Question: 
I read your response to the question, “For benchmarking, why do you recommend using the overall satisfaction question on the employee and physician surveys instead of the would recommend question?”  You stated that overall satisfaction was the best question for employee and physician surveys and provided excellent supporting insights.  Do you think this same logic could be applied to the HCAHPS questions?  In other words, if a hospital was going to pick one question for their evaluation, would you recommend using the top-box percentage on the overall satisfaction question or the percentage of ‘Always’ on the Likelihood to Recommend question?

Answer provided by:
Dr. Randy Carden
Director of Research Services, HealthStream Research

Thanks for your follow-up question.  (You can access the previous Ask the Experts article here) 

I think that the same logic applies to the HCAHPS survey.  The Overall Hospital item is a summative question wherein you rate your entire experience with the hospital.  The HCAHPS Recommend question has the same issues as physician and employee surveys.  Although the forthcoming value-based purchasing model seems to not favor any question over another, if a hospital wants one item to use, I think the Overall Hospital item is the best.

By design, we use the Overall Satisfaction item as our primary benchmark.  We feel that Overall Satisfaction is the single best item when comparing across hospitals and against a single reference point.  The overall satisfaction question has the patient rate his/her experience with the hospital.  This question is less influenced by outside factors and is more of a summative perception of their experience inside the hospital. 

On the other hand, the Would Recommend item may be more influenced by factors outside of the hospital.  For example, this question is related to community reputation, the number of other hospitals in the region, advertising, etc…

Therefore, when comparing hospitals against hospitals or hospitals against a corporate or national benchmark, it is best to use a standard that is not influenced by factors outside of the hospital.  This logic supports the use of the Overall Satisfaction item. 

Do you have a question you’d like to send to our team of experts?  Send an email to researchinfo@healthstream.com, and our interdisciplinary team of experts will provide you with a detailed answer.  Specify if you wish to remain anonymous.