Give greater weight to the ‘Impact Zone’ than HCAHPS scores

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“Tommy, I am cold today.”

A few months prior, I had joined Brockton Hospital in Brockton, Massachusetts, as a transport aid. It was shortly after tearing up my knee during a college football game, and I was in a full leg cast as I wheeled my many patients throughout the hospital.

“Let me get your blanket for you, Mrs. Bernstein. We will cover your legs and ensure you are nice and warm.”

A few days later …

“Tommy, I am scared today. I feel alone. Can you stay with me?”

We had made our way down to what we referred to as “Cobalt.”  I learned that Mrs. Bernstein’s family was not able to join her today.

“Of course, Mrs. Bernstein. Of course. I will not leave you.”

That afternoon …

“Tommy, will you be back tomorrow?”

Years later, I would be meeting with a group of healthcare leaders at a premiere healthcare institution world-renowned for patient experience, empathy and cutting-edge medicine.

And as we were discussing patient experience within an inpatient setting, I shared:

“An amazing mother of a child diagnosed with sickle cell disease was in the hospital some years back.  The care for her child was very good, and yet as this mother looked back on her experience that Easter weekend, away from the rest of her family, worrying about her child, what does she remember? She remembers early that Sunday morning a custodian cautiously asking if he could enter their room, then walking with his arms behind his back, slowly and quietly, toward her as she sat next to her still-sleeping beloved daughter. She remembers his warm smile, his hand placed gently on her shoulder, and then him silently handing her a stuffed Easter bunny for her child. Yes, to this day, that is the experience of that hospital stay with her child she remembers.”

And as these healthcare leaders looked at me, I then shared stories from my experiences as a transport aid (similar to the above).

And as I scanned the room and looked into the eyes of each of these leaders, the response I heard back was:

“But what about HCAHPS?”

Bobby Clampett, the professional golfer, is well-known for his many accomplishments on the course, as well as for the teaching approach to golf he refers to as the “Impact Zone.”

“The Impact Zone philosophy begins by identifying what that proper impact really is and how all golfers can achieve it.” ~ Bobby Clampett

160916-golf-with-tommyRecently, as I was studying up on this approach (in order to remain competitive with my son on the links), the connection between this philosophy and patient experience truly took hold.

If you have read many of my other Hospital Impact blog posts, you know that I have many concerns with financial incentives within the healthcare system.

That said, measurement and evaluation is very important in ensuring improvement, progress, and … wait for it … impact.

But where I believe I diverge from many in healthcare is I do not see HCAHPS (and other survey tools) as the end-all, be-all of patient experience. In fact, far from it.

Where the focus needs to be is in the “Impact Zone.” Or in other words, at the “moment of truth.”

And the moment of truth is not in a survey.

  • The moment of truth is where the true impact takes place.
  • The moment of truth is when the custodian smiled and placed his hand on a worried mother’s shoulder.
  • The moment of truth is when a doctor listens to understand a patient’s whole story (and then together with the patient and family charts a course aligned with the patient’s preference).
  • The moment of truth is when a nurse holds a daughter as she learns her father has passed away.
  • The moment of truth is when a young transport aid stays with a scared elderly woman as together they await her next cancer treatment.

These relationship-centered actions are in the Impact Zone. And this is where patient experience and true healthCARE converge to become healthCARING.

So don’t let an over-reliance on surveys and metrics steer you away from impact. Rather, focus on the Impact Zone, and together let’s innovate healthcare, make an impact and truly care for one another. Always.



  1. I love this, for so many reasons. Thank you for writing about this – we need so much more of this.

    • Thank you, Laura. Truly when we hardwire systems to allow for each of us to focus on the humanity of the healing and dying journeys we will truly be innovating, impacting. and achieving healthCARING.

  2. Thomas, a most thoughtful writing. We do forget, or set aside, what matters for the metrics that measure our worth…the report card that HCAHPS scores are. As a musician, I often talk about the irrelevancy of my brilliant technique (I am a jazz harpist) next to the experience of my listener. In fact, it is only the music as heard by the one listening that has any basis in reality, that matters at all.

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