"How are you feeling?" It seems like a simple question, but it has significant implications for hospitals and their patients. Understanding those ramifications could be the key to improving patients' perceptions of their hospital stay -- and their overall health. Gallup World Poll research has found that positive emotions are effective predictors of self-reported health status and are closely associated with health.
A patient who feels that he's getting better all the time has reason to hope and to invest in the future.
Gallup has also observed this relationship in analyzing the results of HCAHPS surveys. HCAHPS, which stands for Hospital Consumer Assessment of Healthcare Providers and Systems, is a federally mandated 27-item survey that patients take up to six weeks following a hospital stay. Patients' ratings are aggregated by hospital and adjusted to control for factors including survey mode and patient characteristics (patient mix). The resulting scores are reported publicly so the public can compare hospitals. These scores also affect a hospital's Medicare and Medicaid reimbursement.
"HCAHPS scores are extremely important," says Stacie McGaughey Meder, a registered nurse in Lincoln, Nebraska. "Everything we do [as healthcare providers] is represented by the HCAHPS scores."
But by the time patients fill out the survey, they're no longer under the direct attention of healthcare providers. When patients are in the hospital, staff members can check on them as often as needed. "We can't do that when people go home," McGaughey Meder says. "Some people are very active and continue to improve, but some aren't -- and they get worse."
Recently, Gallup researchers examined the relationship between patient responses on two key HCAHPS items: one that asks patients to rate their overall health from "poor" to "excellent" and another that asks them to rate the hospital during their stay from "worst hospital possible" to "best hospital possible." Eight in 10 patients (82%) who considered their health to be excellent rated their hospital a 9 or 10 on the item assessing the overall quality of the hospital. In contrast, 6 in 10 patients who rated their health as fair (64%) or poor (59%) rated the hospital a 9 or 10 on this item.
Given that about one-quarter of hospital patients view themselves in fair or poor health, this group represents a significant opportunity for a hospital to increase its overall score. And there's a lot that hospitals can do to change how patients look at their health if hospitals understand -- and can broaden -- the patients' point of view.
The benefits of positive emotions
"Even thirty years ago, psychologists were finding that stress exacerbates illness, but doctors were hesitant to buy into that," says Shane Lopez, Ph.D., professor of business at the University of Kansas and author of Making Hope Happen. "Now we know how physically debilitating stress and depression are. Only recently have we learned how important joy, contentment, and happiness are. Positive emotions have a positive physical effect. Yet physicians are very slow to accept that positive emotions affect health in a big way."
The beneficial results of positive emotions have been studied in depth -- one of the most well-known ideas is the "broaden-and-build" theory developed by Barbara L. Fredrickson, a professor at the University of North Carolina and principal investigator at the Positive Emotions and Psychophysiology Lab. But these studies have focused largely on the relationships between positive emotions and psychological health. Research into the medical aspect of positive emotions is more recent, but it's already turning up information that hospitals should know.
When Dr. Lopez and two other leading researchers examined the link between emotion and health in more than 140 countries using Gallup World Poll data, they found that positive or negative emotions accounted for 46% of the variance in self-reported health. They also found that the links between self-reported emotions and health were "stronger than the relative impact of hunger, homelessness, and threats to safety on health."
Those links may provide the insight hospitals need to improve their overall HCAHPS ratings. For instance, many hospitals have a program to contact patients after they've been discharged. "We have an assistant nurse manager who calls to check on patients three days after they've gone home and then three weeks after that," McGaughey Meder says. The nurse manager asks about prescriptions, if the patient still understands everything the nurses and doctors said, and if they have the family help they need. "I think the impact of this is huge. Patients feel better when they know someone is checking up [and] not leaving them in the abyss of being home alone," says McGaughey Meder.
Programs like the one at McGaughey Meder's hospital are a good approach to helping patients take ownership of their health. But there's an added benefit to helping patients connect their behavior now with their future health. "There's a psychological upward spiral," says Lopez. "When you feel as though you're continuing to improve, you feel better emotionally, which then leads you to feel better physically -- and when you're feeling better physically, you feel better emotionally."
A patient who feels that he's getting better all the time -- and that if he follows his doctors' directions, he'll improve even more -- has reason to hope and to invest in the future. So he's more likely to do the things that improve his future -- such as take his pills, go to checkups, or exercise -- which helps improve his health. The opposite is also true: People who feel their health is poor aren't as likely to do the things that will help improve it. "Hope for the future is what pulls people forward," says Dr. Lopez. "Positive emotions are great predictors of physical health, and they go hand in hand with feeling good physically."
That's an important discovery for healthcare organizations because people tend to credit their hospital for their improving health -- or to blame the hospital for not fixing it. Says Dr. Lopez, "It all kind of rolls up into a positive narrative: 'If it weren't for those guys, I wouldn't be feeling this way right now.'"