Hospitals may see a dip in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, the national, standardized, publicly reported survey of patients’ perspectives of hospital care administered by CMS, because of how COVID-19 affected the experience of patients in the past year.

The HCAHPS survey asks 29 questions about recent hospital stays, with 19 core questions about such critical aspects of the experience as communication with nurses and doctors, the responsiveness of hospital staff, cleanliness, quietness, and education about medications. The survey also asks for an overall rating of the hospital (i.e., whether they would recommend it to others). The survey is administered to a random sample of adult patients between 48 hours and six weeks after discharge.

Hospitals may take a hit in the next round of HCAHPS results because of the COVID-19 pandemic, says Matt Dickson, vice president for product strategy and general manager with Stericycle Communication Solutions in Forest Park, GA, which provides patient engagement services to healthcare providers.

The company regularly conducts its U.S. Consumer Trends in Patient Engagement Survey to gauge satisfaction in areas that may influence HCAHPS results. The company recently asked 500 U.S. consumers about their experience during the pandemic. (Read more here.) These were some of the key findings:

  • There was a 13% decrease in patient satisfaction with provider communications since the beginning of the pandemic.
  • Provider COVID-19 policies and procedures were not effectively communicated before scheduled appointments (37% of respondents).
  • Virtual waiting rooms were preferred over physical waiting rooms during the pandemic (81% of respondents).
  • There was a 10% increase in the number of patients seeking mental health treatment during the pandemic.
  • Sixty-seven percent of respondents used telemedicine or virtual channels at least once since the pandemic began.

Some effects of the pandemic have been talked about at length, such as the expanded use of telehealth. But the survey uncovered some other issues.

“One of the interesting things we found, and it is kind of counterintuitive, is that people are feeling more rushed now than they had historically when they attended an appointment,” Dickson says. “One would think that during the pandemic, people want to minimize the time they spent in a doctor’s office, but we found that there was a 35% increase in people who said they felt rushed during an appointment.”

Even more alarming, particularly as it may affect HCAHPS scores, is what drove this feeling of rushing.

“Many people were telling us their providers were not spending adequate time with them and were making assumptions about what was wrong with them and the right course of treatment,” Dickson reports. “We can see how that might have a noticeable impact on HCAHPS scores, particularly with how patients perceive their communication with nurses and doctors during their stay.”

These survey results may be a “canary in the coal mine” for HCAHPS survey results, Dickson says.

“We are seeing that the number of people who are satisfied with communications crashing and the number of people who are very dissatisfied accelerating. People are feeling more rushed, and we know very specifically that those sentiments affect those HCAHPS scores in relation to doctors and nurses,” Dickson says. “I would imagine that those two things would portend that those HCAHPS scores would be more negative than they have been historically.”

Before the pandemic, 73% of patients surveyed said they were very satisfied with the communication with their healthcare providers. During the pandemic, that figure nosedived to 60%. The number of patients who said they were not satisfied at all tripled.

“The lesson is that you have to double down on communication, trying to make it more effective, more tailored. Much of the communication has been focused solely on COVID-19 responses, and limitations and requirements, and now the vaccination effort,” Dickson says. “It’s time to start thinking rather aggressively about how to re-engage consumers. For those patients affected by the limits on elective surgeries, for example, what do you need to do to re-engage with them, make them feel welcome, and communicate effectively with them?”

The survey results revealed intriguing information about the “channel of choice” among consumers, Dickson says. There is a disconnect in how patients say they want to communicate with healthcare organizations and what communication techniques actually result in patients acting.

When asked what type of communication they prefer with healthcare providers, 37% said email. Another 30% said by phone, and 28% said by text. But for patients who had missed an appointment during the pandemic and rescheduled it, the survey asked about what triggered rescheduling. Even though 37% said they preferred email communication, only 2% of respondents said an email had triggered them to reschedule, Dickson reports. “The far and away leader for getting people to take action and reschedule an appointment was a phone call, with 56% of our respondents saying a phone call was what got them to take that action,” he says. “You have to have these aggressive outreach campaigns if you want them to really take action to reschedule these elective surgeries and other things that were delayed. Now is the time to be very proactive about engaging with consumers.”

Another area of concern involves a heightened desire for mental health services during the pandemic, Dickson says. Before the pandemic, about 16% of survey respondents were using mental health services, but that number went up to 26% during the pandemic.

Not only did the number increase, but the patterns of demographics of those using mental services also shifted. Prior to the pandemic, the demographic most likely to use mental health services was patients age 55 years and older. During the health emergency, ages ranged from 35 to 54 years.

Dickson suggests healthcare professionals may need to change their approach to mental health as the pandemic wanes. The survey revealed 23% of respondents had missed at least one appointment with a provider, of any type, because of their state of mental health during the pandemic.

Here, it is important again to consider communication preferences and how those vary by age. The Stericycle survey showed patients age 25 to 44 years prefer texts, while an older demographic wants to receive a phone call. Patients in the middle prefer email.

“You have to have effective strategies based on demographics and not a one-size-fits-all approach,” Dickson says. “But at the same time, you have to tailor your approach based on outcomes and not just stated preferences. That’s where a lot of health systems fall down today, by not closing that loop. They just look at how the patient says they want contact and flood that channel with communication, as [opposed] to looking at whether they’re really inducing action, and what they might need to change.”

The method of communication might need to change according to what kind of information clinicians are trying to provide. For an appointment reminder, the patient’s preferred channel might most effectively reduce no-shows. However, when it comes to re-engaging patients in their healthcare, the preferred channel might not be the method that produces results.

“A key finding for hospital administrators, particularly those focused on quality, is reminding their staff that now, more than ever, is the time to slow down a little bit and spend more time with patients. Make sure they feel like they are getting complete answers, all the information they are seeking, and not feeling rushed,” Dickson says.

It is important to maintain a strong, proactive strategy for patient engagement. What Dickson sees more often is a reactive strategy, in which clinicians put out a general message with a phone number or website.

“It is not very tailored to the individual, and it certainly is not speaking to things like saying ‘pre-pandemic, you were going to have this procedure, and let’s see what we can do to get you back in the process and ensure your long-term health,’” Dickson explains. “That takes more effort, but that’s what makes patients feel you are communicating effectively and actually care.”