The value of patients' handwritten comments on HCAHPS surveys

Some patients write comments on their Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys, but survey vendors do not record them, and the value of this anecdotal information is not well understood. However, many rating websites contain both numerical ratings and anecdotal comments from consumers who wish to share their experiences, and the option to write comments enhances the appeal of these survey forums. Recent research shows that numerical ratings do not sufficiently capture the range of consumer experiences and that comments contain additional information that complements survey responses. In this study, we investigate the contribution of anecdotal comments on HCAHPS surveys to the prediction of two global outcome measures: overall hospital rating and intention to recommend. HCAHPS surveys were collected retrospectively from 589 inpatients at two community hospitals, whose answers to the HCAHPS questions plus any handwritten comments were entered into a database. Nearly 20% of the surveys contained at least one written comment. A content analysis was performed, and comments were classified as positive, negative, neutral, or mixed. Regression analyses showed that negative comments significantly affected patients' overall hospital rating with and intention to recommend the hospital. After adjusting for their quantitative ratings on the HCAHPS questions, we found that patients who wrote negative comments gave the hospitals significantly lower satisfaction and intention scores. Consistent with prior research, our study showed that the information contained in numerical HCAHPS composite measures was enhanced by patients' commentary. In addition, quantitative HCAHPS ratings appear to underestimate the feelings of people who write negative comments, validating practices at hospitals that use surveys containing negative anecdotes in quality improvement initiatives.