Address Falling HCAHPS Scores with Better Communication Tools

By Matt Phillion

A recent RAND study found a 3.6% decline in HCAHPS scores across 3,400 hospitals (2021 vs. 2018-2019), with the greatest decline in communication-related areas like post-discharge details and care team interactions. As hospitals continue to battle burnout and staffing shortages, the need for advancements in patient/provider communication is rising so that healthcare teams can provide a better experience and improved interactions with patients.

Dr. Will O’Connor, Chief Medical Information Officer with TigerConnect, notes that the expectations of the average healthcare consumer has changed in the past 10 or 15 years as improved communication has become the norm in industries outside of healthcare.

“You bring your car in for service, you get constant updates. You order a package and you’re constantly updated about its status,” he says. “People are used to having communication be easy and having it take place over the medium of your choice, whether that’s voice, text, etc. That’s not consistent in healthcare at all, and people notice the difference.”

By comparison, healthcare often still relies on a louder, more intrusive style of communication.

“There’s still a huge reliance on overhead paging, on yelling down the hallway. Nurses are sometimes required to wear voice-based badges that they receive calls on all the time,” says O’Connor.

He had a chance recently to experience the noise and clatter of hospital communication recently when his mother needed to be admitted.

“The nurse in my mom’s room was having a rather sensitive discussion and was doing a great job showing empathy but was suddenly interrupted when her badge started squawking that another patient needed help getting off a bedpan in another room,” he says. “This style of communication is interrupting a super sensitive conversation with something that can be handled by a tech in that moment.”

This style of communication can be not only intrusive to the patient the nurse is speaking with and the nurses themselves as they are interrupted while providing care, but also to the patient asking for help on the other end.

“After about three hours, I knew what was wrong with the patient in the next room over,” says O’Connor. “I should not have known that. It created a frantic experience and a loss of privacy.”

The EHR still takes center stage

Another challenge O’Connor notes is the way organizations rely heavily on the electronic health record (EHR), often for tasks the EHR is not designed specifically for.

“A lot of systems rely on the EHR for everything. If a nurse messages a physician through the EHR and they don’t respond, there’s no way of immediately knowing if they received the message or even messaged the correct physician,” he says.

EHRs are the elephant in the room when it comes to introducing new administrative technology tools into the mix, O’Connor explains.

“EHRs are sucking all the oxygen out of the room and a lot of the money out of IT budgets. They’re tremendously expensive, and they are trying to do everything, to be a Swiss army knife,” he says. “EHRs are essentially, on purpose, a billing tool and they are patient centric. The communication tools we need should be provider-centric, built around communication rather than a chart.”

Trying to use legacy technologies not meant to be a communication tool is one of the biggest barriers to improving success in this area, he says.

Users relying on out-of-date, inefficient technologies can also be problematic when trying to improve the patient experience.

“People are still using pagers,” says O’Connor. “Healthcare is the only place you see them in use at all. Some physicians like them because they offer a barrier for how they respond, but that lack of transparency isn’t fair to the nurse at the bedside who sends that page out into the ether. It’s a stressor for the nurse and for the patient not knowing if and when the physician is going to respond.”

Sending a message through a purpose-built communication tool where they can see the message was sent, received, read, and responded to offers more transparency for everyone.

Add to this technology mix the added challenges in communication during shift changes and handoffs and you risk creating a bad experience for the patient, O’Connor says.

“If all of the moving parts don’t connect because you don’t have the type of communications systems that exist in every other industry, it all combines into people getting very upset,” he says.

Change is hard for many health systems, O’Connor says, and often it requires someone at the top to enforce change as the right thing to do to improve care.

“We know, there’s evidence, study after study that shows that most errors in hospitals—medication errors, patient errors—are due to gaps in communication, and that’s a great reason to take steps to change your communication solutions,” says O’Connor.

Communication and burnout

The correlation between burnout and communications struggle is a clear line, O’Connor says.

“We’re making their jobs a lot harder and a lot more stressful by not making these tools available; it’s death by a thousand cuts,” he says. “You’re being annoyed all day either by delayed responses, lack of responses or being interrupted. If I’m dispensing a complicated medication, I don’t want a badge squawking at me when I’m trying to do mental math. If we’re interrupting staff when they’re doing complex tasks, of course more bad things will happen.”

With the ever-increasing issue of the labor shortage, tasks are being routed to nurses, including tasks that might not necessarily require an immediate interruption, which decreases their capacity for patient care.

“The technology exists to make these things easier,” says O’Connor. “Consider the option to telemedicine into the patient’s room, particularly now with COVID. The time it takes to don and doff PPE, the expense incurred for that PPE, for a 30-second question—you save 10 or 15 minutes per patient, and that adds up.”

Change from within

It’s going to take the combined influence of physicians, nurses, leadership, and even patients to make an industry-wide change in how communication is handled in healthcare, O’Connor says.

“We know this has a demonstrable, positive effect on cost, quality, and efficiency of care,” he says. “It’s the right thing to do for both the business and the patient.”

Nurses and physicians banding together to ask for modern communication tools like those used in other industries would be hugely influential.

“Don’t burn us out,” says O’Connor. “Make the job easier and less prone to burnout.”

Patients can leverage their influence in this case as well by asking healthcare to modernize communication in ways that mirror other industries.

“We as a society should be demanding this. There’s no reason for a patient to be there in a loud environment. And the waiting—if you ask anyone in a healthcare situation what they’re doing, the answer is often: I’m waiting. We wait a lot. And a lot of that is poor communication,” says O’Connor. “It’s important for hospital leaders to realize this is bad for business.”

It’s where quality of care meets financial impact, he explains. Doing the right thing the right way impacts length of stay, which in turn enables organizations to see more patients more efficiently. It’s a win for everyone in the process.

“I think these systems should be mandatory,” says O’Connor. “We have had this in the past. The EHR became mandatory, essentially, and not only do you have to have them, you have to have meaningful use. We passed all those requirements and I don’t know if EHR has really improved patient care—clinicians are spending half their day in the EHR. But in this case, we know there’s a demonstrable improvement when communication tools are used. We need to create this communication fabric across our health systems. It’s going to benefit care and greatly improve the patient experience.”
One of the biggest barriers to innovation, O’Connor says, is showing that real impact.

“I still think that looking at the baseline problem that such a high percentage of errors are errors of communication, and in many cases we’re either using archaic systems or systems that are not built for communication, it’s having a negative impact on cost, quality, and experience for both the patient and caregiver,” says O’Connor. “These technologies are easy to install, easy to use, and demonstrably improve the experience overall.”

Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at