The Problem with Satisfied Patients
I finally got to read the article in The Atlantic about patient satisfaction surveys. All I can say is...
YES!!!!!
And now I will jump around.
None of this is new. First off, nursing knows that hospitals are juking the stats. Scripting is juking the stats. They’re refusing patients to keep their scores high, sending sicker patients to other hospitals, or other states. So the scores on the government website don’t actually reflect the safety or care of any hospital. They just reflect how well any given hospital plays the game.
Nursing also knows that happy nurses make happy patients. Not nurses faking being happy. Not nurses pretending they’re not slammed. HAPPY NURSES. But happy nurses are expensive. We’re the biggest line item of any hospital budget. So if you want to make money, happy nurses aren’t going to bring in the buck. But they will save lives. And they will improve outcomes.
A few choice quotes from the article.
The vast majority of the thirty-two-question survey, known as HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) addresses nursing care. For example, in a section about nurses, the survey asks, “During this hospital stay, after you pressed the call button, how often did you get help as soon as you wanted it?”
This question is misleading because it doesn’t specify whether the help was medically necessary. Patients have complained on the survey, which in previous incarnations included comments sections, about everything from “My roommate was dying all night and his breathing was very noisy” to “The hospital doesn’t have Splenda.” A nurse at the New Jersey hospital lacking Splenda said, “This somehow became the fault of the nurse and ended up being placed in her personnel file.”
What to the what? You mean hitting the call light when it’s important vs. just hitting the call light and expecting someone to be at your beck and call?
In fact, a national study revealed that patients who reported being most satisfied with their doctors actually had higher healthcare and prescription costs and were more likely to be hospitalized than patients who were not as satisfied. Worse, the most satisfied patients were significantly more likely to die in the next four years.
Oh, did I just piss you off? Save your life. I’m kidding. Maybe.
And because almost every question on the survey involves nurses, some hospitals are forcing them to undergo unnecessary nonmedical training and spend extra time on superfluous steps. Perhaps hospitals’ most egregious way of skewing care to the survey is the widespread practice of scripting nurses’ patient interactions. Some administrators are ordering nurses to use particular phrases and to gush effusively to patients about both their hospital and their fellow nurses, and then evaluating them on how well they comply. An entire industry has sprouted, encouraging hospitals to waste precious dollars on expensive consultants claiming to provide scripts or other resources that boost satisfaction scores. Some institutions have even hired actors to rehearse the scripts with nurses.
EVERY QUESTION ON THE SURVEY INVOLVES NURSES. Talk about denigrating the important, life-saving, highly skilled job we do that requires a college education.
Yes, at my hospital they want us to gush effusively about our fellow nurses. You know what? I actually do this one, but not because some consulting group told me to. It’s because my colleagues are awesome trained professionals and when I hand off my patient, I know they’re in great hands. We pride ourselves in our care. Not in making people happy or satisfied.
Great nurses are warm, funny, personal, or genuine—and requiring memorized scripts places a needless obstacle in their path.
Yes we are. Bedside nursing is a job where you work with the human condition. It’s a people job. Let us be ourselves and we’ll show you a good time, hold your hand, make a joke, bring a smile to your face, tell you we believe in you, maybe even kick your ass to the curb because it needs to be done. We don’t need scripts. We’re awesome without them.
The patient is NOT always right. They just don’t have the knowledge and training.
But hospitals, too, can offer poor care and still get high patient-satisfaction ratings, and an alarming number of them do. I examined Medicare’s provider data for thousands of hospitals—the data on every hospital in the country that the agency makes publicly available. I found the hospitals that perform worse than the national average in three or more categories measuring patient outcome. These are hospitals, in other words, where a higher number of patients than average will die, be unexpectedly readmitted to the hospital, or suffer serious complications. And yet two-thirds of those poorly performing hospitals scored higher than the national average on the key HCAHPS question; their patients reported that “YES, [they] would definitely recommend the hospital.”
This is the part that’s terrifying. HCAPS offer a false sense of security. They are not the way to determine whether or not you’re more likely to die in one hospital over another. Yet we’re compromising care for them.
Patient surveys won’t drastically and directly improve healthcare. But research has shown that hiring more nurses, and treating them well, can accomplish just that.
What to the what again? You mean people who are doing life-saving work will do that work better and save more lives if they are happy? Rested? Fed? Crazy talk I tell ya. Really, fill out this survey.
A Health Affairs study comparing patient-satisfaction scores with HCAHPS surveys of almost 100,000 nurses showed that a better nurse work environment was associated with higher scores on every patient-satisfaction survey question. And University of Pennsylvania professor Linda Aiken found that higher staffing of registered nurses has been linked to fewer patient deaths and improved quality of health. Failure-to-rescue rates drop. Patients are less likely to die or to get readmitted to the hospital. Their hospital stay is shorter and their likelihood of being the victim of a fatigue-related error is lower. When hospitals improve nurse working conditions, rather than tricking patients into believing they’re getting better care, the quality of care really does get better.
Instead, hospitals are responding to the current surveys and weighting system by focusing on smiles over substance, hiring actors instead of nurses, and catering to patients’ wishes rather than their needs.
Moral of the tale? Never go to the hospital. Those places will kill you. But you might get some valet parking and wine with your dinner.
