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The education topic for this edition covers 2 CAHPS Survey questions:

Rating of this Hospice
1. Using any number from 0 to 10, where 0 is the worst hospice care possible and 10 is the best hospice care possible,
what number would you use to rate your family member’s hospice care?

Willing to Recommend this Hospice
2. Would you recommend this hospice to your friends and family?


Rate This Hospice: 81%

Willing to Recommend This Hospice: 81%

Click here to check out the National Averages.

Click here to check out State Averages. 

Why These Scores Matter

The survey is a regulatory requirement.

The results guide decision making both internally and externally. Internally the results should be used to improve processes. Externally, the results feed into public ratings which impacts consumer decisions, referral decisions, and perhaps as is often discussed, CMS pay structure.

The CAHPS evaluation is different from improving a clinical or technical process. The evaluation, especially as it regards rating & recommendation, is about the experience.

In many ways it’s simpler to correct a clinical problem or process. Improving an experience requires an entirely different skill set. Is your hospice agency ready with the right staff, skill sets, time, energy, and expense to implement the fundamental changes it will take to improve these scores?

5 Point Plan To Improve The Hospice Experience:

A key point to keep in mind, the CAHPS survey is not a survey of how the hospice patient experienced hospice, it’s a survey for everyone BUT the person who went through hospice.

Another important element to remember is that the survey takes place approximately 2 months after the patient passes. The family member or caregiver who completes the survey may be dealing with grief, regret, loss and the memories of the details of things the hospice agency may have done right, like resolving breakthrough pain that holiday after-hours may have faded away.


5 Points to improve the hospice experience:

A. Create Non-clinical QAPI (Quality Assurance and Performance Improvement) Leaders

  • Get someone experienced in marketing (with a background in sales & customer service is a huge plus) to head up the Hospice Experience Improvement Program
  • Clinicians are great. We love clinicians. But this is a customer service issue, not a clinical issue. It’s about how people felt you treated their loved one, not whether your treatment was clinically appropriate.
  • Clinicians are busy and expensive. If your plan to improve how people feel about how you treated their loved one is to toss it onto the plate of one of the discipline heads, your approach is really only an incremental step and not a commitment to excellence.

B. Organize & Train Non-clinical Staff Responsible For Improving The Hospice Experience

You already have a format in place, it’s the format you use to get referrals. In most agencies the representatives responsible for generating referrals are non-clinicians. Duplicate the hospice training you provide for them with the non-clinical staff tasked with improving the hospice experience for family members & caregivers. This means:

  • Have them accompany all disciplines (RN, SW, Chaplain, Aide) on patient visits. They can’t improve the experience if they don’t know the experience.
  • Have them follow the hospice admin and other discipline heads (DCS, DON, Directors etc.). This will provide an understanding of the back-end problems, logistics (Scheduling, DME, Pharma), operations, internal decision making so they can understand how information flows and how that impacts the experience
  • Even if these team members have other responsibilities in the company, as it pertains to this project organize these team members under the marketing or customer service departments under a specific leader (point A). This should not be an unwieldy company wide project with input from every corner and endless meetings.

C. Train All Staff in QAPI Concepts & Techniques

  • Regular training and refresh of QAPI for all staff should already be part of your operations.
  • Expand the existing QAPI training & refresh with a team member from this project to update and inform the rest of your staff at company meetings, events, IDG, internal newsletters. The goal is to share information as to what is happening in the project, what steps are being instituted, what the best practices are, and to let that information influence and impact the rest of the company staff.
  • The information flow should be in one direction, from Hospice Experience Performance Improvement to everyone else. These meetings will fail if advice and suggestions are proposed from every side. Questions can be asked to clarify the knowledge, not to challenge or to lead into a litany of suggestions.
  • Institute a process outside of training & refresh meetings in the previous point whereby others can make suggestions. Great ideas can come from anywhere and people should be heard and feel like they are being heard.

D. Elevate Customer Service

  • Make your mindset an intent to wow and delight family members and caregivers.
  • From the start of hospice service create a plan for the caregivers and family members. Build on that plan throughout the hospice experience.
  • List all family members and caregivers and their contact details.
  • Call family members on a regular basis and talk with them. Listen to them. Hear them. Discover what they like and don’t like about how hospice is handling their loved one.
  • Duplicate how representatives get referrals. They don’t just make 1 phone call and hope to get referrals, your reps go out into the field and talk to referral sources. And then they go back and talk to them again. And again. Replicate that with family members and caregivers.  Have a team member join a clinician on a visit to a patient and while the clinician is with the patient, the experience improvement team member can talk with the family members and caregivers.
  • Track family member special events, holidays, birthdays, anniversaries and send a card, or an e-card through email. Note: if communicating through email, make sure all team members are paranoid about HIPPA.
  • In short, treat the family and caregivers as clients in their own right, not merely as an afterthought of hospice services.

E. Target Bereavement

Remember, the survey is going to the survivors, not the patient. And it’s going to them about 2 months after their loved one passed. It’s their last experience of your agency and how you handle bereavement will have a massive impact on the impression they are left with and how they feel about the hospice experience with your agency

Bereavement is already one of the top ten causes of deficiencies: CMS Top Ten Hospice Survey Deficiencies Compliance Tip Sheet. This means that most agencies are focusing on bereavement as a compliance issue: what must be done at minimum and not as a customer service issue: how do we wow and delight our client. Changing this mindset is critical to making bereavement a pro-active positive impact on your CAHPS scores.

Make sure that all bereavement information, cards, notices, etc., go through the hospice experience improvement team to be updated and have  brand consistency of imagery, messaging, and positioning. Chaplains, social workers, bereavement coordinators can often find themselves stuck in a rut sending outdated pdfs and form letters for generic memorials and 3rd party information to just one family member and checking the box that the task is complete.

Start planning for bereavement from the start of hospice service. For example, once end of life arraignments are made, the experience improvement team should get involved and start collecting stories for different family members to be utilized at end of life event through speaking at a service or a book given to the family with stories and pictures.

When your mindset is to wow and delight, the possibilities are endless.


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