He says that's a great way to begin a discussion about HCAHPS not being the final arbiter of patient experience or quality, "because it's a great measure of 'always.' If my mom was getting care, do I want her to say that someone ‘always' did this or that—whatever question is being asked—or that her nurse was compassionate and took good care of her?"
He says he sees a lot of working to the test and toward obtaining the "always" answer.
"When you put them to a test that requires an ‘always' answer, it doesn't give them any opportunity to impact the patient experience," he says. "I don't believe a lot of hospitals are going past HCAHPS scores. About 20% are doing it because there's a penalty associated with it, and most of the rest are lagging and not doing anything about it."
UCLA's Feinberg says, without a hint of hyperbole, that from a leadership standpoint, patient experience is his "singular focus."
He practices what he preaches by rounding on patients for a couple of hours each day, and he makes it clear that he expects his management team to do so as well, if not to his extent from a time standpoint. He insists that everything else should be subordinate to what he calls a "laser focus on making sure the next patient gets that best care."
When others, including patients, see examples of great care through actions or patient referral, he makes a point of celebrating it, making sure the individual who exceeded expectations gets the credit.
"When we fail, we share that broadly as well," he adds. He encourages the staff—anyone who comes in contact with a patient—to probe patients and their families to "see where we messed up," he says. "I give out meal coupons and Starbucks coupons. We're pretty service minded."
He says service recovery, in the form of responding when things go wrong, is key to retaining patients over the long term, and that's what he's most concerned about—test scores are only one way of measuring how well they are meeting that goal.
"We're clearly far from perfect, but when those things happen, we're aggressive in seeing if we can make amends," he says.
Every unit, every shift, huddles around metrics and reviews handwritten notes as well as current HCAHPS scores and core measures scores. That kind of daily reinforcement helps tie workers more closely not only to how to recover from mistakes, but also to the patient's needs, refocusing them on what's most important.
"The best thing we've ever done to improve employee satisfaction is not to focus on it. Rather, we've focused on patient satisfaction," says Feinberg. "People here want to take care of others. If we're doing that, they're more satisfied in their jobs. I don't care if we ever become an employer of choice. We want to be a place that patients choose. If you get it right for the patient, your employees are happy, because their job is easier and you've tapped into their purpose."
This article appears in the February 2012 issue of HealthLeaders magazine.