Avera St. Anthony

Avera St. Anthony’s Hospital


In 2011, Avera Health, parent health system of St. Anthony’s Hospital, began its partnership with HealthStream to help the system align patient experience goals across facilities and celebrate accomplishments. A team of 6-8 department directors was formed to develop a comprehensive approach to help educate both staff and patients on the new process for collecting and reporting data. The task of staff education was arduous and therefore, was rolled out over a 10-month period using training sessions to introduce staff to the new measurement system and its reporting, as well as the development of supporting documents that included discharge instructions, flyers, and handouts that explained the process to both staff and patients.


Early in the process, there was little to no awareness among St. Anthony’s employees of the hospital’s HCAHPS scores. The lack of awareness meant that there was no foundation on which to hold leaders and employees accountable for scores. In addition, the lack of awareness contributed to the notion that the scores were strictly the responsibility of nursing management.


The first step was a 10-month process of communication and education for staff designed to help employees understand how to build reports on HealthStream’s reporting website, Insights Online. Employees and nursing leadership found the new reporting clearer and easier to interpret.

Holly Tracy, Director of Nursing, and her team of department directors worked hard to ensure that everyone understood Top Box reporting.“Staff understand this now and take action; it really ups their game and helps them understand where their focus needs to be.” Once the staff was fully trained, St. Anthony’s leadership team held each department director accountable to monitor and report scores. Department directors met quarterly with their supervisors. At each meeting the department director was required to report on their results and the progress on each of the domains that had been targeted for improvement.

In addition to creating accountability for their results, the team at St. Anthony’s also served as a great resource by building requested reports and sharing best practices to support improvement initiatives. Ms. Tracy noted that real-time reporting helped the hospital develop action plans to address issues faster.

HealthStream gets us as close to real-time data as possible. We aren’t chasing a problem from six months ago. Having the real-time scores is beneficial.

 St. Anthony’s also found HealthStream’s Voice of the Patient helpful in achieving their 5-Star HCAHPS status. This feature allowed leaders and staff to listen to actual patient comments recorded directly from the patient interview. “Anytime you personally listen to the words from their mouth, it will impact you—good, bad, or otherwise. When you hear that voice and you hear them talk about their experience, I don’t know anyone who couldn’t take that to heart. We have used it when communicating accolades and during education.” Deb Tejral, Clinical Manager

The leadership team carefully monitored results in order to see when a newly-implemented strategy was having a positive impact on scores. The team from St. Anthony’s shared, “Staff were able to map it out and see that they can impact the scores.” For example, they were able to use the reporting to see that hourly rounds had a very strong correlation to the overall hospital rating, and when rounding was executed well, it had a positive impact on scores.

St. Anthony’s team also regularly communicated patient feedback to physicians. While this domain is generally highscoring, reports can be sorted to show results by physician with comparisons to regional and national norms, as well as to their colleagues within the hospital and the system. These reports also helped St. Anthony’s hold the locum service that provides their Emergency Department physicians accountable for physician performance on ED metrics. When results revealed significant differences by provider, the hospital asked the locum service to stop sending low-scoring providers—communicating a strong message about the importance of the patient experience.

Lastly, St. Anthony’s shared its recommendations on how other hospitals might also achieve a 5-Star HCAHPS rating. The team emphasized the importance of staff communication and education as a foundation for all performance improvement efforts. “It is important that they understand the initiative and the scores.” They also urged restraint when deciding on the number of initiatives to begin at any given time. “You need to focus your energy on one question at a time. Staff are already overloaded with emails, EMR, their clinical and administrative responsibilities and adding even one more thing can result in staff resistance to the implementation of initiatives to address low scoring domains.”


After switching to a phone-based methodology with HealthStream from a mail-based methodology, St. Anthony’s was able to change its approach to managing and improving the patient experience. Using real-time data in HealthStream’s Insights Online reporting tool, they developed a more in-depth understanding of the organization’s HCAHPS scores and as a result,

  • Achieved a 5-Star HCAHPS rating
  • Fostered a sense of ownership and accountability for HCAHPS scores across the organization
  • Implemented communication strategies to help connect employees to the organization’s HCAHPS scores and improvement resources
  • Developed focused and effective improvement strategies based on data from patients

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