I ran across an interesting post on Facebook. A nurse was railing against the entire concept of patient satisfaction. She called patient satisfaction a “dirty little secret” – a secret that is killing her profession and harming patients. Hundreds of nurses chimed in supporting her contentions, which can be summarized as:
The public doesn’t realize that 30% of a hospital’s reimbursement is tied to patient satisfaction scores.
These programs were designed by bureaucrats who know nothing about patient care.
Patient satisfaction scores are all about flat screen TVs, creating a Ritz-Carlton like experience, and “treating patients like coddled customers” – all of which distracts from the hard, thankless job of taking care of patients and getting them better.
I used to hear some of this (especially from physicians) a decade ago, but I was surprised, I guess, to see that some people still feel this way. It reminded me of the hospital CEO who told the story of trying everything to improve his hospital’s patient satisfaction scores without success. He couldn’t get staff to buy in and embrace his programs. One morning, walking through the parking lot, he saw a bumper-sticker that read “A nurse’s job is to save your [rear-end], not kiss it!”
He realized the problem. His nurses didn’t get what he was trying to accomplish. Patient satisfaction isn’t about kissing the patient’s rear-end at all. It’s about respect for patient autonomy, about engaging them in their care, about being service-oriented, and making their experience, even in challenging times, as good as it can be.
Let’s assume our Facebook nurse really cares about patients and her rant comes from a good place. But let’s look at what she gets wrong:
Medicare payment to hospitals is absolutely affected by low patient satisfaction scores. Hospitals face a penalty of less than 2% (not 30%) of their total Medicare Payment for low scores. The money saved goes into a program which rewards hospitals that perform well. Patient satisfaction is only part of an overall program of rewarding hospitals for quality of care instead of the volume of care provided – a long overdue change.
Experts, including leading physician and nursing organizations, were concerned for decades about the quality of patient care, actual patient outcomes, and research showing that the patient and family experience (attention to needs, creating a healing environment, communication, respect for patient autonomy, navigation of the care system, etc.) was far less than ideal. These things affect overall health and respect for patients. In addition, patients ARE customers, paying exorbitant amounts for care and expecting some basic level of service and coordination of care is not unreasonable. The program was carefully designed over years working closely with leading quality of care organizations and experts.
The required patient surveys explore the basics: Communication with nurses and doctors, responsiveness of hospital staff, cleanliness and quietness of the hospital environment, pain management, communication about medicines, and discharge information. There aren’t any questions about the size of the TV in the room, how impressive the dining menu is, or whether nurses treated you like you were at the Ritz.
We’ve all seen hospitals with lovely cafeterias and flat screen TVs and valet parking that miss the basics of care coordination and making patients feel valued and taken care of. At the same time, we’ve all seen an older facility without the amenities whose staff goes out of their way to comfort patients and families and meet their needs. The TVs at the former hospital don’t help their survey scores. The level of service and compassion at the latter hospital more than make up for the old TV in the room.
Perhaps that poor nurse who posted her frustration works at a hospital that simply doesn’t get it. I’d refer her, and her administrators, to any of the stories about the Cleveland Clinic or the other hospitals that do. Most of us have heard Toby Cosgrove, CEO of the Cleveland Clinic, describe their journey. This world-class, physician led system realized they could do more to serve and treat their patients better. They set out to do so very deliberatively – and did, and their patients are better off for it.
The Facebook post concerned me on several levels:
If she’s representative of even 10% of nurses, we have a problem.
Nursing career satisfaction and turnover are a growing problem. We are placing more demand on them. We need them to do more, and to do it well. We need them to be adaptable and innovative and if they are this frustrated, they will be neither. Good, young nurses will eventually leave the profession.
Some hospitals clearly still don’t get it. We know hospitals that are successful at building a culture that values quality and service, but it takes a leadership team that appreciates the value of culture AND the persistence, caring, and know-how to make that happen.
I hope that nurse can start a dialogue with her organization to realize what “patient satisfaction” really means. Maybe we should just re-name these surveys to “patient and family appreciation of the level of service and compassion provided by the hospital”? That might be a better description of what we are really trying to measure.
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