May 21, 2015

Hospitals Are At It Again

If hospitals could get worse, I don't know how they would do it. When I read this blog, I had to laugh at what they do in the name of progress. I also thank the doctor that wrote the blog and is standing up for nurses. Too often, the reverse is true.

I must admit that the Nurses Week of May 6 to May 12 seems strange and but the dates are picked to honor certain nurses and that is their choice. But that is not the reason for this blog. Hospitals are pulling out the wallet to pay for some rather absurd customer relations. Hospitals are hiring "customer relations" experts to train hospital staff, and nurses in particular, in how to become more Disney. They think this will solve their problems.

A recent article in Atlantic, titled “The Problem with Satisfied Patients," describes the economic incentives hospitals face to improve patient satisfaction scores. Granted, hospitals have a financial stake in this, and the Centers for Medicare and Medicaid Services (CMS) controls some of the money they feel they are entitled to receive. The amount of this money is linked to patient satisfaction scores. The majority of the 32-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 sounds reasonable on the surface, but then look deeper to see what sorts of issues patients were concerned about when they rated nursing care poorly on this section. Again, from the Atlantic:
  • “My roommate was dying all night and his breathing was very noisy”
  • “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.”
  • An Oregon critical-care nurse had to argue with a patient who believed he was being mistreated because he didn’t get enough pastrami on his sandwich (he had recently had quadruple-bypass surgery).

Now hospitals are using misguided attempts to improve healthcare and this has led some hospitals to focus on making people happy, rather than making them well. When healthcare is at its best, hospitals are four-star hotels, and nurses, personal butlers at the ready, at least, that’s how many hospitals seem to interpret a government mandate.

When Department of Health and Human Services (HHS) administrators decided to base 30 percent of hospitals’ Medicare reimbursement on patient satisfaction survey scores, they likely figured that transparency and accountability would improve healthcare. The CMS officials wrote, rather reasonably, “Delivery of high-quality, patient-centered care requires us to carefully consider the patient’s experience in the hospital inpatient setting.” They probably had no idea that their methods could end up indirectly harming patients.

The doctor then wrote, “Now think of the terrific nurses in your lives. Are they terrific because they act like Disney concierge services to patients? Now certainly that wouldn't exclude them from being terrific, but those are not the qualities that come to my mind when I think of terrific nurses. Think of: strong, compassionate, "real," able to confront challenging patients in a way that I could never do as a physician, resourceful, creative, and watchful for errors or early signs of distress. Note that "finds Splenda and extra pastrami" do not appear on this list.”

This patient satisfaction thing has gotten out of control. It's a tremendous amount of money being spent on the wrong thing. Of course, treating patients with respect and dignity is important. That's not the same thing as satisfaction, though. The patient satisfaction thing places the emphasis on making patients happy, not healthy, feeling pampered, not prepared for the worst.

An example that really makes the point is this:
A hospital that switched its meal service to microwaved meals, food-service administrators openly attributed low patient scores to nurses’ failure to present and describe the food adequately. It is both noteworthy and unsurprising that the hospital’s response was to tell the nurses to “make the food sound better” rather than actually to make the food better.
This is the wrong way to enhance patient satisfaction. This may come back to haunt the hospitals. I feel the effort is misplaced and will result if less patient satisfaction.

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