Parents Have More to Say: Comments From the Child HCAHPS Single Question Versus a Narrative Item Set

Narrative comments from the Child Hospital Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey from a single open-ended question are specific enough to make improvements (ie, actionable). A multiitem set might yield more insights. We compare comments from the single-item Child Hospital CAHPS and the 6-item beta version Narrative Item Set (NIS).

The Child HCAHPS NIS was piloted 2021 to 2022 at an urban children's hospital that fielded the Child HCAHPS survey since 2017. We analyzed 382 NIS comments (n = 77 parents and guardians) and compared them to single-item comments.

NIS respondents wrote nearly 6 times the word count compared with respondents presented with a single item, with 75% of NIS respondents providing narrative to 5 or 6 NIS items. Single-item comments were more positive (57% vs 39% NIS), yet most (61%) NIS comments included at least 1 negative remark (vs 43% single-item). Eighty-two percent of NIS comments included content on the Child HCAHPS survey (vs 51% single-item). The most common Child HCAHPS topics in NIS narratives were about being kept informed of child's care and whether doctors treated respondents with courtesy and respect. More NIS comments were deemed actionable (69% vs 39% single-item), with 1 NIS item - what a parent wished had gone differently- eliciting the most-actionable narrative.

The multi-item NIS elicited high percentages of comments with sufficient detail to make improvements. A large NIS demonstration is needed to assess how quality leaders and frontline staff use NIS comments to improve inpatient pediatric care.