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How “OK” Can Hurt Your HCAHPS Scores

How “OK” Can Hurt Your HCAHPS Scores

How to Find the Silent Saboteurs

The Tyranny of the Few

HCAHPS survey responses reveal that dissatisfied patients are relatively rare — but carry a heavy weight against top box scores and make a significant negative impact on scores. For most hospitals, HCAHPS response rates have fallen to as little as 1925%.  The percentage of not-top-box varies from 5% to 40% meaning that all of your negative responses are coming from less than 10% of the population and, in some cases, less than 2%.  That means that you’re visiting as many as 50 patients to find just one not-top-box respondent. Rounding is the only way to find these patients, but these numbers help us understand why modest changes in the number of patients visited have had a limited impact on PEX scores.

 But it’s even worse than the numbers would suggest.  It turns out that our most vocal complainers rarely become not-top-box respondents. The optimist concludes that nurses are doing a great job addressing concerns for these vocal patients. The cynic concludes that these patients always complain so our performance doesn’t warrant the effort of a survey response.

 Instead, the majority of your not-top-box respondents are people who did not self-identify in the hospital. It’s hard to say why. These patients may be adverse to conflict, [assume hospital stays are bad], they may not want to complain about the person who’s sticking them with a needle, or they may simply feel that they’re not qualified to complain to nurses and doctors.  Whatever the reasons, these silent saboteurs are responsible for your HCAHPS challenges.

How AI Gives Silent Saboteurs a Voice

How do we find people who don’t want to talk to us?  By applying machine learning to the pattern of HCAHPS responses, it’s possible to predict which patients will return not-top-box scores which gives silent saboteurs a voice.

When talking to a likely Silent Saboteur, ask twice.  Be sensitive to terms like “OK” and “Fine”.  For other patients, this may simply mean that they understand that a stay at a hospital is an unpleasant experience.  For Silent Saboteurs, this could be an indicator of an unspoken concern.

 Using insights from APEX, healthcare teams can focus on providing more efficient and more effective care.

Learn more about APEXAmenity’s smart recommendations.

Ambassador Software Works 

Ambassador Software Works provides AI-based patient insights through its proprietary APEXamenity Rounding Tool and through partnerships with leading Rounding Tool vendors. To learn more about how AI-based patient insights can improve your patients’ experience, HCAHPS scores, and VBP reimbursement, please call 855.349.4224 or email