A unicorn is a mythical creature. It does not exist.
Which brings me to Press Ganey scores.
For those of you entirely immune to the numeric patient satisfaction benchmarks, Press Ganey is eponymous with HCAHPS scores mandated by CMS. HCAHPS was initially rolled out to allow comparisons between institutions providing inpatient care. How satisfied are patients receiving care at those institutions. Like any federal mandate, it grew. Patient satisfaction surveys are now ubiquitous. They are now tailored to rate individual physician practices; emergency departments, urgent care centers, and dialysis units.
Broadly, I think information gained related to patient feedback can be useful.
But there are three important caveats.
There must be a meaningful sample size to draw conclusions.
The feedback must be gathered close in time to when services were rendered.
Detailed comments are more important than numeric scores.
I’ve been on a search for the single physician who is a fan of Press Ganey scores. I exclude those who have a connection to the company. I exclude those who work in administration (where scores are used to determine how much the institution is reimbursed). I’m just looking for that physician who says these scores are meaningful to them. And they find the scores to be constructive criticism allowing them to improve their service.
Candidly, I’ve not found that unicorn yet. I’ll keep looking.
Here are the beefs I HAVE heard in my quest.
Most patients throw letters from Press Ganey in the trash. The surveys are not filled out. The “n” is too low.
Most patient who receive emails from Press Ganey press the delete button. The “n” remains low.
If a patient does complain, by the time their response is collated, too much time has gone by. It’s hard to do proper service recovery when there’s a giant chasm between when the patient was seen and when their response was received.
Many physicians believe we are teaching to the test; that patient perception of how care is delivered is valued more than the actual care itself. As to whether there is merit to that claim, I cannot say. But that is a strong perception. Put differently, if a doctor is generous with pain medication or provides requested antibiotics for viral infections, the fact that that patient is satisfied seems to matter more than data related safety and clinical outcomes.
Every doctor will at some point become a patient. When you become a patient, you will want care to be delivered with respect. You will want to be treated by dignity. So, there is merit to doing our best to learn about how we deliver care. I’m just not convinced the best way to do that is by chasing unicorns.
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ABOUT THE AUTHOR
Jeffrey Segal, MD, JD
Dr. Jeffrey Segal, Chief Executive Officer and Founder of Medical Justice, is a board-certified neurosurgeon. In the process of conceiving, funding, developing, and growing Medical Justice, Dr. Segal has established himself as one of the country’s leading authorities on medical malpractice issues, counterclaims, and internet-based assaults on reputation.
Dr. Segal received his M.D. from Baylor College of Medicine, where he also completed a neurosurgical residency. Dr. Segal served as a Spinal Surgery Fellow at The University of South Florida Medical School. He is a member of Phi Beta Kappa as well as the AOA Medical Honor Society. Dr. Segal received his B.A. from the University of Texas and graduated with a J.D. from Concord Law School with highest honors.
Dr. Segal is also a partner at Byrd Adatto, a national business and health care law firm. With over 50 combined years of experience in serving doctors, dentists, and other providers, Byrd Adatto has a national pedigree to address most legal issues that arise in the business and practice of medicine.
If you have a medico-legal question, write to Medical Justice at infonews@medicaljustice.com.com.
I agree. The forty+ yes/no questions are meaningless. After a hospitalization 2 years ago for knee replacement, I submitted a comment for which an answer from the nursing staff would have been appropriate. To date I have received none. The press ganey numbers for the pediatrics ward at the same hospital are n= 4-20! (there are approximately 50-80+ patients per month on the ward per month) yet every quarter the hospital resports them out as if they are significant and pays enormous fees to Press Ganey which I believe would be better spent on Reiki and Music therapy for patients to improve their outcomes! We devised a 4 question survey for our office where parents provide written feedback that has been VERY helpful but get pushback from our Medical Home evaluators because it is not an official CAHPS survey 🙂
I am familiar with these scores which administrators use to browbeat doctors. Administrators are, of course, Christ like figures who have stellar bedside manner, are great communicators and, most importantly, know how to take care of patients, especially at 3 oclock in the morning when the patient comes into the ED and has to go to the OR for a 3 hour operation to save their life.
But from a purely statsitical and scientific point of view these reviews are inherently biased and the studies about these type of reviews are clear. Almost 100% of the time the people who will take the time to respond to these reviews are people who are dissatisfied with their care. Someone who received great care is not going to respond. Think about it. When was the last time you wrote a letter to a company, praising them about how great their product is. But if that product turns aut to be a lemon, you are going to raise holy hell about it. You will write letters, make phone calls, etc. Thus the built in, inherent bias. You are always going to hear from the dissatisfied customers far more often than the satisfied customers.
DS hit the nail on the head. I’ve said the same for years . And it’s regional. People in the northeast (read NJ/NY) are type “A” and will almost never give a 5/5. It’s just the mindset. The Midwest, very different. Almost everyone is nice/ pleasant/ laid back. 5’s flow like a river.
I also agree with the prior comments about limited value. The information is too far removed from the event to be helpful in making meaningful change. The patients can’t always identify the healthcare team, so we are all lumped together with the last person to touch the patient prior to discharge, in many cases. And there is an inherent bias for more dissatisfied patients to be willing to respond to the surveys.
In addition, the use of percentiles automatically makes it into winners and losers, no matter how close the actual numbers are. A few percent difference in satisfaction can mean quartiles of difference in the percentiles. This boils down to a swing in rating of one or two patients in most cases. Some recognition of the “clinical” validity of the percent satisfied as opposed to the artificial stretching of a few percentage points into a 100 percentile difference. It “feels” different when you are at the 25th percentile with 83% satisfaction when the 80th percentile is 86% satisfaction. Realistically, there is probably no valid difference between the 2 locations.
As with many things, the concepts are valid concerns; the implementation leaves something to be desired as an instrument of learning and change.
There were enough reasons for us to opt out of Medicare in 2011. If you’re still working for yourself as a physician, opt out of MCare and go third party free.
How delightful that as a small private practice dentist I don’t need to get involved with this. It is far too stressful for me to run my practice as a primarily numbers and production-based business. That is not why I became a health-care provider. Believe it or not, I joined the profession to provide for peoples’ health! I am a nurturer, not a statistician.
There are so many confounding variables and biases that the information is of limited value. However, since the management people place such value on them, I have started giving them very low scores when I get surveys on their management performance. Every year, they announce that only a 9 or 10 is helpful. That information is really pandering so that they get their bonuses or keep their jobs; so, I am no longer willing to give them gratuitous “great” scores when their performance is mediocre, or they use the same scoring schemes to browbeat physicians.
Are these scores and surveys useful?
No.
Why?
Because they were designed by non physicians who have no idea what is really meaningful to patients, under the demand of Medicare.
As stated the questions are poor. The scoring is abysmal. The results help no one.
I have looked at the results for my treating physicians. I cannot distinguish those results from any other physician. The sample size is too small and is likely to be biased.