Do Press Ganey Scores measure Quality Care?

MunoRN, RN · Jun 24, 2014

I think maybe we confuse different types of "customer satisfaction" survey's. Press-Ganey, along with other vendors, offer generic customer satisfaction surveys which don't really have much to do with the quality of care provided.

Press-Ganey also administers HCAHPS surveys (the ones that can affect reimbursements), which clearly have some relation to the quality of care provided. It's pretty basic stuff, did staff explain medications before giving them, did they do proper discharge teaching, etc which seems pretty reasonable; if you don't do the job well then you don't get paid well.

Cuddleswithpuddles · Jun 24, 2014

This is one of the questions that I would think the nursing community is all for. The only way to do better on this question is for facilities to provide better staffing, what's wrong with that?

Logically, yes, but some managers chose to penalize nurses or aides with this information instead of helping them. For example, one department in my hospital had the unit secretaries time the number of minutes it took for a call light to be answered by a staff member. People who, for whatever reason, did not meet the magical number were penalized. No additional staffing was provided. Only increased surveillance and verbal warnings. Thankfully this project did not last long because the unit secretaries, who were often CNAs themselves, "forgot" to time people as a form of protest.

I guess I am not as resentful of HCAHPS and similar surveys as much as I am towards ineffective use of the information they provide.

Ruby Vee, BSN · Jun 25, 2014

Those surveys have absolutely NOTHING to do with quality of care. I refuse to fill them out when I get them. If I have a complaint I know who to go to. I have only done this twice. Once in regards of the care of my son at an urgent care where the nurse had extreme difficulty drawing up oral meds in a syringe (yes I mean extreme difficulty). Another time when a resident ticked me off in the way he was treating my grandmother.

I always fill them out -- might as well throw in a positive survey here and there just to confound the P/G gods.

Ruby Vee, BSN · Jun 25, 2014

I found THIS was the most telling paragraph of the article:

"Satisfied patients are not healthy patients. In a paper published in 2012, researchers at the University of California, Davis, using data from nearly 52,000 adults, found that the most satisfied patients spent the most on healthcare and prescription drugs.^[2] They were 12% more likely to be admitted to the hospital and accounted for 9% more in total healthcare costs. Strikingly, they were also the ones more likely to die."

Caffeine_IV · Jun 25, 2014

This is one of the questions that I would think the nursing community is all for. The only way to do better on this question is for facilities to provide better staffing, what's wrong with that?

If only it were that simple. Maybe that wasn't the best example of question but I just don't "like" that the answer must be always to get anything. People rarely answer in absolutes.

THELIVINGWORST, ASN, RN · Jun 25, 2014

I really want to bring this up at my hospital. Nobody fills out a survey when they are satisfied.

jadelpn, LPN, EMT-B · Jun 25, 2014

Some of the HCAHPS questions from P/G are related to "did the nurse care about you as a person" and "were your visitors treated nicely" lines of questioning. Which has nothing to do with "did you understand the medications that you were given" or "discharge instructions".

Subjective questioning on something that effects reimbursement, and nothing done to effect staffing in a positive way continues to set nurses up to fail. Fortunetely, there is any number of unemployed, fresh new nurses who can replace those who do not comply.

Because remember, loyalty, quality nursing practice, and gentle reminders on how a patient can function well are not even something that is important anymore. What is important is that a nurse do what they are told, when they are told, and have a smile on their face and a song in their heart whilst doing it. Quickly. But not so quickly that the patient feels as if they are being slighted. Or misunderstood. Nor their visitors. And keep it quiet, as noise control is also an HCAHPS question.....

llg, PhD, RN · Jun 25, 2014

I guess I am not as resentful of HCAHPS and similar surveys as much as I am towards ineffective use of the information they provide.

Yes. That is how I feel. Let's not confuse the surveys themselves with the stupidity of the people mis-using the data they generate.

Instead, we should get involved in the process and insist that the data be used wisely.

wooh, BSN, RN · Jun 25, 2014

This is one of the questions that I would think the nursing community is all for. The only way to do better on this question is for facilities to provide better staffing, what's wrong with that?

We're told we can't get better staffing until we do better on questions like that. You realize that LOGIC isn't actually taken into account with staffing, right? :)

KatieMI, BSN, MSN, RN · Jun 26, 2014

This is what has to be done with Press Ganeys in order to make them effective tool measuring QUALITY of care (one possible way, IMHumbleO):

1) there has to be multicenter, nation-wide trial, using all main types of inpatient facilities;

2) at least 85% patients must fill questionnaries, whether they like the care or not;

3) out of these 85%, all outliers must be eliminated (please see below); it will give out 25 - 35%;

4) the remaining 50 - 60% must be grouped according to type of facility and care received;

5) each facility group must be matched against several randomly chosen the same facility type's group and correlation analysis should be performed;

6) the further analysis should consider variables like demographics;

7) the results should be matched with known quantitative outcomes' data (mortality, complications, CAUTI, VAP, DVT, falls, pressure ulcers, readmissions, etc.)

8) and only after that we will be, hopefully, able to say if the question "did nurses always explain you your meds?" has anything at all to do with quality of care, and if so, in which particular populations/circumstances.

Reg. outliers: I think, it would be prudent to imply that people unable to maintain their own health are probably also unable to give comprehensive rating to the care they receive from others, as they clearly do not consider health care as something important in their lives. A person who visits ER 25 times a month for the same (non-emergent) reason and totally ignores the recommendations he/she receives every single visit should not be considered able to rate the care received in the said ER, as he/she clearly doesn't consider the said care as anything worth his/her minimal attention. And we have a nursing diagnosis of "health maintenance, altered", with interventions and outcomes.

EHS: Nursing Diagnoses, Outcomes, and Interventions - Nursing Diagnosis: Health Maintenance, Altered

"only" two things need to be done about it: this diagnosis has to become as "legal" and "official" as "pneumonia" so that these patients could get resources and help they need, and an easy working tool needs to be developed in order to diagnose it. In my place now patients admitted more than "X" times in ER over 1 calendar year with the same problem or another one but etiologically connected with the original diagnosis (like "CHF exacerbation" OR "repeated afib with RVR" OR "SOB" all are accounted as the same thing) can get more social support, more referrals if needed, and more education. This is a sort of budding of the process, but if we had a scale of events signifying problems with health maintenance, we could better help patients as well as exclude from the surveys those who likely won't get "completely satisfied" anyway and who just can't fully understand that they're not allowed ketchup with salt on their burgers for their own lives' sake.

rnsrgr8t · Jun 26, 2014

I hate the surveys just like everyone....but we have to realize something here.....using the surveys in relationship to reimbursement was a calculated move. It gives justification, that the ordinary lay person will not realize, to NOT PAY FOR CARE! It is a cost saving move. Set the standards so unrealistic that they cannot be made (which we ALL NO WE CANNOT) hospitals do not get paid and the American people are not going to be storming Washington because healthcare is not being paid for.... They will be told, "we did not pay them because the hospitals are not satisfying you!" Win win all the way around as far as they see it! When healthcare professionals complain, we are labeled as uncaring, greedy etc. just like the hospitals are telling nurses, "no more staff until you get your scores up" which is impossible......CMS is doing the same thing, "we are not going to pay adequately unless the scores go up" but they cannot afford the resources that may make the scores go up so CMS does not pay. How about every CEO of a hospital that is floundering who makes millions pays a fine until satisfaction is better....THAT would get the $$$$$ spent more wisely! Sad thing is if MDs and nurses collaborated and stood together nationally, this would all fall apart. There is no hospital without docs and nurses. If they TRULY wanted to assess this acurrately, they would do what a previous poster suggested with making a survey that is studied and scientifically significant and combined with measurable outcomes. But since the motivation is to not pay, why would they do that? The government never is going to just give you money.....

Seeing this with all of the "meaningful use" money the government has "offered" hospitals to use EMR. My hospital is way ahead with use of EMR, they have had it for 13years and it as awesome system. Patients can email providers and it automatically populates in there chart, they can make online appoints, providers can sign things with an actual signature electronically, can fax through the system, all specialties can communicate through the system etc. we gut new measures on how we are doing so we can get our "meaningful use" $$$$$. The new metrics are so ridiculous, we cannot meet them. Now it is not enough for us to have patients contact us via email and have us respond to them, we have to INITIATE email discussion (we are now being to randomly pick patients to email to just check in even if you do not have a clinical reason to), we have to send data to cancer data warehouses (even in a non oncology specialty) and we have to teach/educate families on getting online/email so they will sign up for internet access to our system. I do not know why anyone thought the "meaningful use" metrics would be easy to reach!