Capturing the patient's voice: Kano Analysis of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey

BACKGROUND: Traditional methods are not able to differentiate which feature customers regard as attractive, mandatory, performance, and which feature customers are indifferent about. These categories can only be differentiated based on a specific technique called Kano survey. Specific aim of this study was to categorize the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction survey questions into Kano categories. MATERIALS AND METHODS: Design of the study was survey research. It was conducted from 6/2019 to 8/2019 at OSF Saint Francis Medical Centre in Peoria, Illinois, USA. A 34 question Kano survey (17 positive and 17 negative questions) based on HCAHPS patient questionnaire was designed. Surveys were analyzed using Kano analysis template. Comparative analysis of Kano categories based on demographics was also performed. RESULTS: 39 current patients and 25 caregivers completed the survey. All of the 17 HCAHPS questions except “noise level at night” were classified as mandatory requirement with highest number for information on “indications of medicines.” There was a minimum variability in the satisfaction coefficients but large variation in the dissatisfaction coefficients. More patients above 50 years consider “help going to bathroom” as mandatory (70.2% vs. 40.7%, P = 0.01). Sixty-four percent of caregivers considered “explain things (nurse)” as mandatory as opposed to 51.2% of patients (P = 0.03). CONCLUSION: Current U. S healthcare consumers have high expectations from healthcare delivery and consider most HCAHPS questions as mandatory requirements. Kano analysis needs to be done on a larger, more diverse hospital setting and potentially the HCAHPS survey needs to be modified to reflect prevailing healthcare customer requirements.