It is quite common to hear the following sentence around healthcare conference room tables where patient experience data are being discussed, “We need to get more surveys back so that our scores will go up”. Sound familiar? This ‘more equals better’ assumption appears logical. In general, as well as depending on the circumstances, more does equal better. More time, more money, more sleep, etc.

But why is it that the ‘more equals better’ assumption is unequivocally accepted when it comes to patient experience data? This belief is especially puzzling in the presence of another common sentence at those same conference room tables, which is, “Only the dissatisfied patients return surveys”. Perhaps we should examine what exactly happens to scores as more surveys are returned.

A 2012 study conducted by Bob Hayes, Chief Research Officer at Appuri and author of the Business Over Broadway blog, analyzed a twelve-month segment of raw HCAHPS survey data made available by the Centers for Medicare and Medicaid Services. The aim of the analysis was to find out what affect response rates have on HCAHPs scores, and if the ‘more equals better’ hypothesis holds true.

Bob Hayes’ approach in this study was to first make a distinction between the pure number of completed surveys and response rate.  There is an important difference.  You can increase the number of surveys returned, but still be unsatisfied with the rate at which surveys are being returned. By first making a clear distinction between response rates and the number of completed surveys, the analysis unveiled very interesting findings.

Without taking into account the hospital level response rate, hospitals with less than 100 completed surveys had higher HCAHPS scores when compared to hospitals that received more than 100 surveys. As the pure number of surveys returned decreased, the scores increased. This could be an indication of hospital size and volume, which was not included in this analysis. One could argue that hospitals receiving less than 100 surveys returned in a year these are smaller hospitals with lower patient volumes which should lead to a more comfortable and personal culture and better service. Also, take for example a scenario where a segment of dissatisfied patients randomly return their surveys all around the same time. This influx of negative returned surveys is bound to have a negative impact on scores and would create a situation where scores actually decrease when simply focusing on getting more back.

Conversely, the exact opposite happened to HCAHPS scores when the measure of the response rate increased. The study also finds that hospitals with higher overall response rates received substantially higher HCAHPS scores. There was approximately a 20 top box percentage point difference between the lowest response rate segment of hospitals (20% response rate or lower) and the highest response rate segment of hospitals (51% response rate or higher). There are opinions that it is not the response rate that is driving the higher scores. Rather, a high response rate comes from patients who are more positively engaged with the hospital in the first place, which is why they are more likely to give more favorable scores. It is not the rate at which surveys are returned that give patients a positive perception, but rather an actual positive experience and relationship that give patients a positive perception.

What’s important for healthcare leaders to focus on, then, is improving the patient experience first and foremost. By prioritizing improving the experience over the resulting data, leaders can position themselves above the fray and avoid pursuing the wrong objectives. Providing a consistently high-quality experience will yield consistently high scores as the number of surveys returned and response rates fluctuate.  If you create the exceptional experience, the scores (and response rates) will come.