Employee engagement, leadership styles and organizational culture can have significant affects on patient satisfaction, as well as a hospice’s performance on quality metrics.

This is according to findings in a recent BerryDunn report, which found several challenges that hospice and home health providers experienced when it comes to improving their Consumer Assessment of Healthcare Providers and Systems (CAHPS) scores.

The impact of office staff, customer service training and leadership oversight cannot be underestimated, BerryDunn researchers indicated.

“Performance improvement in home health and hospice settings is closely tied to organizational alignment, targeted training and thoughtful workforce management,” BerryDunn researchers stated in the report. “Agencies that invested in formal training for office and support staff saw measurable gains in overall experience ratings, particularly in areas related to communication, responsiveness and coordination of care.”

The U.S. Centers for Medicare & Medicaid Services (CMS) requires that hospices send a CAHPS survey to families following a patient’s death to gauge their satisfaction with the services they received. A hospice’s performance on these publicly reported quality measures can be a key differentiator for referral partners, payers and consumers. Poor performance on quality measures can pose risks to a hospice’s bottom line and could indicate that patients and families are not receiving appropriate care.

The BerryDunn report highlights results of a National Project and Family Satisfaction Quality Improvement Project, which examined common themes in the quality outcomes among 27 hospices and 36 home health organizations over a 12-month period from 2023 to 2024. The project was designed to address clinical, administrative and leadership factors that influence the care experience.

The report found “strong correlations” between employee engagement and retention and higher patient and family caregiver satisfaction scores. The ability to provide patient-centered care was found to be impacted by back-office staff functions, customer service training and the critical role of management.

Hospices that invested in formal training for back-office administrative employees saw higher CAHPS scores compared to others, seeing an average of 3.5 satisfaction star ratings, the BerryDunn report found.

The research also found a “notable decline” in quality ratings among hospices with a higher percentage of unfilled registered nurse positions. The trend resulted in those organizations being less likely to report visits during the last days of life, a key factor in caregiver satisfaction.

Organizations that participated in the project received six months of training on ways to achieve sustained improvement through patient and family person-centered care models, accountability and service excellence. A key component of the program focused on management development to enhance leadership skills that foster stronger employee engagement, retention and a patient-centered organizational culture.

Quality improvement requires training, leadership development and culture-driven mentorship, BerryDunn researchers indicated.

Hospices and home health providers that participated in the study implemented enhanced customer service training. These providers saw improved CAHPS outcomes, particularly in communication scores and a family’s willingness to recommend their services, the BerryDunn report found. Additionally, increased peer-based mentorship showed strong benefits for hospices’ overall quality ratings, but had limited impact in home health settings.

Home health organizations could benefit from integrating staffing structures that mirror interdisciplinary hospice models, the researchers indicated.

“[Our] findings suggest that home health agencies may benefit by implementing hospice-structured processes — such as mandated interdisciplinary team (IDT) meetings — that facilitate mentorship, peer connection and ongoing staff education,” BerryDunn researchers said in the report. “Prior to allocating resources to new or additional initiatives, organizations should first ensure internal readiness and operational stability to maximize the potential for successful implementation.”