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June 2014 Moms
Damnliz
member
Patient satisfaction is overrated. Wonder what other healthcare professionals think...
Damnliz
member
This discussion has been closed.
Re: Patient satisfaction is overrated. Wonder what other healthcare professionals think...
Luckily he worked at such a place that actually looked beyond the actual 51% score and his job was safe. He works for a practice now that does the surveys (they are looking to get away from the press ganey company soon) but doesn't base his bonus on the score but does it based on participation.
Patient Satisfaction is Overrated
by William Sonnenberg, MD
I recently was at the Scientific Assembly of the American Academy of Family Physicians (AAFP) in San Diego, giving a lecture to a large audience of Academy members on respiratory syncytial virus (RSV) bronchiolitis. I mentioned why I thought identifying the RSV virus was important. I stated that if you tell the family the infant has RSV and that there is the expectation that cough will last 1-2 months, this may forestall them going to the ER or urgent care center. In those assembly lines of healthcare, they will be told that their child has "bronchitis" and will receive the inevitable azithromycin script. This will make the parents happy, free the healthcare provider of the need for further explanations, and result in a satisfying visit for the administrators of that facility. The trouble, of course, is that an antibiotic has again been used to treat a self-limited viral infection.
A physician came up to me afterwards and agreed with me but said that he had no choice. He works in one of those venues and is subject to surveys to measure "quality." For him, quality is measured in 2 ways: The first is by getting the patient door-to-door in 45 minutes, and the second is by a Press Ganey survey to see if the patient was happy. Because of these measures, he is forced to abandon his role as a responsible steward of antibiotic use to keep his job and get a bonus.
Another physician in the audience told the crowd that he was able to increase his satisfaction score by 7% simply by prescribing an antibiotic to all patients who call with a complaint of cough, sore throat, or sinus headache. One doctor reported to the media that he had to give Dilaudid® for minor pain because his Press Ganey score was low the previous month.
I believe that this little-known company, Press Ganey, from South Bend, Indiana, has become a bigger threat to the practice of good medicine than trial lawyers. They are the leading provider of patient satisfaction surveys for hospitals and physicians. For the past decade, the government and healthcare administrators have embraced the "patient is always right" model and will punish providers that fail to rate well in these surveys. Press Ganey's CEO, Patrick Ryan, said, "Nobody wants to be evaluated; it's a tough thing to see a bad score, but when I meet with physician groups I tell them the train has left the station. Measurement is going to occur."[1] Obamacare has budgeted $850 million in reduced Medicare reimbursement for hospitals with lower scores.
The mandate is simple: Never deny a request for an antibiotic, an opioid pain medication, a scan, or an admission. One emergency room with poor survey scores started offering hydrocodone "goody bags" to discharged patients in order to improve their ratings. And doctors face the reality that uncomfortable discussions on behavioral topics -- say, smoking or obesity -- come with the risk of a pay cut. If you tell a patient that their knee pain is related to weight, that their smoking is worsening their child's asthma, or that they can't lose weight because of French fries and not a glandular problem, your ratings and pay will take a hit.
Satisfied patients are not healthy patients. In a paper published in 2012, researchers at the University of California, Davis, using data from nearly 52,000 adults, found that the most satisfied patients spent the most on healthcare and prescription drugs.[2] They were 12% more likely to be admitted to the hospital and accounted for 9% more in total healthcare costs. Strikingly, they were also the ones more likely to die.
Overtreatment is a silent killer. We can overtreat and overprescribe. The patients will be happy, give us good ratings, yet be worse off. We must have the ability to deny treatment for a patient's own good. Patients aren't the best judge of what is best for them. Several years ago, an elderly female patient wanted me to write a prescription for tamsulosin because she got a coupon in the mail. It did not matter that she lacked a prostate.
We should try to be kind to our patients and take time to understand them, but we must resist these misguided pressures and do the right thing. Sometimes patients have to be told "no," and the leadership in healthcare must understand this. Take heart in the words of Mark Twain: "Always do what is right. It will gratify half of mankind and astound the other."
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edited because I remembered one more from last month:
- that the free car seat she was being given looked "too boyish" in her opinion for her baby girl
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BFP 10/8/2013
Miss Camryn Marie arrived 6/20/2014
Every task I do as a nurse seems to be logged and if I don't "work effectively" I get in trouble. For example: we are supposed I transfer patients within one hour of a new bed assignment. One shift I was staring to move a patient and he pulled of his colostomy bag. Poop everywhere. Literally a poop explosion. Obviously I cleaned the patient, applied a new ostomy appliance and changed the linens before I transferred him. I also got reprimanded for transferring him outside the one hour time window. I politely told my charge nurse that I didn't care, I wasn't going to send a patient out soiled. Despite having good reason, my "error" was still reflected in our unit numbers.
A system that takes the true human experience into account (open ended questions, interviews on all sides, etc...) would paint a much clearer picture of the care provided and received. However, such a system would not be cost effective so we get stuck in a bad cycle.
I believe that as health care professionals we should try to make our patients as satisfied as possible but within reason. Some complaints are reasonable but the majority are ridiculous. For example, post op patients who are capable of walking themselves to the bathroom and whom would benefit from (and are ordered for) early ambulation demanding a bed pan and throwing a fit because the mean nurses make him/her walk.
Also, patients often come into the hospital with unrealistic expectations. How many patients come in expecting to have no pain after surgery and getting annoyed that vitals need to be taken every four hours even over night. I have seen complaints on the press Ganey surveys where patients say that they unsatisified because they were woken up for vital signs their first post operative night. Seriously? We aren't doing this just for fun, it's for your safety.
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I read this somewhere and I agree: "let's give those in direct patient care the support and resources they need to give the best care they can and want to give. I'll bet you patient satisfaction goes up. I'll bet you staff satisfaction goes up. OR, we can keep using key words at key times, apologizing all day long for what we can't do, even as bladders fill, stomachs remain empty and pedometer counts steadily rise."
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I have worked as a nurse and waitress. These are customer service industries. I make a point to point out good service in both. But I have been in both.
I think most people that want to complain find a way to.
Let me tell u it's hard being a nurse.