Examining Patients’ Representativeness in HCAHPS Surveying: A Mixed-Method Approach in Healthcare

Date of Award

Spring 2024

Document Type

Dissertation

Degree Name

Doctor of Healthcare Administration (DHA)

Committee Chair

Alyncia Bowen

Committee Member

Lori Salgado

Committee Member

Bora Pajo

Abstract

This study examined the representation of racial minorities in the demographic subpopulation of Hospital Consumers Assessment of Healthcare Providers and Services (HCAHPS) survey respondents. These survey scores are the basis for a substantial portion of financial compensation from the Centers for Medicare and Medicaid Services; they are used to drive the process improvement of patient-centered care. Considerable previous research has focused on factors that affect HCAHPS scores and made adjustments to the scores of many other demographic factors. However, none has focused specifically on race and representativeness, which is needed to ensure benefits for all health care consumers. Reliance on this mechanism as the single measure of patient experience on which financial decisions are made and improvement efforts are centered may be a further example of systemic racism in a system with an established history of racism. This study examined the use of a representative sample from a social justice perspective utilizing Rawls’ framework from A Theory of Justice. Following the logic of this work, most people would not choose failing to hear diverse patient voices at a representative rate when blinded to their own identity, as this would not represent the choice most likely to result in patient-centered care for all health care consumers. This mixed-method, convergent parallel design study compared the sample of patients returning HCAHPS surveys, the inpatient population, and contextualized those results with semi-structured interviews with patient experience professionals to provide context to the need for a representative sample.

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