HCAHPS Questions
A Comprehensive Guide to HCAHPS
Table Of Content
eBook: A Guide to the Hospital Consumer Assessment of Healthcare Providers and Systems Survey
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What are the 32 Questions on the HCAHPS Survey?
YOUR CARE FROM NURSES
- 1. During this hospital stay, how often did nurses treat you with courtesy and respect?
- 2. During this hospital stay, how often did nurses listen carefully to you?
- 3. During this hospital stay, how often did nurses explain things in a way you could understand?
YOUR CARE FROM DOCTORS
- 4. During this hospital stay, how often did doctors treat you with courtesy and respect?
- 5. During this hospital stay, how often did doctors listen carefully to you?
- 6. During this hospital stay, how often did doctors explain things in a way you could understand?
THE HOSPITAL ENVIRONMENT
- 7. During this hospital stay, how often were your room and bathroom kept clean?
- 8. During this hospital stay, how often were you able to get the rest you needed?
- 9. During this hospital stay, how often was the area around your room quiet at night?
YOUR CARE IN THIS HOSPITAL
- 10. During this hospital stay, how often were doctors, nurses and other hospital staff informed and up-to-date about your care?
- 11. During this hospital stay, how often did doctors, nurses and other hospital staff work well together to care for you?
- 12. During this hospital stay, did you need help from nurses or other hospital staff in getting to the bathroom or in using a bedpan?
- 13. How often did you get help in getting to the bathroom or in using a bedpan as soon as you wanted?
- 14. During this hospital stay, when you asked for help right away, how often did you get help as soon as you needed?
- 15. During this hospital stay, were you given any medicine that you had not taken before?
- 16. Before giving you any new medicine, how often did hospital staff tell you what the medicine was for?
- 17. Before giving you any new medicine, how often did hospital staff describe possible side effects in a way you could understand?
- 18. During this hospital stay, did doctors, nurses and other hospital staff help you to rest and recover?
LEAVING THE HOSPITAL
- 19. Did doctors, nurses or other hospital staff work with you and your family or caregiver in making plans for your care after you left the hospital?
- 20. Did doctors, nurses or other hospital staff give your family or caregiver enough information about what symptoms or health problems to watch for after you left the hospital?
- 21. When you left the hospital, did you go directly to your own home, to someone else’s home, or to another health facility?
- 22. During this hospital stay, did doctors, nurses or other hospital staff talk with you about whether you would have the help you needed after you left the hospital?
- 23. During this hospital stay, did you get information in writing about what symptoms or health problems to look out for after you left the hospital?
OVERALL RATING OF HOSPITAL
- 24. Using any number from 0 to 10, where 0 is the worst hospital possible and 10 is the best hospital possible, what number would you use to rate this hospital during your stay?
- 25. Would you recommend this hospital to your friends and family?
ABOUT YOU
- 26. Was this hospital stay planned in advance?
- 27. In general, how would you rate your overall health?
- 28. In general, how would you rate your overall mental or emotional health?
- 29. What language do you mainly speak at home?
- 30. What is the highest grade or level of school that you have completed?
- 31. Are you of Spanish, Hispanic or Latino origin?
- 32. What is your race? Please choose one or more.
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WHAT DOES THE HCAHPS SURVEY LOOK FOR?
The HCAHPS questions are grouped into domains that reflect the patient experience. As of 2025, HCAHPS measures the following key domains:
- Communication with Nurses
- Communication with Doctors
- Responsiveness of Hospital Staff
- Communication About Medications
- Cleanliness of Hospital Environment
- Restfulness of Hospital Environment (NEW composite)
- Discharge Information
- Care Coordination (NEW composite)
- Information About Symptoms (NEW standalone item)
- Overall Rating of the Hospital
- Willingness to Recommend the Hospital
Some domains have been revised or replaced:
- The Pain Management domain has been removed.
- The Care Transitions composite has been retired and replaced by more focused items on care coordination and discharge planning.
WHAT IS THE HCAHPS SURVEY?
The Hospital Consumer Assessment of Healthcare Providers and Systems Survey, or HCAHPS (pronounced “H-caps”), is the first national, standardized, publicly reported survey of patients’ perspectives of hospital care. Developed by the Centers for Medicare & Medicaid Services (CMS) and the Agency for Healthcare Research and Quality (AHRQ), HCAHPS is designed to capture consistent and meaningful data on patient experience across hospitals in the United States.
The questions, though simple on the surface, were developed through an extensive scientific process involving literature reviews, focus groups, stakeholder input, and field testing. Since its implementation, HCAHPS has been endorsed by a wide range of stakeholders including hospitals, consumer groups, and professional associations.
The written version of the survey is available in English, Spanish, Russian, Vietnamese, and Chinese. Phone and web-based versions are available in English and Spanish. As of 2025, HCAHPS may also be administered through mixed-mode formats that include web, mail, and phone outreach.
WHAT IS THE PURPOSE OF THE HCAHPS SURVEY?
WHEN DID HOSPITALS BEGIN TO USE THE HCAHPS SURVEY?
The information from the HCAHPS Survey began to be collected – voluntarily – in 2006. In 2008, the information from the surveys was first publicly reported. CMS reports the results of the survey for each hospital on the Hospital Compare website. The results published online are based on the past four consecutive quarters, with the oldest quarter being discarded when a new quarter arrives.
The HCAHPS Project Team not only collects the data from surveys and reports it but also makes adjustments necessary to ensure fairness. There are some factors that are beyond the control of hospitals that can impact the results of the survey. The HCAHPS Project Team accounts for any factors that would mar the results of the survey and makes adjustments before publishing the final results on the Hospital Compare website.
WHY IS HCAHPS IMPORTANT?
- Comparability: It provides comparable data on patients' perspectives of care that can be used to compare hospitals locally and nationally.
- Accountability and Transparency: Public reporting incentivizes hospitals to improve patient-centered care by making their results visible.
- Value-Based Purchasing: HCAHPS results impact Medicare reimbursement through CMS's Value-Based Purchasing (VBP) program. Performance on HCAHPS domains can directly affect hospital payments.
In short, HCAHPS is more than a patient survey—it’s a public, financial, and quality benchmark.
WHO IS ELIGIBLE TO TAKE THE HCAHPS SURVEY?
Most patients who stay at a hospital are eligible to take the survey, although there are some exceptions. The specific requirements for participation include:
• The patient must be at least 18 years old at the time of admission to the hospital
• The patient must have a non-psychiatric MS-DRG/principal diagnosis at the time of discharge
• The patient must have stayed at least one full night at the hospital
• The patient must be alive at the time he/she is discharged from the hospital
While the HCAHPS Project Team designed the survey to gather information from as wide a spectrum of patients as possible, but there are limitations to the survey that must be accounted for – which is why some patients are ineligible to participate. For instance, the survey was not designed for pediatric patients or patients who have been diagnosed with behavioral health issues.
Patients who only came into the hospital for a short period of time – those that did not stay overnight – are also excluded because they have not had enough interaction with the hospital staff to be considered in the overall survey.
To meet the needs of the survey requires not only that the patient has stayed at the hospital and received care, it also requires that the patient be accessible after discharge to take the survey. Some other patients are ineligible to participate in the survey because collecting information from them would prove too difficult to be practical. These ineligible patients include:
• Patients who have a home address outside of the United States
• Patients who have been discharged to hospice care
• Patients who have been discharged to specialized care facilities, such as nursing homes
• Patients who are prisoners
Hospitals are required to offer the survey in the patient’s preferred language. As of 2025, proxy respondents are now permitted when a patient is unable to complete the survey.
WHEN AND HOW IS THE SURVEY ADMINISTERED?
The survey is administered 48 hours to 6 weeks after a patient is discharged from the hospital. Approved modes include:
- Mail-only
- Telephone-only
- Mail with phone follow-up
- Web-mail or web-phone mixed modes (NEW in 2025)
The survey data must be collected within the six-week window post-discharge for it to be valid.
WHAT CAN HOSPITALS DO TO IMPROVE THEIR HCAHPS SCORES?
The key to improvement lies in understanding that excellent medical care is expected—what truly impacts HCAHPS scores is how patients feel about their care. The updated HCAHPS domains emphasize personalized care, proactive communication, restful healing environments, and team coordination.
Hospitals can focus on these strategies:
- Train staff on courtesy, empathy, and clarity. Patients want providers to listen, explain clearly, and treat them with respect.
- Promote restfulness. Minimize nighttime noise and interruptions. Bundle care activities. Create a quiet, healing environment.
- Strengthen team coordination. Patients now rate whether staff worked well together. Internal communication matters.
- Educate on discharge. New items ask if patients and their caregivers received clear instructions and knew what symptoms to watch for.
- Be responsive. The revised responsiveness domain now covers all help requests, not just call lights.
- Engage families. Include caregivers in conversations about discharge and recovery when possible.
Hospitals that embed these behaviors into their daily culture—what we call an “Always Culture”—are best positioned for sustained HCAHPS improvement.
LEARN MORE
If you’re looking for tools to train staff on behaviors that impact HCAHPS scores—like communication, responsiveness, or restfulness—there are video-based training solutions available.
One example is Always Culture, our patient experience training platform designed for nurse educators and quality leaders. It features short, scenario-based videos that align with HCAHPS domains and make expectations clear for both staff and patients.
Learn more about our PX Training for Hospital Staff or ask your Patient Experience team for available training resources.
NOTE: HCAHPS questions and domains evolve over time. For the most current survey instruments and guidance, visit the official CMS HCAHPS website.
Our Training library includes
Our training library includes 42 videos to improve patient experience and HCAHPS scores through patient-centered training.
Training your staff on effective communication, active listening, empathy, setting realistic patient expectations, and exceeding those expectations will not only help significantly improve HCAHPS scores but will assist in creating a patient-centered culture.