How to Improve HCAHPS Scores Under the New 2026 Measures

If you run a hospital unit, you've probably been asked how to improve HCAHPS scores more times this fall than you've been asked how you're doing, because CMS's updated patient survey now feeds the public numbers. Hospitals have been sending it to patients discharged since January 2025. CMS says the updated questions map to publicly reported measures "beginning with the October 2026 Care Compare refresh." Star Ratings went public on Care Compare in October too, per the HCAHPS site.

When I read the actual questions, what jumped out was how few of them are about medicine. Most ask, one way or another, whether a scared person in a bed felt heard.

I'm a stand-up comedian, and I also train nurses and nurse managers. My family got through the pandemic with both of my in-laws on ventilators at the same time, and what I remember most is how the nurses talked to us. That's why I read these surveys closely.

What changed in the new HCAHPS survey?

The updated survey has 32 questions, up from 29, with eight added and five removed, according to NRC Health. The old Care Transition measure is gone. In its place, CMS's crosswalk lists new measures that ask some very human questions:

• Care Coordination asks how often doctors, nurses and other staff were "informed and up-to-date about your care," how often they worked well together to care for you, and whether they worked with you and your family or caregiver on plans for after you left.
• Restfulness of the hospital environment asks whether you could get the rest you needed, whether the area around your room was quiet at night, and whether staff helped you rest and recover.
• Information about Symptoms asks whether staff gave your family or caregiver enough information about what symptoms or health problems to watch for after discharge.

The nurse questions still open the survey. Question one asks how often nurses treated you with courtesy and respect, and the next two ask whether they listened carefully and explained things in a way you could understand.

Why the new measures are really about listening

My read on this, and it's an opinion: a patient experiences care coordination when their daughter asks the day nurse a question and the night nurse already knows the answer. Patients never see your EHR or your huddle board. What they see is whether the people in the room seem to know each other and know them.

The symptom question asks about the family or caregiver, which raises the bar. Telling a groggy patient what to watch for at 6 a.m. won't cover it. Somebody has to tell the person who'll actually be driving them home.

There's evidence that the talking part is the hard part. In an Oct. 27 piece for The Health Care Blog, Xavier Wartelle, CEO of the medical imaging company Avatar Medical, points to a Medical Care analysis of nearly 4,000 hospitals over eleven years. Physician communication improved by 0.8 percentage points, the smallest gain of any major HCAHPS domain, while nurse communication improved. (He sells visual communication tools, so weigh his fixes accordingly.) His bigger point holds up, though: the survey is moving toward measuring whether patients understood.

Patients are walking in with a second opinion from a chatbot

A new study adds a wrinkle. In a qualitative study accepted Nov. 3 in Frontiers in Public Health, researchers interviewed 18 clinical nurses at three hospitals in China about patients who bring AI-generated health information to the bedside. Patients asked nurses to confirm it or used it to question them. The nurses did more explaining. The researchers also found it opened more chances to talk.

The nurses who handled it well did two things, according to the study. They figured out what the patient was really worried about, and they explained how the AI answer differed from that patient's situation.

That's a small sample in one country, and the authors say it needs more study. It still lines up with what I hear in workshops. The patient holding a phone full of chatbot answers is usually scared and trying to get some control back. If the nurse argues with the phone, the nurse loses. If the nurse asks, "What did it say that worried you?", that's a point on "listened carefully."

How to improve HCAHPS scores, starting tomorrow

None of this needs a new vendor contract. Here's where I'd start with a unit:

1. Make the handoff visible. Do bedside introductions at shift change, in front of the patient: "This is my colleague who's taking care of you tonight, and they already know about your daughter's question on the meds." One sentence like that speaks to both "informed and up-to-date" and "worked well together."
2. Use teach-back with the family in the room. For symptoms to watch for, ask the caregiver to say it back in their own words. If nobody from the family is there, write it down and tell the patient you're writing it down for them.
3. Ask before you correct. When a patient brings up something they read online or got from a chatbot, ask what worried them before you explain anything. That's active listening in nursing, and patients notice it.
4. Own the night. Restfulness is now its own measure, so pick one thing your unit controls after 11 p.m., like hallway volume or how vitals get bundled, and fix it on purpose.
5. Practice the hard sentences. Nobody gets good at "I don't know yet, but I'll find out" by reading a slide. You get good by saying it out loud in a room where it's safe to sound awkward.

That fifth one is where a comedian comes in handy. Stand-up is a listening job: you read the room, notice who's checked out, and adjust on the fly. It's also the core of the nurse communication training I run: practicing the behaviors the survey asks about, with enough laughing that people actually want to keep doing it.

Patient experience improvement is a staffing question too

One fair warning to leadership. Every behavior on that list takes a few minutes, and minutes are exactly what short-staffed units don't have. I wrote recently about why bedside nurses are leaving, and you can't run a listening-based survey on a unit with no time to listen. Patient experience improvement and nurse retention are one project, and they should share a budget.

The new HCAHPS questions reward what great nurses already do, like introducing a colleague by name or walking the family through the plan on the way out. Leadership's job is to give them the minutes to do it and to stop treating it as a soft extra.

More on this in the human touch in healthcare series and in my post on humor in hard healthcare moments. If you want your nurses practicing the exact questions patients will be answering, let's build a workshop around your unit.