5 Questions to Add to the HCAHPS Survey

June 6, 2014

The word “flourish” is relatively new as a humanistic goal for healthcare — for patients, staff, and our communities. And, it is an easy word to say but so difficult to define, particularly in this era of HCAHPS surveys.

I’m not sure of the difference between thriving and flourishing.

However, I know that when we talk about someone thriving, it is generally circumstantial, as in “Bill thrives in his current job.” Or, “Sara thrives in the middle of stress.”

The word “flourish,” as I have heard it used, is a broader sense of wellness — a state of joy along with the state of well being.

What if our life and health goals were not circumstantially based? What if the patient experience was not limited to what happened during the hospitalization as the current HCAHPS survey evaluates, but rather was measured by how it informed health and life futures?

There’s a disconnect between life outcomes and patient experience outcomes. How about adding these questions to the HCAHPS survey:

1. As you look to your recovery, how do you measure your hope?
2. As you think about who you are following this health crisis, do you see yourself as stronger or weaker?
3. Are you more determined to be well or resigned to the status quo?
4. Do you think it is worth your time and effort to go through the tedious medications and exercises to stay well?
5. How do you feel about your future?

In truth, for all of us, every time we just don’t feel well, we know we’ll either get well or it may be a symptom of something more serious. Whatever we feel, the interaction between our physical self and our sense of self can be challenging.

At some point, as we get older, we may wonder what happened to our “spry self” given it has been replaced with our “pooped self.”  In the hospital, however, patients continuously wonder what happened to them and struggle to create an identity that can survive the hospital experience.

We already know that patients can slip into learned helplessness as a result of needing assistance to do what they have done for themselves since they were potty trained and not being able to affect their own situation.  Their loss of independence, even if temporary, is not only sudden, but goes without comment or acknowledgment.

Yes, for most patients, this is short term.  However, is the goal really only to get them to be able to go to the bathroom on their own? Do we set the goal as just “getting out of the hospital, ” or do we set the life goal of our patients at “flourishing”?

If patients do not have a sense that caregivers are invested in their vitality; their forward movement into a better future, why would they adhere or try to understand the complexities of their discharge instructions?

Chronic conditions are even more difficult than acute conditions.  Some chronic conditions are not fully resolved until life is over.  How can caregivers help these patients flourish?

How can everyone who works in a hospital invest in their co-workers so that they can flourish as they do their work at the bedside every day and still have vitality for life?

Florence Nightingale put it on the nurse to help patients live.  She wrote, “Being well is using well the powers we have.”

Caring for patients, in her vision, was not only about treatment.  It was about encouragement, about respect, about compassion and empathy.  Yes, it was about human flourishing.

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