What Does This Score Mean?

I’ve worked in patient experience for many years in several organizations in different parts of the country and, while there are differences between health systems, there’s one thing I’ve seen in every one of them: a firm belief that only the angry people fill out surveys. 

It simply isn’t true.

And it makes me sad because it tells me that no one has taken the time to really explain these scores. 

Typically, when scores are posted, staff only see their percentile ranking. This is how your hospital compares to the rest of the hospitals in the database. It’s important because this is how CMS determines your reimbursement, but it doesn’t tell the whole story.

One of the best things you can do, especially in an under-performing hospital, is to break down the percentage of patients’ ratings for each question. If you’re scoring low when you look at the percentile ranking, look instead at how you’re actually being rated. 

For example, in answer to the question “Would you recommend this hospital to your friends and family?” your hospital’s responses are:

Definitely Yes 66%

Probably Yes 23%

Probably No  8%

Definitely No  3%

Does that look like only the angry people are filling out surveys? 89% of patients would recommend you. That looks pretty good, right?

Here’s the thing: CMS is only looking at the percentage of patients that gave you the highest, or Top Box, response. If it isn’t Definitely Yes, it doesn’t count. And, they’re comparing you to the other hospitals in the country and right now, 66% only puts you at about the 35th percentile. 

Think of it this way: if I got a 66% on a math test in a class full of smart kids who all got 90% and my teacher grades on a curve, I just failed. But if I’m in a class full of knuckleheads who all got 30%, I got an A. It’s all about your compare group. And you can’t control your compare group.

For a hospital that’s low in the percentile rankings, I find it’s best to break out each of the responses and focus on moving the second-highest scores to the Top Box scores. 

Here’s another example: your score for courtesy and respect for nursing is in the 12th percentile. Sounds terrible, right? But if you break it out, it might look something like this:

“During this hospital stay, how often did the nurses treat you with courtesy and respect?”

Always 70%

Usually 24%

Sometimes 4%

Never 2%

94% of patients gave positive responses; the key is in moving people from Usually to Always. 

When I took this approach and broke it down to the staff, a huge lightbulb went on and suddenly, it all started to make sense. Now, they weren’t feeling defeated being in the 12th percentile. Now, they knew they had to move a few Usually responses to Always responses and they didn’t have that far to go.

I still would want to investigate the 2% of patients who said Never, but the message to the staff, the way to keep them engaged and excited is to show them they’re not doing nearly as bad as they think. It isn’t only the angry people who fill out surveys.

Author: Kate Kalthoff

It's simple: leave people, places, and things better than I found them. For more than 20 years, Katherine Kalthoff has been working to improve the way healthcare organizations connect with the people they serve. She began her career at Gift of Hope, the organ procurement organization for Illinois, approaching families and securing their consent to donate a loved one’s organs for transplant. Through compassionate, empathetic listening, Kate led the Family Services team to one of the highest consent rates in the country. From there, Kate went to Advocate Health Care, Illinois’s largest healthcare system, as a Physician Relations and Business Development Manager, improving physician satisfaction and strengthening the relationships of both the employed and independent physicians with the system as a whole. Just prior to joining Northwest Community Healthcare as the Patient Experience Officer, Kate was the first Manager of Patient Experience at DuPage Medical Group where she built a platform of organization-wide service excellence through her inspiring brand of education, training, and one-on-one coaching. A much sought-after speaker and trainer, Kate has a very simple approach to her work: leave people, places and things better than you found them.

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