees’ attention.

Interested in learning more about building excitement for your employee engagement survey?  Check out our case study from AtlantiCare to learn how they boosted survey participation rates among their employees.


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Topics: employee engagement survey

Three Reasons Why CAHPS Survey Questions Aren’t Enough

Posted by Greg Hyman on Jul 29, 2014 9:41:56 AM

The Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys have done much over the last several years to encourage increased focus on the patient experience by tying patient survey scores to a portion of Medicare reimbursement.

Where many feel CAHPS has fallen short, however, is in potentially creating the impression that a static, standardized national survey is a sufficient tool for assessing the patient experience, let alone serving as a jumping point for improvement.  What more and more healthcare leaders are recognizing is that CAHPS surveys alone simply are not enough.

Scientific research bears this argument out.  A recent article in the journal Health Marketing Quarterly reviewed the validity and usefulness of HCAHPS. The authors concluded that the HCAHPS survey is an excellent beginning, with some problematic elements.

The results of the study closely mirror the findings of similar analyses conducted by Avatar.  In one such analysis, Avatar researchers compared the scores of clients who use an Avatar patient survey in conjunction with HCAHPS against the scores of those who use HCAHPS only.  The researchers found that clients who use an Avatar survey in conjunction with HCAHPS perform significantly better than clients who use HCAHPS only.

So why the discrepancy in scores among users of a robust, customized survey tool and users who limit themselves to the CAHPS survey?  HCAHPS measures only a small portion of the patient experience. Many other service and care factors are important or even central to the patient experience.  As a case in point, a regression analysis performed by Avatar researchers found that HCAHPS predicted only 38.6% of variance in Overall Hospital Rating and 35.8% of Recommend.  As such, HCAHPS is not providing complete information on the patient experience, potentially leaving organizations with missed opportunities to improve performance.

This is one of the reasons why surveys customized at the point of generation to reflect the individual patient experience are so powerful.  Adding items addressing services that an individual patient has received allows organizations to collect more accurate, more comprehensive data on the patient experience, extending the reach and specificity of their performance improvement initiatives.

While existing and emerging CAHPS programs have helped shift healthcare to a culture with increased focus on the patient experience, the demand this focus places on healthcare leaders to identify and improve service gaps underpins the reasons why CAHPS survey questions aren’t enough.  Customized, diagnostic surveys measuring each specific aspect of the individual patient’s experience have proven a powerful tool for driving significant gains in experience scores, and thus are the natural complement to any CAHPS program.

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Topics: HCAHPS, CAHPS Survey, patient satisfaction surveys, patient experience surveys

Three Ways to Ensure Confidentiality When Conducting Employee Engagement Surveys

Posted by Melissa Herrett on Jul 23, 2014 1:54:49 PM

Often, one of the biggest deterrents for employees when completing an engagement survey is their concern that the survey is not entirely confidential. If employees are worried they could be identified by their responses, they may be less apt to fill out the survey, and/or they may not be as truthful. The information gathered from the survey may therefore be inaccurate, and improvement plans will be less impactful.

In order to gather the most comprehensive data, organizations must be proactive about alleviating employees’ concerns regarding confidentiality.

Here are three tips to help ensure employees’ confidence in the confidentiality of your next employee survey.

  1. Contract with an outside party – Employees will likely feel more comfortable taking the survey if they are submitting their responses to a third party, rather than to management directly.
  2. Include information about confidentiality in the survey instructions – By clearly explaining what measures you are taking to keep responses confidential, employees will have a better understanding of these measures and will be more trusting of your commitment to maintaining confidentiality. Include detailed information in the survey instructions, clearly outlining your methods for keeping responses confidential, thus encouraging employees to state their honest opinions.
  3. Don’t report results under a certain threshold – If a manager only has one or two employees, it will be much easier to identify which employee is responding in a certain way. Therefore, to avoid this issue, report responses for small groups of employees as part of a larger group. At Avatar, for example, we maintain a five-person threshold, where responses from groups with less than five people are not reported directly to managers, but rather folded into a larger group.
By taking these steps to ensure confidentiality, you will show your employees you are dedicated to getting the most accurate responses and ensuring they are at ease answering the questions honestly. Alleviating confidentiality concerns will likely contribute to higher participation rates, thus allowing you to gather the most actionable data to engage your employees.
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Topics: employee engagement survey, employee engagement, Confidentiality,

Patient Satisfaction Survey Questions and Dimensions

Posted by Kelli Killian on Jul 8, 2014 6:09:30 PM


Patient satisfaction is a priority objective for many healthcare leaders today. With the implementation of Value-Based Purchasing (VBP) and the increased importance placed on patient loyalty, healthcare leaders are focused on finding ways to improve patient satisfaction. One influential way to implement this change is by administering a patient satisfaction survey to gather detailed information.  Patient satisfaction survey questions are posed based on broad dimensions of health care through which they can be measured.  Avatar Solutions utilizes the 5 point Likert scale to measure response to survey items instead of questions that make statements such as “Overall I was satisfied with the care I received.” Survey items that can be measured from “strongly agree” to “strongly disagree” dig deeper than questions alone. Read on to learn some of these dimensions and their common accompanying items that help to measure patient satisfaction.

Physician A high area of interest for healthcare leaders conducting a patient satisfaction survey is the physician dimension. This dimension measures the patients’ satisfaction with their doctor. There are many items of focus under the physician dimension. Common survey items include:

    • The doctor treated me with dignity and respect

    • I was given the opportunity to ask questions

Check-Out Process As an important part of the patient journey, the check-out process is frequently measured on patient satisfaction surveys. Common survey items include:

    • How promptly you were able to check-out

    • Explanation about the use of medications

The check-out process is one of the last points of contact during the patient journey and thus an area that healthcare leaders are concerned with measuring patient satisfaction.

Facility The organization’s overall facility is an important and often overlooked part that helps make up the patient experience. Common survey questions include the following:

    • Comfort and safety while waiting

    • Adequate parking was available

These are just a few of the dimensions and items that can be addressed on a patient satisfaction survey. To learn more about patient satisfaction, check back on our blog next week and join Avatar’s LinkedIn group The Patient Journey to continue the conversation.

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Topics: patient satisfaction survey

What the 4th of July Can Teach About Employee Engagement

Posted by Melissa Herrett on Jul 3, 2014 10:58:42 AM

In honor of the holiday tomorrow, let’s examine what July 4th can teach us about employee engagement.

Independence – On Friday, we celebrate the independence of the nation. Just as our forefathers desired independence, employees also want autonomy. Most engaged employees excel in environments where they are allowed to be independent, without a manager constantly looking over their shoulder. When given the independence and leeway to accomplish tasks in their own way, employees see that their managers trust them to get the work done, and these feelings of being trusted are instrumental to engaging workers.

Celebration – The 4th of July is a day filled with barbeques and fireworks to commemorate the holiday. It’s important to remember that employees want to be celebrated too. Take time to recognize what employees are contributing. Recognition doesn’t have to be monetary or extravagant. A simple “thank you” goes a long way. Sit down with employees to acknowledge the hard work they are doing for your organization on a regular basis. This extra effort will be incredibly effective when it comes to engaging your workers.

Community – over the July 4th holiday weekend, a lot of attention is given to community. Whether you’re going out with friends, hanging with family, or barbequing with neighbors, the holiday is often a time to bond with people important in your life. At work, employees need the opportunity to connect with their coworkers as well. After all, they see these individuals often, even more so than some of their friends and family. Given this frequency, it’s worth the effort to encourage employees to establish rapport and relationships among their peers. Additionally, Avatar has found that coworker satisfaction strongly impacts retention. By encouraging employees to get to know each other in a more personal way, you will contribute to their engagement and retention.

Fun – July 4th is a time to kick back, relax, and have some fun, which is why many people look forward to the holiday. Adding a little fun into the workplace regularly can go a long way in engaging employees. Avatar has found that fun is strongly linked to engagement. Employees appreciate the opportunity to let loose a bit. Not only does it help them unwind, it also helps reduce stress which may lead to burnout.

Beyond independence, celebration, community, and fun,the 4th provides a great opportunity to inspire employees to maintain a work/life balance. Encourage workers to completely disconnect for the holiday and enjoy their time off. Let them go home a little early on July 3rd so they can get a jump start on their weekends. Employees will appreciate your thoughtfulness and will likely come back more engaged and ready to jump into work following the holiday.

Happy Fourth of July! The team at Avatar Solutions wishes you a fun and relaxing holiday!


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Topics: employee engagement

Four Home Health CAHPS Decisions Every Agency Should Consider

Posted by Greg Hyman on Jun 24, 2014 6:00:00 AM

In an age when consumer data and reviews are always just one click away, there are no less than one hundred good reasons why every healthcare agency should be surveying their patients, and many companies are indeed doing so.  But when it comes to implementing a highly regulated survey like Home Health CAHPS, many agencies hesitate.  The prospect of additional regulatory requirements to comply with is seldom an attractive prospect to leaders, who may also be unsure how to navigate the aspects of the survey for which there is a choice of approaches or methods.

To help leaders develop a recommendation regarding how to move forward with Home Health CAHPS, here are four exploratory decisions that every agency should make:

Decision #1: When to Implement?  For most organizations, the decision of whether to implement Home Health CAHPS can be approached as a matter of straightforward arithmetic.  CMS has tied a 2% Annual Payment Update for Medicare to participation, and for large agencies, this financial incentive can be significant.  So the question then becomes when to implement.  Agencies that have the resources to put a Home Health CAHPS process in place are advised to do so early, to help align performance in anticipation of future public release of data. Improvement initiatives supported by your survey data this year can generate ROI not only through the Annual Payment Update, but also through improved reputation and patient retention.

Decision #2: In-house or Outsourced?  While some organizations opt to conduct their Home Health CAHPS surveys in-house, most home health agencies will find the financial and ancillary benefits of outsourcing their Home Health CAHPS process far outweigh the initial investment. In addition to saving you time and ensuring compliance with complex regulations, an experienced vendor can provide resources to help your organization improve its scores, as well as make expert recommendations on administration and sampling techniques.

Decision #3: How Much Data?  Home Health CAHPS is an excellent starting point for assessing the patient experience. However, because the information it captures is very high-level, users who wish to understand why they scored a particular way and how to improve will need more insights. Vendor-developed diagnostic survey items designed to provide actionable insights can be included with each Home Health CAHPS survey to support improvement efforts.

Decision #4: What to do with the Data?  Some organizations will content themselves with a Home Health CAHPS process designed solely for and ending with fulfilment of the CMS participation requirements. However, these agencies are missing out on a powerful opportunity.  By using the CAHPS and supplemental survey item data to steer improvements, agencies can drive better financial outcomes and, more perhaps important, honor the feedback of their patients.  Organizations that don’t take these steps may even risk appearing cavalier regarding the feedback their patients have taken the time to share.

Whether the focus is Home Health CAHPS or any other patient survey, agencies are well-served to consider these questions and make an informed initial decision as part of the exploratory process.  The answers to these questions, as well as the underlying rationale, can help not only determine whether and how to implement a survey, but also how to position the initiative when submitting a proposal to executive leadership or a board of directors.


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Topics: CAHPS, Patient Survey, Patient Surveys, patient experience, patient experience survey,, Home Health Care CAHPS, HH-CAHPS, medicare, home healthcare

Employee Engagement Versus Satisfaction: Which Is Best for You?

Posted by Kristina Anderson on Jun 19, 2014 8:30:00 AM

Despite the permeation of employee engagement throughout the industry, there is still confusion about what employee engagement is, how it differs from satisfaction, and which is a better indicator of workplace success.  Measuring employee engagement versus satisfaction can impact the results you see from your employee survey.  While satisfied employees may be happy in the workplace, they aren’t necessarily the best performers, and vice versa for engaged employees. 


When thinking about the difference between employee engagement and employee satisfaction, it’s important to think about the impact of each on an employee’s job performance.  For example, your organization may choose to improve the employee parking situation, which would make employees happy and satisfied.  However, while they may be happy, is that happiness likely to translate into better performance? 

On the other hand, your organization may choose to add more career development opportunities, helping employees see their potential future within the organization as well as providing effective training to help them in their current positions.  This type of improvement, related to employee engagement, is likely to actually boost performance as it makes employees more excited about the organization and the work itself, and therefore willing to exert extra effort into their work. 

When deciding which type of survey is best for your organization, it’s important to think about what you’re measuring and how it will impact the organization.  If you suspect satisfaction issues are driving employees to resign, an employee satisfaction survey may be a better starting point for your organization.  However, if you’re looking to improve business outcomes, employee engagement may be a better fit.  To learn more about the different types of employee surveys available, check out our previous blog post here


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Topics: employee engagement versus satisfaction

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