A Death Knell for Press Ganey?


For those of you who believe that patient satisfaction ratings are a detriment to health care and to our patients, a study published yesterday in the Archives of Internal Medicine titled “The Cost of Satisfaction” is a must-read.

Not only does “satisfaction [have]little or no correlation with Health Plan Employer Data and Information Set quality metrics,” but, according to the results of this study, hospitals that push to have the highest satisfaction scores may be harming or even killing their patients.

Noting the “tenuous link between patient satisfaction and health care quality and outcomes” the authors found that patients who had the highest satisfaction were more likely to be admitted to the hospital, spent more on health care, spent more on prescription drugs, and were 26% more likely to die than those who had the lowest satisfaction. When study authors excluded data for patients who rated their health as “poor” or who had a “substantial chronic disease burden,” they found that with “healthier” patients, the association between high patient satisfaction and increased patient deaths became even higher.

Next time you see a hospital brag about its high patient satisfaction scores, remember what this study shows: High satisfaction with a health care facility means that you’re more likely to be admitted, you’re more likely to pay more for your care, and you’re more likely to be discharged in a body bag.

Still think “satisfaction” and “quality” are synonymous?


  1. Dree Daugherty on

    Someone needs to “follow the money”. Just like there was documented corruption between Big Pharm and the AHA/ASA, there HAS to be some collusion between CMS and the patient satisfaction survey companies (e.g. Press Ganey). According to a Press Ganey representative that spoke at our Grand Rounds this morning, CMS is in charge of the survey questions, the questions used, the fact that they only count a “5” score, and will only above pay HCAHPS moneys above the 50%ile.

    I would like to see an investigation of the circumstances and payoffs survey companies have with CMS. The whole affair smacks of corruption. Also, does CMS require statistical verification for their survey rankings? We complain frequently about the low number of returned surveys used to calculate our percentiles.

    When is an investigative reporter going to get to the bottom of this debacle? The legal, social, and medical ramifications are huge!

    • Very well said. I am an RN in a suburban hospital and it is becoming worse every day. You are right and I so wish a “60 Minutes” or some big media giant would expose this farce that is absolutely ruining healthcare.

      • Thank you! When I first put a link to the article saying it would link payments to patient satisfaction, I said I would worry about this because of the effect it might have on staff, because of what happened with schools; those underfunded in the first place had no way to make it up.
        I further more just received a letter from Press Ganey that implied they were the CMS. I had to look them up and reread the letter to find out PG was a professional survey company.

  2. I’m not surprised by the conclusions of this study. Our hospital is rapidly moving towards a “the patient is always right” model (which of course means that the staff member is always wrong), even when what the patient wants is potentially or actually detrimental to the patient’s well-being. Thank you Press Ganey for pushing for such great outcomes!

    • I’m a nurse. We get lectured every week about our ‘scores’. The patient didn’t like the room decor! The patient thought the person who served their room service meal wasn’t friendly enough. (She was friendly, just not ‘friendly enough’.) What the hell? We are teaching patients to value the wrong things. We can save your ass or we can kiss it, you pick.

      • When you’re seriously ill or dying, you want to remember a caring loving doctor or nurse in the last minutes of life in this world… The end of life is not something most of us look forward to. So why not make your best effort of compassion? It’s that simple.

        • I think you miss the point entirely. Health Care is a limited resource. Do you want your health care dollars spent on refilling ice pitchers or on things that need to be done.

          And BTW, how would you know what someone wants in the last minutes of life?

    • Yeah, the customer satisfaction is why I retired early. Life is far too short to deal with nursing and hospital nonsense.

  3. As a patient, I have grave misgivings about Press Ganey. The common wisdom is to get recommendations from friends for a good doctor. This is hogwash if your friends are not medically trained. Lay people recommend doctors who have have great bedside manners, are prompt, and are sympathetic. Some of the best doctors don’t have any of those qualities. Press Ganey produces similar results as the recommendations of friends.

    I only get recommendations for doctors from my doctors. I actually do not care whether my doctor has a great bedside manner. I need someone who knows what he is doing and doesn’t overlook things. My personal friends can give me all the sympathy I need.

    I have to rely more on instinct than knowledge when sizing up a doctor, but the best evaluation comes from another fine doctor.

  4. I think we should remember that it is the US government that required HCAHPS and designed the study and that companies like Press Ganey originally tried to prevent HCAHPS from being put into place. We should also remember that there are many other companies out there that provide the patient satisfaction data to the government and this isn’t Press Ganey’s “fault.” and last you should consider that where there is correlation, there isn’t always causation – just because higher patient satisfaction (with their doctor, by the way, read the study in detail) is correlated to high mortality and cost, that doesn’t mean that hospitals who strive to provide great service to their patients are killing them or spending more. First, note that the study measured patient satisfaction with their doctor and the overall experience of health care for the last year. Second, maybe these patients are sicker to begin with, and therefore get lower nurse-to-patient ratios while in the hospital. Or maybe those sicker patients have more frequent interactions with their doctor (remember that study from the university of michigan years ago about the frequency and style of physician communication leading to higher patient satisfaction?)

    those of you who blame companies like Press Ganey for CMS rewarding hospitals for great service to their patients are clearly proving your ignorance to the entire concept of HCAHPS and likely provide horrible experiences for your patients and simply need a scapegoat for your own performance. Shame on you. In any industry, healthcare included, the customer is always right. And in healthcare, the customer at the end of the day is THE PATIENT. Press Ganey, and other companies, simply give patients the voice to speak to ignorants like yourselves. I’m embarrassed to be associated with people like yourselves.

    • Thank you, Mrs. Ganey. Say hello to Dr. Press for me, will you?

      P.S. The study controlled for “sicker” patients and when that patient population was removed, the association between higher satisfaction and death nearly doubled.

      • Great….either someone with a medical degree from Google University, or, even worse…..


        ps….To all you nurses who have sold your soul for a suit and a 403(b)? The rest of us loathe you!

      • “The customer is always right”????? PATIENTS are NOT CUSTOMERS. They are just that….patients. They do not know how to treat their illnesses a vast majority of the time, thus they go to the doctor/hospital. If patients were always right they wouldn’t need us (RN’s/MD’s). To believe that simply because I didn’t greet you the way you wanted be greeted in the morning or heat your coffee up quickly enough equates to substandard care is asinine.

        Nurses are voted one of the top 5 most trustworthy professionals every year, yet management in its infinite wisdom has chosen to believe the word of the patient over an RN’s word every single time (no matter if the patient is a junkie/alcoholic or any other kind of untrustworthy).

    • I am sorry, but the patient is not a customer. The patient is a patient. We take care of the patients. Customer satisfaction scores mean nothing to me as an ER doctor. If I save their life, that is what means the most to me. It has come down to giving patients the strongest pain meds, running blood tests and doing everything on patients so that way they are happy and give you good Press-Ganey scores. This is ridiculous. I don’t need to give someone with sciatica Dilaudid. I don’t need to run blood tests or do xrays on these people. They are my patients and I do what is best for their medical condition. If you dont give the patients narcotics to go home with, they will write a bad review. All the people who criticize the ER need to work or shadow me or other ER docs to see what it is really like. To see the way we are abused by patients mentally and physically.


      • What a strong attitude. There is something wrong in every industry. Good Doctors bad Doctors, good lawyers and bad lawyers. Your attitude is too strong for me to ever want to meet you in the ER. With that being said, I do not ever want to be in the ER or hospital period. I watched the medical industry kill my mother. I took care of her for 14 years, get her into the medical care and skilled nursing and all was less than skilled and very poor in being sanitary. NASTY!!!! I lost my mother for poor medical care in an emergency. A long 6 1/2 months of torture and slow death. I can complain about people that want a free ride in my business also but their lives are not in my hands. You and others in the medical industry have too strong of a personal attitude to truly help a patient.

      • I dont agree, I work in medical on the Health information management side – a patient is a customer – Just like in any profession – there are customers who pay, those who dont, those who are satisfied and those who wont be, regardless of what you do. I dont think the PG scores should be used to evaluate a doctor’s or hospital’s overall score for care provided. But should be a tool utilized to see if the process can be improved.

        A customer in health care requires several items
        1. Be given the information they need to make an informed decision. In a professional and respectful way.
        2. Be listened to – their concerns and questions answered.
        3. Be given what they need to improve their health care situation if medically necessary.
        4. Medically necessary = after study what was found to be the underlying medical problem that needs to be addressed.
        5. Be treated timely when they arrive and informed that they may be treated out of order of arrival depending on their level of medical need.

        What really needs to happen is our health care system revamped. The reason so many people are seen in the ER – is that hospitals “have” to see them wether they can pay or not. Private physicians wont see a patient unless they can pay.

        With the possible cuts to the medi-cal and medi-caid programs of the state of CA. This will lead to many people not being seen by private physicians because they will stop taking these kind of patients because they wont even get paid enough to recoop the costs for basic services.

        Many Rural hospitals may close their doors, because you cant give from an empty cup. Resources are finite. If the facility isnt even being paid to replace the resources they have to use on these types of patients, they will not have any to use for anyone else.

        Essentially – health care for everyone – Obama Care just went down the comode.

        There is no quick fix.

        Just remember doctors – documentation is your friend, it should be: Dated timed and signed. legible,complete and detailed.

        Good Luck – because good doctors are hard to find.

    • And I’m sure Press Ganey is making quite a bit of money in their collusion with CMS. I do think patient satisfaction is important and we could do well to better listen to our patients but why does there need to be a middle man translating for us at the expense of the patient’s health?

    • When you want to see how the art of medicine and everything it once stood for…to the new guard and how bad it has fallen…look no further than Monica. Read an then reread that thread. All I can say is WOW!!

  5. I don’t get the big deal about patient satisfaction survey. Every profession deals with this. If my clients aren’t satisfied with me, regardless of how much or little they understand what I’m doing and how much it benefits them, they can go elsewhere. And yeah, it costs me money.

    I have a friend who actually beat me in a real estate case on summary judgment, and his idiot client was mad at him that he didn’t get to have his day in court. So he hired a different attorney for the remainder of the case. It happens.

    I’m not sure why you guys thought you’d be exempt from it and it would never affect your bottom line. If anything, it maybe should wake you up to the perils of continuing on the path you’re on. This kind of stuff will take over your lives as Obamacare progresses.

    Why the world’s wealthiest profession remains so poorly represented when it comes to the takeover of its industry is beyond me.

    • Imagine working for a law firm in which your job depended upon little more than making clients happy. If clients wanted you to file a frivolous lawsuit, you had to do it, even though it was wrong to do so. If clients wanted you to perform potentially illegal acts, you had to do so or risk losing your job.
      A couple of incidents where you did lose your job and then you have trouble finding another job.
      That is the atmosphere under which many providers practice due to patient satisfaction.
      You’ll probably say something to the effect that if docs don’t like it, they should get out of the situation. More and more of the good docs are doing so. People are going to be so satisfied with fewer docs that the death rates will just continue going up because they can’t find a doctor to treat them or the lines in the emergency departments are so long that they can’t get timely care.

      As for a takeover of the industry, we’ll see what happens. Whatever does happen, I’m glad I’m a doctor.

      • Your situation is not as unique as you believe it to be. What illegal acts are you asked to perform that will get you fired if you don’t? Other than that you’re describing every profession. There are architects who have clients that want them to cut corners or they will fire them. There are engineers under pressure to falsify reports or they’ll lose a large client. And I’ve been fired for refusing to do everything my client wanted when I felt it was simply wasting te court’s time. Welcome to being a professional service provider.

        The fact that you’re still questioning the changes is mind boggling. Particularly in light of the recent contraception “compromise”. I can only assume you are being willfully blind because I know you’re smart enough to see it.

    • Matt,
      Last I checked, real estate agents, architects,and lawyers were not responsible for people’s lives.
      You may lose a client because they are not satisfied with you. Big deal. You are just out of money.
      But when physicians are pressured to give a treatment that causes physical harm to a patient- and they refuse which results in a poor PG score, then you will know what I am talking about.
      I remember the days when physicians were pressured into giving antibiotics by their patients. They succumbed- and now we have drug resistant bacteria.
      That is just one example.
      Medicine is so different from other fields. A complaint is a loss of money to you.
      Keeping a patient happy can result in a bad outcome.

      • Medical field is the same as others except, you can kill someone directly with medicine. Such as what happened with my mother. The medical field and many within it ignored ME, her caregiver for years. What could I possibly know. I found in records medicines given in the hospital against my say because of her allergy to it only to discharge her saying she was stabilized. What a waste of medicare and health insurance money on poor medical practice. I am sickened by the entire industry.

      • I think another frustrating part for the ED physician is that the hospital administration constantly rides them about their patient satisfaction results without any consideration for health outcomes. ED docs (and other healthcare providers) are constantly working at odds with an administration that employs them and what they know is the right thing to do. You, on the other hand just lose one unhappy costumer.

  6. gerges williams on

    why don’t we rise up together with a class action lawsuit. stating unreliable data with punitive consequences. make the hospitals and pres ganey liable. obviously their statistics are inaccurate. I suspect if all physicians join the suit that the hospitals will have to buckle to the pressure. This in effect will bankrupt pres ganey

    • I like your thinking, Gerges.

      Any of you that have never seen a Press Ganey Survey should get one and read it. There are no questions about actual medical outcomes only about PERCEPTIONS of quality. I have received several of them and always return them uncompleted with a note explaining what total BS the survey is.

      As a 30 year veteran of the ER I know that many patients come with unreasonable expectations and it would be malpractice for me to acquiesce to them, even though it would improve our P-G scores.

  7. Of course there is a high correlation between patient satisfaction and high mortality rate. I already see how it could happen on my floor. I have my manager called me into her office basically telling me indirectly that if a self care patient ask you to clean there a**.. You must do so because of patient’s satisfaction. In my head, I’m thinking what the hell happen to self-promotion and early mobilizations to prevent physical decline and PNA.
    Our healthcare system has turned into a hell hole, being reimbursed depending on patient satisfaction and not their health outcome….is total BS. Sometimes I feel more like a maid instead of an RN.
    This whole healthcare reform is getting out of hand.

    • Sometimes I wonder if patients who can perform self care and wants a nurse to do it for them is in some way getting off on it.
      It is like sexual harrassment.

  8. Pingback: Does better patient satisfaction cause higher mortality? | Code 3 Spots - Code 3 Spots

  9. Really,
    If you are lying in the bed and someone doesn’t tell you what’s going on, what you are getting, why you are getting it and what it does, would you accept this? If someone doesn’t introduce themselves, doesn’t answer your questions, and is rude, would you continue going there?
    Press Ganey is a gauge. HCAPS not only measures customer satisfaction, but also quality. Clinical outcomes and readmission rates within 30 days are also being measured. If you can’t provide excellent customer satisfaction and superior outcomes, you shouldn’t be in the business, and I certainly don’t want you to touch me.

    • If Press Ganey was an appropriate gauge of that, I’d be for it, but it is not. In the ICU where I work we have a great team of nurses and MD’s who really care about the patient but some of our Press Ganey Scores are 20%. Part of the problem is low return rates. Last quarter we had 2 surveys returned. The question that lowers are scores every time asks “Did the nurse always explain the side effects of every medication?”. I can honestly say I don’t always explain the side effects every time. For instance, when my patient has issues with pain, we usually work out with the patient what medication works the best. The patient may ask for and receive that medication multiple times in a day so I don’t think about going through the side effects every time. But does that mean that I am rude? Does it mean that I don’t take the time to introduce myself and answer the patients questions?

    • Eduardo Osorio on

      Seriously, the vitriol in this thread is embarrassing. Quality AND Satisfaction, people. We need both. We should incentivize both.

  10. Our society is super concerned about satisfaction. More butter, more salt, more alcohol, less exercize, less effort, less overall knowledge. Nobody can have any discomfort. Nobody should ever have to wait. I want it now super size it. Make me feel comfortable all the time. Patients take that attitude to the ER and we are supposed to satisfy them? They dont care you have been busy resuscitating their neighbor in the next room. They want their ingrown toe nail that has been bothering them for weeks removed now.

    • And it takes verve, diplomacy and the patience of a saint to tend to those entitled individuals. A never ending well of head tipping and nuances to convey that you care and that they are right. I could just puke.

  11. I understand where you all are coming from. Satisfaction/expeience is not always synonymous with great quality of care. The truth of the matter is, quality & safety are not high priorities in healthcare. Airlines take more precautions in this area than hospitals do. And that part is a fact. Moving on…

    That said, one writer mentioned that America is more concerned about satisfaction. And that is true. If you go to a restaurant and you food isn’t cooked to the temperature or taste that you prefer, you will complain and send the food back. Or maybe leave altogther. If a grocery store advertizes a discount and they are all sold out, you want a rain check…”cuz you gotta be satisfied.” If your mechanic makes an error and doesn’t fix your vehicle properly, you take it back to get fixed again and want a refund on top of that. Each of us takes an advantage of the “customer is always right” scenario. Each of us. When we pay for something, we want it to be to our liking.

    Although customer satisfaction in hospitals may not be as important to us, think about if the focus by CMS was solely on quality. Hospital errors, near misses, cleanliness of the hospital campus–we’d lose more money than we are with HCAHPS and Value-based purchasing. Hospitals would be in a whole lot of trouble if we were truly compensated based on the product that we put out.

    I’ve been in healthcare for 20 years and have always been amazed at how uncaring healthcare workers can be. They should change the name of the industry or just remove the word “care” altogether. My experience in 5 large hospital systems across the united states in 20 years is that as long as errors are not detectable or can’t be traced back to hospitals, they generally don’t care if their product (quality medical care) is of value or done correctly. Why? Because they are underpaid, too short staffed, don’t get enough attention from administration, they aren’t recognized enough, blah, blah, blah, blah.

    The truth is, healthcare doesn’t want to be monitored or measured. Yes, some of the methodolgy is flawed, but that simply means that we as healthcare physicians, administrators and clinicians should have lobbied together and collectively made our voice heard. We fell short on that part.

    • ExperiencedRRT on

      I agree with you! It amazes me that people in the medical field are still confused about the reason they are there. It’s not so they don’t have to deal with people! Some deal with people better than others..I think it’s time that the hospitals which don’t know how to satisfy their patients start looking around at the ones that do! Bickering and complaining about being monitored isn’t going to improve scores. Many of us in the industry who are in the trenches wonder why Administrators and managers seem to exist solely for their own benefit. The old Hierarchy system in medicine isn’t working!!

  12. Let me add, patients deserve better. Each of us deserve better. HCAHPS extracts the quality related experience that patients have. It’s a touch base to understand the patient’s perspective of how well we communicate and how well we deliver. Since nurses, doctors (definitely not doctors), managers and administrators don’t bother rounding on every patient and asking them each day how their experience has been and where they have fallen short, then the next best thing is to utilize HCAHPS because its important to touch base with the customer.

  13. I just got my very first Press Ganey survey in the mail. I’m not a physcian, but I’ve seen many in different states and also in different parts of Europe. And my Ph.D. research (back in the ’70s) was done in a biobehavioral science done in a lab affilated with Yale.
    The reason I’m alive is that I used my own judgement and research skills when listening to MD’s diagnoses and treatment options. In my decades-long experience with U.S. doctors, it is very hard to find a physician who really knows his or her stuff, especially beginning with MD who got their sheepskins after the ’60s turmoil was over, which was when grade inflation became entrenched, and cheating to be able to get into professional schools became common enough to make the news for a while. As for hospitals: I’m wise to their touting their survey-derived reputations. All levels and phases of American medicine are money-driven and it is the rare, rare holder of the MD certificate who (1) really enjoys defeating illness and (2) knows enough to chase down an accurate diagnosis.

  14. Sorry, but unless you’re in the medical field and currently working in a hospital, you have no idea the pressures MD’s and RN’s are facing in the hospital setting.

    RN’s are certainly not in it for the money. I also don’t think the physicians that I work with it are in it for profit. We all work very hard to keep our patients alive and to resolve their critical health issues.

    Saw a bumper sticker which stated “Paid to save your ass,not kiss it” – unfortunately, now we are told to do both and the patients and their families know it.

  15. MedicarePatientSpeaking on

    I guess I simply need to be treated with dignity and respect, whether I have Medicare or other insurance, whether I have a mental health dx (which IS a medical condition btw) or not… If Press Ganey has influence and cracks the whip on that, I’m all for it. CMS is a lame duck if I ever saw one–it doesn’t matter if I reported my doc tried to strangle me in front of an audience, they won’t do anything about it. Press Ganey, however, seems to have some power/voice with you folks for once. So you go on talking among yourselves, but the rest of the world is watching; so you might as well lose the ME-go. Nobody likes a jerky doc or nurse, and more realize they don’t want one “saving” them either.

  16. I’m not sure I’ve seen such a blatant display of disguising “correlation” as “causation”. I wonder, were you in such a hurry to spin this report to back up your claim that customer satisfaction is not important that you didn’t have time to read the entire thing?

    Couple of things to point out. The study states that “”higher satisfaction was associated with less emergency department use but with greater inpatient use, higher overall health care and prescription drug expenditures, and increased mortality.”

    The keyword here, boys and girls, is “associated”.
    Can you say “asociated”? I knew you could.

    In fact, the final paragraph of the study goes so far as to say “These associations warrant cautious interpretation and further evaluation.” But I guess that didn’t help make your point, huh?

    Moving on, the study goes on to say “regardless of physician actions, patients may also have fundamental tendencies to be more or less satisfied that are associated with distinct care-seeking patterns.” In other words, the guy who visits the ED 5 times a month, wanting nothing more than attention, may be more likely to score his visit low, regardless of the outcome. Likewise, a patient that sees his doctor once a year, and is in generally good helth, may be more likely to score his visit highly, regardless of the outcome.

    With that in mind, let’s take a look at the “associations” this study mentioned again. Higher satisfaction is associated with less ED visits, more inpatient admissions, higher prescription expenditure, and higher mortality. Could it be, perhaps, that people who only go to the doctor when it is important are more likely to be happy with their visit, being as their health is, by association to their frequency of visits, higher? And while they do visit the ED less, and score their visit higher, could it be that they are admitted to inpatient more often because, when they do visit, it turns out to be for something serious that calls for being admitted? And when we admit patients, isn’t it generally because they have a serious issue, one that could, I don’t know, kill them. That would raise their mortality rate, wouldn’t it? And when they are admitted for something serious that could kill them, isn’t their visit, by nature, going to call for more meds, procedures, and stays, which would, maybe, cost more?

    Notice I asked a lot of questions, instead of stating facts from mere associations, since that would make me look quite silly. Instead, I would suggest that readers look at the 5th paragraph under the “COmment” section, which states:

    “While patient satisfaction correlates with the extent to which physicians fulfill patients’ requests, patient satisfaction can be maintained in the absence of request fulfillment IF PHYSICIANS ADDRESS PATIENT CONCERNS IN A PATIEN-CENTERD WAY.” It goes on to say, “patient-centered communication requires longer visits and may be challenging for many physicians to implement.”

    So, this study that you used to make a non-existing claim basically says customer satisfaction is important, but it will take hard work on the part of physicians to make it work.

    Don’t worry, though, if your job is too tough for you, there are plenty of other jobs available out there.

  17. Lorenzo Alberto on

    Healthcare in the US is a business model. Healthcare in all other developed countries is a public service. The US spends double the amount per capita as those other countries & ranks last in all measurements of healthcare EXCEPT satisfaction & leads the world in prescriptions of opiates and benzodiazepines.
    Keep ’em happy on drugs, keep ’em ignorant, and keep ’em in the dark. Just pay up….and now we can use the Govt to mainly finance big Pharma. It’s all ok as long as we have the right to sue you if we aren’t satisfied and you are not 100% accurate.
    ER Doc

  18. What the pollyannas and outsiders fail to lock onto is the fact that patients’ opinions about their care are about as relevant to practice as housewives’ opinions about nuclear physics and space travel, or childrens’ opinions about their vegetables.

    I work in an ED that sees 400 patients daily, 24/7/365. Probably 20 a day are narcotics seekers. We detect them and refuse their scams with about 98% success. Out of the 12K patients we see a month, our Press-Ganey scores are typically based on <50 responses returned, or 1/3 of 1%. A common caveat in opinion polling is that the dissatisfied respond at rates 10 to 20 times that of the satisfied. So when we infuriate 600 douchebags a month sponging for narcotics, like ethics, policy, and the law require us to do, what're the chances they're making up a significant percentage, if not the bulk of the responses? If surveys get mailed to 5% of all patients, that means 30 went to drug seekers refused their fix. And we get, once again, fewer than 50 responses/month, going back several years.

    This process is as asinine as basing police salaries on the opinions of those they ticket and arrest.

    And don't wave the customer service ethos of other professions in our faces. Call me when the government mandates that you have to serve the people in your business that you'd currently throw out the door, and THEN you'll be comparing apples to apples. When was the last time McDonald's was mandated to feed homeless people regardless of ability to pay, and then receive government compensation at 2 cents on the dollar based on how satisfied those who hadn't paid were with the product? (Hint: never. And neither is any other business known to man.) And if they were, they'd be out of business in a week.

    So either clue into how retarded that entire idea is, or save your uninformed opinions for a Press Ganey survey, so at least we can properly discount them as such.

    • An Average Gal on

      “as relevant to practice as housewives’ opinions about nuclear physics and space travel”

      Wow… Do you good old boys in the misogyny club have a special handshake or do you all just recognized each other on site?

      While your point was very valid, your condensending attitude makes it hard to take anything you say at face value. My guess is that your holier-than-thou attitude comes across in your patient interactions as well.

      If I visited your ED and you spoke to me with even half that much snotty faced, self important attitude you would not have to worry about your scores as I would have requested a new doc immediately.

  19. Porcoimundo on

    Press Ganey goes beyond affecting clinical staff: it does come down hard on support services, mostly housekeeping that so happens to be my thing. It’s very common to come across comments such as “I had a four day stay and not once saw a housekeeper” or “During my stay my bed linen was never changed”. Considering that these comments often come from Med-Surg floors I cannot help to think how much of this perception is basically induced into the surveyed population by the questions as they are written. Those of us who day in and day out dwell in a busy hospital very well know how financially critical it is to keep discharges going at a frantic pace, with the level of “stat” beds being called on the bedboards and how it affects the proper sanitization of a patient room and, more importantly, of a semi-private patient room. So here we are, discharging a bed that is separated from the other one by a flimsy privacy curtain, lights on looking for dirt and blood spots, dealing with trash, suction canisters,IV poles and whatever else equipments are left behind. The next you know the patient on the other side will get a survey at home and one of the questions will be in regards to the “quietness” of the environment. Press Ganey chips in and all of a sudden hospitals start being judged by hotel standards, like beeping monitoring equipment, carts on wheels providing different services are an unnecessary nuisance. As a matter of fact I had the opportunity to watch first hand when the company servicing the Boston Children’s Hospital brought in someone with a hotel background to run housekeeping. Needless to say what a true disaster that experiment was! All hospitals are short staffed on both ends, clinical and support services, but still pressed to deliver above and beyond on a routine basis, to the point you can stick your finger in an electrical outlet and not even feel the shock. Patient care? Hardly.

  20. Mighty Quinn RN on

    Use your brain people! If you were disgusted with your hospitilization do you think you would live longer? Dont be that gullable people!! This is just another attempt by the right-wing to dissuade slow-thinkers from accessing the affordable care act (Obama-care), which holds physicians and healthcare providers responsible for the care they deliver by making their delivery of care more consumer oriented. Do not trust any physician or healthcare provider who suggest you should not be pleased with the care they are providing!! “If your experiment needs a statistician, you need a better experiment.” ― Ernest Rutherford

    Satan delights equally in statistics and in quoting scripture…. ~H.G. Wells, The Undying Fire

  21. Pingback: Top infection risks are all our fault | The Pediatric Insider

  22. ExperiencedRRT on

    Reading the comments on here is enlightening. Finally, the patients have a way to get their voices heard. I have worked in many hospitals over a 40 year period. Patients have complained about the same things for years. Hospital workers want a decent place to work. However, obviously from the Press Ganey scores, management hasn’t been listening, so now they are forced to listen in the only way that their attention can be had..PAYCHECK!! Hospital management has always spent their attention and energy on profits while overlooking the needs of their patients and servers (workers). People don’t just automatically know how to manage any more than they automatically, genetically or through osmosis, know how to serve people with grace and kindness. Going to medical school, nursing school or any other professional training doesn’t automatically translate into “great caregivers”. People have to be given skills, training and competent managers to guide them. Hospitals are horrible at this. They are huge conglomerates of incomepetence, political systems of infectious cultural nepotism. If hospital CEOs had been listening to their patients and their employees with even a slight level of sincerity, they wouldn’t be forced into oversights like HCAPS. I think hospitals are actually getting off lightly. Imagine if their patients were trained and educated in medicine and the service levels they should be expecting, what would happen to the HCAPs scores then? It wouldn’t matter who did their surveys, most hospitals would fail miserably.

    • Well said experienced RRT. I believe Respiratory always has a bird’s eye view of the hospital due to the fact we as Respiratory Therapists participate in treatment of patients throughout the hospital! Also, I believe the focus should be on management and as you stated, energy and attention toward the workers….when this occurs, happy worker, happy patient, happy administration, happy bottom line! All else falls into place!

  23. Customer Experience on

    Looking deeper it seems that our patients and their loved ones primarily want is information about what to expect while they’re receiving care.

    Any professional who either attests or agrees that “we’re here to save patient’s asses, not kiss them” is a discredit to the profession. Do you tell your patients and their families those words or do you save it for when they’re out of earshot like some squeamish passive-aggressive nobody? Tell the patient with end-stage pancreatic cancer that you’re there to save his ass, not kiss it. Tell the 10 year old with a broken arm that you’re there to save her ass, not kiss it. Go to the waiting room and tell the parents of the DOA teen whose car was plowed by a drunk driver that you’re there to save their ass, not kiss it.

    If you work in any role in healthcare and do not believe that your job is to reduce suffering in whatever way is at your disposal, you should consider a new place to work for the sake of others.

    If you work in any role in healthcare and are not interested in improving your professional and clinical proficiency by incorporating your customer’s thoughts and ideas into the work you do, you should consider a new place to work for the sake of others.

    If you work in any role in healthcare and do it out of your love and concern for others, I respect and thank you from the bottom of my heart.

    • I don’t disagree with anything you say, the issue is whether HCAHPS is the right tool to measure it. I don’t feel that the questions on the survey get to the heart of it. Absolutely, we should treat our patients with dignity and respect and we should educate them and partner with them to get their needs and goals met. I just don’t feel that HCAHPS scores reflect that.

  24. As an American I expect to pay for quality. I have had to access the health care only in emergency rooms and I am disgusted at what I see there.

    I can understand ER doctors and nurses being stressed at trying to treat patients as customers. Grubby people wanting every possible extra they can get their hands on.

    My suggestion would be controversial but here it is. Segregated Health Care. If you have insurance and can pay, use this line. No insurance, unable to pay that line. This system works everywhere else in our economy. I don’t go the BMW dealership to buy my cars because I can’t afford them. I don’t fly first class. I don’t eat caviar and smoked salmon. I don’t drink expensive champagne all for the same reason. I can not afford them. Yet I do have a very good health care plan that I pay for.

  25. We have made a grave mistake in health care by confusing patient satisfaction with patient engagement. Patient engagement actually correlates with improved health and decreased utilization of resources. That’s what we want! But patient satisfaction is often irrelevant – what you might do to get hig patient satisfaction scores is not the same thing you might do to improve their health. And, every hospital and clinic in the country could have patient engagement scores in the 90th percentile – and it would be great. But not every clinic can have patient satisfaction in the 90th percentile. And the people who set these goals have never taken a statistics class in their life.

  26. I am just an ESA. When a patient is really sick all they care about is a skilled Doctor and a compassionate Nurse and when the blinds go up and they are on the road to recovery that is when they become a Customer

  27. The surveys should reflect patient satisfaction with safe and appropiate care. I believe patient satisfaction is important, but the surveys need to be more realistic correlated with patient outcomes…focusing on patient safety and appropriate care. A hamburger for a triple bypass patient, overdosing pain medication, or over prescribing or over testing for patient satisfaction does not equal safe or quality care. I think what some surveys may be missing are circumstances, context, its affects on decision making and treatment, especially, because it affects hospital resources and therefore it’s capability to help other people. Definitely more public awareness and public health education for the current system should be promoted, especially, preventative health education. There should be more innovation to provide a measurement that does not compromise safety or quality care, yet still keeps wholistic treatment of the patient’s experiences intact.

  28. I think that the intent of Press Ganey scoring is to number 1: create a marketing atmosphere to the public between hospitals, allowing the layperson to have some choice in which hospital or MD they wish to care for them; and 2, the creators of this system (CMS) were well aware of the potential motivation by corporate America to play such a capitalistic game where the winners receive gain(money). The word “Satisfaction” is what has everybody that has a role in healthcare confused. It seems as though many think the custormer should’nt care about satisfaction and should just take what we give them; after all, we went to school and know what we’re doing, right? Well, welcome to the era of transparency. Yep, now even lay peoples’ rights are being stood up for, and rightfully, by who, the federal government, that benevolent entity that we all expect to uphold our laws and give everybody their “equal rights.” Be careful looking for studies that prove your point on this matter. Yes, anyone can find a study that will prove their point. There are all kinds of studies that link poor health and obesity to eating fast food, but that doesnt make these entities any less profitable. The goal of capitalism does not have your longevity at its core. People that patronized Mc D. and the king of burgers are “satisfied.” When you pass another burger joint to go eat at their establishments,its satisfaction that drives you to them. Dissatisfaction is why you dont shop at certain places or eat at certain places. I think that CMS is in-fact the proper entity to bring forth such a design. Like many other “rules” brought down from the mountain top of government, you all will see how in the long-run, this is just us (U.S.) keeping to our capitalistic ways as a nation. No harm done here to others. Which is kind of like a law or rule some of you may be familiar with: nonmalefeansance?

  29. A similar phenomenon is occurring in the education sector where student “happiness” has become more important than meeting service delivery performance outcomes. Students are happier when the education “bar” is lowered to the point were no effort is required to receive a their diploma. Institutions that are focused on student satisfaction produce inferior graduates.

  30. Satisfaction surveys from patients who seek a controlled substance medication (e.g., narcotic, benzodiazepine) must be scored separately from surveys from other patients. The need for this separation is very clear. The failure to separate such ratings from ratings by other patients invalidates all patient satisfaction ratings.

  31. I wish I had read this article before I completed their survey, which is primarily designed to show that the physician is a nice person. My doctor is a thorough, efficient, experienced professional who just also happens to be kind. No one receives a degree or license in kindness,,

  32. As can be seen by the spectrum of comments, patient satisfaction and health care performance is a huge quagmire of various groups believing in their own purpose. There are certainly needs for patient surveys and there are very valid arguments that health care providers are being too heavily critiqued based on a number of business model applications that don’t mesh well with the health industry. Couple this with the fact that many, if not all of these health institutions are managed by business-minded people, where satisfaction is paramount to profit. Its like mixing oil and water and sometimes more like oil and fire. As a doc of 25 years who has had both office practice as well as (currently) ER experience, we often feel belittled when we are told we need to improve metrics that pander to coddling and not the important things involved in health care. The surveys DO ask important questions, but they also ask questions that are purely business-minded and lead to modification of behavior that can and (apparently from the article, do) threaten patient outcomes. Scores that near 100% are a clear sign that too much deference is being given to what the patient wants and not necessarily what is best for them. Statistically speaking, this is a certainty. You cannot please all of the people all of the time unless pleasing them is the ONLY thing that matters. Unfortunately, in medicine, even the best physicians don’t know everything, but patients most certainly “don’t know what they don’t know”, which means they shouldn’t be confusing their Google search with someone’s medical degree. So what’s the fix? A lot of people are shouting…”FIx the system! Its broken!”. Well, the short answer is, its likely not fixable. There are simply too many variables. When lives hang in the balance of decisions that are based on efficiency of spending, efficiency of time, efficiency of resources and expectations of the “best care possible”, you’re going to be constantly pulling the ropes in different directions. By giving that magical “increased time with the patient”, are you sacrificing time elsewhere (other patients, who will complain about waiting? Or sacrificing time needed to relax so you don’t get overstressed and scream on forums like these about how bad things are for health care workers?, ect. Yes, you can go to another facility/hospital/doctor/clinic if you are not “satisfied”. Chances are, you’ll find problems EVERYWHERE you look when you are really just looking for problems. As someone mentioned, the best chance you have of finding a good health care giver is NOT the media, the survey companies, or your friends…its docs. I’ll go so far as to say I’d even advise caution on nurses’ recommendations. Get a recommendation from a doctor’s peer or take your chances. Even then, so many variables can make the experience a bad thing. The problem is, today’s generations are so much less tolerant of inconvenience and equate inconvenience with threat. Waiting 45 minutes to see a good doc is an inconvenience. Waiting 15 minutes to see a doc with chest pain is a threat. You can’t teach these things to adults. They are hard wired to already act the way they will act, and very few are needed to make your PG scores look like you aren’t very good, especially when they don’t follow statistical significance rules of polling. Good luck. Most of those here are right, on both sides of the fence. Its the system that’s broken on both ends and unfortunately, with 350 million people, its not going to get better.

  33. Janet Christian on

    There must be balance between “the patient is always right” and “the doctor/nurse is always right”. I’m a living example of why this is vital. I now live with two chronic conditions, both because doctors dismissed my claims and concerns.

    My first gastroenterologist refused to believe me when I asked if my sudden pain might be pancreatitis. He literally rolled his eyes at me when I said I’d been reading online. I’m an educated, intelligent woman who found information on valid sites (MDanderson, MayoClinic, etc.) that clearly pointed to the likelihood I was suffering from acute pancreatitis. Eight doctors, 8-1/2 months, 50 lb weight loss, and $140,000 in tests and surgeries later, one doctor took my questions seriously and confirmed pancreatitis. In fact, he expressed surprise that no one had bothered to test it before. What started as acute had become chronic because of the long time lag. I now must live with the painful attacks, nutritional issues, and dietary restrictions for the rest of my life.

    The orthopedic surgeon who did my knee replacement would not believe me when I said — the second week of physical therapy — that something was wrong. That I was having pain-pain, not just healing-pain. Just over one year later, I am now sitting here with ice on my knee from a second major surgery. My new doctor determined that I did a major tear of my MCL that second week of PT, and because it was ignored, the MCL “healed” in its torn state. The solution was to replace parts of my artificial knee with larger, thicker parts, in an effort to take up the enormous side-to-side slack in the joint. But I’m stuck with an MCL that is, in the doctor’s words, “a mostly useless mess of scar tissue”. I will live with the pain and physical limitations from that for the rest of my life, too.

    I am a mostly healthy person who has two serious chronic issues specifically because doctors would not listen and take me seriously. So before you dismiss this issue entirely, raise your noses in the air, and claim that you know best and patients should stop whining, remember that no one knows their body better than the patient. Perhaps you should learn to actually listen to what they are saying, even if their terminology is not as accurate as it could be. And even if their suspicions and limited knowledge of potential causes came from online sources.

  34. American Patient on

    In the real-world hospital environment, SOME patients are right, usually if not always. Having been an inpatient several times, twice via ER admissions, I can tell you that nurses and doctors sometimes make really bad mistakes of a purely medical nature. One time I was put on a drip of a dangerous BP med because they saw I took a different BP med, and it was *inconvenient* for them to put me on the correct one because — for some reason my cardiologist could not explain — their protocol required installation of full monitoring, etc. After 24 hours of plunging BP and racing pulse — while I was fighting a major infection — I had to insist on the correct med.

    This is a really common med that controls pulse and BP, with a warning not to stop it suddenly. The medical staff did not know this. They used a med with an entirely different mechanism of action, which worked basically the opposite of what I needed. Another day or two of that and I could have been in cardiac arrest, according to the drug monograph, the PDR, and any other source that people in this job should know, or at least check, when setting a patient up.

    I’m also on a daily med for GERD which they did not have in drip form, so they substituted a different med that is basically obsolete, simply because that’s what they had in stock. Well that med has major interactions with other meds I take, which is another reason I haven’t used it in years. Again, very familiar drug that you can find in any reference book or professional resource, in mere seconds.

    Medical staff failure to check for drug interactions and proper titration are two big failures almost every time I’ve been admitted. But probably the worst is the incredibly weak attention to cleanliness and the risk of sepsis. In a semi-private room I once went into the bathroom and found a used blood bag, from the other patient, left on the edge of the sink by a nurse. This is medical waste, what the $#^# is it doing there? So I call a nurse’s attention, she jumps into action — just moving it into the general trash receptacle, apparently not recognizing that big red bin right next to it.

    The list is endless. Another time I was post-surgical with infection a characteristic big concern, and a pillow fell off my bed. I was immobile so had to ring for help retrieving it. That pillow was handed back to me — straight off an uncleaned floor — without a change of pillowcase. The same nurse came in later to put a new med into my IV, and stood at a counter unwrapping the syringe without having washed or disinfected hands, no gloves, nothing. I said something about it and she looked annoyed. She did not say anything like “I cleaned my hands as I walked into the room” – which would have been possible. No, she obviously did not think it mattered.

    I am NOT a doctor but I am an educated person with some science background who simply reads a lot and takes their own health seriously. I am convinced that my own alertness to things as described here has helped me stay alive in the death traps that American hospitals have become. That, and I do not mind speaking up — and when I see comments here, talking condescendingly about all patients like we’re stupid, and somebody with an MD or an RN automatically knows how to care for me better than I do — well, my experience proves that is really wrong and those of you who feel that way are a big part of the problem.

    Studies show that outcomes improve when medical staff LISTEN to people like me, and other patients. Some of those patients may be ignorant about medicine — but not all of us. STOP LOOKING DOWN ON US.

  35. Hate Surveys on

    Press Ganey sends me a survey after every visit with a Advocate Health Care doctor. I have never filled one out and they go straight into the trash.
    So I have to wonder how many trees Press Ganey kills to produce their worthless surveys. And by extension less trees, leads to more pollution, which leads to more illness. Is it Advocate’s desire to cause more disease by there worthless efforts to collect patient information.

Leave A Reply