SPECIAL SESSION: Studying HCAHPS Scores and Patient Falls in the Context of Caring Science

Description/Overview: This session includes two sub-sessions regarding examination of critical outcomes within care that were identified as both regulatory and financial stressors. Each organization used path analysis derived from a caring science research program to identify which critical outcomes could be studied within the building model of caring science research. Both studies are from acute care hospitals in the USA but have wide application across the globe, to any hospital seeking to improve outcomes within the context of caring science. Within the first path analysis, it was identified the patients perception of caring (using Watson’s theory of caring) was impacted by staff who were clear in their professional role and the organizations’ system which in turn supported creation of a work structure that they could successfully make the patient feel cared for. If the research model could reveal how the context of caring impacted the patient’s report of caring, it seemed like a logical next step to show how this impacted patient satisfaction as measured by the HCAHPS scores. To most deeply understand the context and data relating to HCAHPS scores, a mixed method study was applied. The first of the three methods examined the relationship of caring, using Watson’s theory of caring, with five slightly reworded HCAHPS questions (with permission of the CMS). HCAHPS questions address the patient’s perception of pain, pain management, feeling listened to by staff, education on new medication and discharge instructions. The second method used a semi-structured interview of a panel of nine patients had been hospitalized in this hospital. Patients were selected for the panel because they had provided an HCAHPS score of 7 or 8 but not 9 or 10. It was desired to know where the hospital fell short in the patient reporting the highest scores of care. Finally, a secondary correlation analysis was conducted of HCAHPS scores from approximately 9,000 patients to understand if a profile high HCAHPS scores could be produced. Results provided a contextual understanding of HCAHPS. The second sub-session also used a path analysis within a caring science program to understand the structure of caring science data. This hospital, similar to the hospital studying HCAHPS in the first half of this session, used Relationship Based Care, Watson’s Theory, and was an acute care hospital. The similar context may explain a similar model of staff who had clarity of role and system were also the staff who reported a good work environment (relationally and technically) to make the patient feel cared for. However, this study has some unique behavior in the staff data and subsequent path analysis that encouraged conversation of what might be missing in the model of research. This process of respecification of the model revealed the concept of civility needed to be added as it was suspected the lack of civility (may be referred to as bullying) in some areas of the hospital was impacted the path analysis. The theory of civility proposed by Kathleen Bartholomew was used to study if civility did fit in this model and thus explain some of the variation in these data that had a context very similar to the hospital that studies the HCAHPS scores. Presenters of this study will review the civility, or lack of it, discovered in the hospital staff and how this impacted the model. Presenters will also review what actions were taken to address operationally what was discovered within this research.