Beat up by Press Ganey !

Yeah. I think PG gives a voice to the wrong people. This is my take on it, its probably not the best or most accurate but its my opinion none the less:

The object of nursing is to return people to the highest state of functioning as they were before the disease process took hold. We are, when we are sucessfull with our work, returning people to a higher quality of life.

What about those who have no "higher quality of life to return to"? I'm talking about the pt's everyone points out in here. The ETOH who is in every other week with some new bump on his head or trauma injury from a bar fight who proceeds to abuse nursing staff while withdrawing from ETOH in the hospital. The heroin addict who bullies nurses into extra doses of dilaudid with threats to report them (and somehow they know the right politician offices and hospital administration to call) if their meds are not exactly 15 min. early. Or the frequent flyer who has been diluted into thinking they are at Bed/Bath/and Beyond General who will tie up multiple staff with their irrelevent whims while the hospice pt. two doors down is neglected. These are the people who have the time/energy/desire to fill out surveys.

See, the young baseball player who breaks an ankle and is going back to school with a funny cast wont find time for it. The middle aged working man who fell off a ladder fixing a window who goes home healthy enought to return to work a couple days later and take care of his kids...doesnt have time to fill out surveys. The middle aged woman who was in a MVA on the way home from visiting her folks and is released from the hospital a couple weeks later wants to get back to working and seeing her parents.......not fill out surveys. The young girl who receives outpt treatment for scoliosis but is trying to live a normal teen life.....isnt concerned with surveys.

The problem is, when the nursing process is possible to use and is effective, the people will not help the score. But, with the pt's mentioned first.........they dont work, want to have some control over how their next visit in a few days will go, have no family or friends left to encourage them to do something with their lives........NOW THEY HAVE ALL THE TIME IN THE WORLD TO FILL OUT PG SURVEYS. 95% of the "scores" relating to our care come from this poll of citizens.

Do you really care what they have to say? I dont. PG is a joke on so many levels. We should return to the good old days where people stupid enough to create/enforce such a terrible public policy are dragged out of their homes and stoned to death. Now, something like that might convince the heroin addict to look for a new way of life.

All very valid comments - however .. . . I would like to present a bit of an alternative viewpoint. And - no, I don't work for PG.

PG is simply a survey company. They just collect data and send you the results. The way they come up with 'scores' is by comparing your info to other facilities that are similar to yours, not by comparing your scores to an "ideal" or "perfect" score. Your patients aren't unique - other hospitals have exactly the same issues. If you are in the '30th percentile' that means that 70% of similar facilities - with the same type of patients - have higher scores than you have.

It's not appropriate to blame the tool when you don't get the measurement you want. But it is also not effective or even smart to blame nurses for patiient attitudes or reactions when they may be due to a lot of other factors. Next time your manager starts yelling about bad scores, ask some new questions .. How do those other facilities get better scores? Do they have more staff? Better patient ammenities? Better managers?

I work with facilities that have managed to achieve very high PG ratings - they certainly did not get there by yelling and threatening nurses. They analyzed all the factors and invested time, effort & money to make things better. Otherwise, they may as well hang up signs that say "The beatings will stop when morale improves"

All very valid comments - however .. . . I would like to present a bit of an alternative viewpoint. And - no, I don't work for PG.

PG is simply a survey company. They just collect data and send you the results. The way they come up with 'scores' is by comparing your info to other facilities that are similar to yours, not by comparing your scores to an "ideal" or "perfect" score. Your patients aren't unique - other hospitals have exactly the same issues. If you are in the '30th percentile' that means that 70% of similar facilities - with the same type of patients - have higher scores than you have.

It's not appropriate to blame the tool when you don't get the measurement you want. But it is also not effective or even smart to blame nurses for patiient attitudes or reactions when they may be due to a lot of other factors. Next time your manager starts yelling about bad scores, ask some new questions .. How do those other facilities get better scores? Do they have more staff? Better patient ammenities? Better managers?

I work with facilities that have managed to achieve very high PG ratings - they certainly did not get there by yelling and threatening nurses. They analyzed all the factors and invested time, effort & money to make things better. Otherwise, they may as well hang up signs that say "The beatings will stop when morale improves"

LMAO. Are there really that many managers and administration in here that we all think they are logging on, trying to figure out who is who in here? So many people are making comments about that.

OMG:behindpc:I had better stop being such an ass in here if thats the case.

PG is a wonderful tool that has no effect on the healthcare field other than to give voice to the individuals who work so hard to make this country ....................pffffft..........I cant even finish saying it.

Really, PG is a poor system created by a bunch of college drop outs with uncles who know people, so they have a job and this is it. It has no other function other than to give its company something to do and to keep class B citizens in their home filling out surveys.

As far as you cant blame the tool goes, I'll one up your "tool" comparison. If you have to fix your car, and the wrench you are using cant reach the part that is broke............you:

A: Get another tool.

B: Get another tool.

C: Ask the heroin addict down the street, the chroicly unemployable next door and the drunk at the bus stop what is wrong with what you are doing (PG's system).

D: Get another tool and kick the dork who came up with PG in the nuts.

I choose...........D.

This is why I don't work in acute care anymore, and never will again. I absolutely LOVE working with patients (yes, even the PIAs), but I cannot put up with any more stupid hoops to jump through. I just want to do my job, competently and compassionately. I did spend several years of my life becoming educated, I shouldn't have to go to a special inservice to learn how to deliver "customer service."

I don't think all patients (or even most) patients truly understand the reality of what is going on outside their hospital room. As an example, I was recently in the ER for injuries acquired when I stupidly intervened in a dog fight. I was in a considerable amount of pain with several deep lacerations and a broken finger. I was quickly given an ER room, and within 15 minutes I was well medicated. I was irrigated and stitched within an hour. I was in a double room with a curtain, and the other patient was a middle aged-to-elderly man with acute chest pain. The nurse assigned to me was also assigned to him. After being stitched by the PA, it took almost 2 hours for me to be bandaged and dismissed. I totally understand that the cardiac patient had to be prioritized above me. And that the nurse very likely didn't get her dismissal orders in a timely fashion due the work-up being done on the cardiac patient. But my daughter didn't see it that way. I had to listen to "Why are they all just sitting out there" "Why does that nurse keep walking right by our room?" (I love my kid, but BLAH BLAH BLAH). It was NO use trying to explain to her the intricacies of the ER. Dismissal cannot happen until you have ORDERS, which have to be SIGNED. Let alone the fact that lacerations take a back seat to chest pain.

A hospital isn't a restaurant. There WILL be people who feel they were "ignored". But we're talking about life and death, not how hot your plate was. I refuse to be treated like a waitress. I am all for empowerment of patients, but not to this degree. All this "customer service" BS out there now does nothing but make patients believe they are entitled to things that are very often beyond our power. Acute health care just isn't the right place for surveys like PG.

PG is simply a survey company. They just collect data and send you the results. The way they come up with 'scores' is by comparing your info to other facilities that are similar to yours, not by comparing your scores to an "ideal" or "perfect" score. Your patients aren't unique - other hospitals have exactly the same issues. If you are in the '30th percentile' that means that 70% of similar facilities - with the same type of patients - have higher scores than you have.

Not how it works for me. For us, it's all about how many "very good care"s we got. 1 out of 4 says anything less, we're at 75%. Floor doesn't get 93% "very good cares" for the year, everyone's raise is cut by almost HALF. Doesn't matter that we kept your kid alive, you had one time that you had to wait for coffee and you think that means your care was only "good" instead of "very good" and next year, (like this year), my raise won't even keep up with cost of living.

Sorry. I am feeling grumpy tonight. Why isn't a hospital like a restaurant?

The problem is this: health care costs have gone up and up. The result is that a patient being admitted to the hospital is going to spend a considerable sum of money just on their admission, making their stay a "consumable good" so to speak. The amount of money is now large enough that they do not feel they are contributing to the cost of care but rather purchasing something.

It sounds horrible but when I gave birth to my daughter here in the ATL, I knew I would pay at least 2k to do so. 2k is family vacation money for two years. My ex told me, "Baby, you get yourself the best room in the best hospital!" There are lots of hospitals here to choose from so...I shopped. I choose a group that worked at the facility that I wanted to use. When I gave birth, I was assigned to a nurse who was taking care of 6 other "couplets." I barely saw any of my nurses. I was unhappy about it because I had a C section and no help from family all day long and I found this to be an unpalatble situtation. I was, at some point, surveyed. I complained.

I am student now. I understand that the nurse did not wish to leave me alone. I understand that she probably would have loved to check on me during the 8+ hours she never laid eyes on me or my baby. I am sorry to realize that this probably reflected poorly on her.

It doesn't change the situation however. I felt I wasn't complaining about the nurse but rather letting the facility that provided a service I felt I was consuming that I wanted more nursing care. It is a not an indictment of the nurse. I understand she is busy but rather of the facility that gave her an outrageous number of patients but they asked so I answered.

Go ahead. Flame me. I am jsut trying to provide another viewpoint.

I am very worried about talk of universal health care until we do away with Press Ganey and customer service as a measure of how good nursing care is. The measure of nursing care should be progress towards mutually agreed upon goals. That is just basic nursing process. Can you imagine any facility trying to order an RN to write a goal of "Patient will receive all pain medicine 15 minutes early" or "Patient's family will get warm blankets, hot coffee and roll away cots"? Universal health care will be paid for by my tax money and yours. I am perfectly happy to have it go towards health but will be enraged if it goes down the tube to make people feel as though they are at the Ritz. And we definitely can't afford that.

In my experience, the typical respondant is NOT someone who is going to be paying $2K for her care, and wants the best possible value for their buck. No, the typical respondant is a drug addict who didn't get Dilauded every hour like they wanted. Or get enough free "guest" meals for their several dozen visitors. Or the person who won't be paying a dime for their tens of thousands of dollars worth of hospitalization, whose bill is being paid for BY the taxpayers (meaning, of course, the STAFF) who still manage to complain in the hopes that they get yet something else out of us free.

A hospital is a business, feel free to shop around. But I'll be darned if I'm interested in listening to someone complain that they didn't get enough care when they DID, that they didn't get enough attention when they DID. I'm not here to kiss your butt, I'm here to take care of it--appropriately. If someone feels that includes far more than is actually deserved, that's his problem, not mine.

Sorry. I am feeling grumpy tonight. Why isn't a hospital like a restaurant?

The problem is this: health care costs have gone up and up. The result is that a patient being admitted to the hospital is going to spend a considerable sum of money just on their admission, making their stay a "consumable good" so to speak. The amount of money is now large enough that they do not feel they are contributing to the cost of care but rather purchasing something...

Here's the thing - you really can't "purchase" something that isn't there to begin with. I can only give you what I am provided with in "goods." And, furthermore, my skills are not "goods."

When you were hospitalized, did you call for your nurse and receive no answer? Or were you just waiting around for her to "wait" on you? What, exactly, did you expect or need from your nurse?

All of this "customer service" stuff is, I believe, raising expectations to an unrealistic level. I'm truly not flaming you, or trying to be adversarial. I really am interested in what your expectations were - and how that affected the way you reflected on the care you received.

I was reading a list of complaints from my former hospital's PG surveys.. 99% of them were...not enough sports channels, food is bad, curtains are dingy, MD didn't spend much time with them, "old" looking decor...COME ON now, this is NOT the Four Seasons.

Here's the thing - you really can't "purchase" something that isn't there to begin with. I can only give you what I am provided with in "goods." And, furthermore, my skills are not "goods."

When you were hospitalized, did you call for your nurse and receive no answer? Or were you just waiting around for her to "wait" on you? What, exactly, did you expect or need from your nurse?

All of this "customer service" stuff is, I believe, raising expectations to an unrealistic level. I'm truly not flaming you, or trying to be adversarial. I really am interested in what your expectations were - and how that affected the way you reflected on the care you received.

I gotcha. First, I will say that our skills are goods. The hospital places a price on them and charges the insurance company and/or the patient for these goods. Lots of folks sell skills as goods. Lawyers are an example. They not only sell their skills but their services to their clients. Lunching their clients isn't a way to help the client. Its a way of maintaing their business relationship. A necessary evil.

In terms of what is there and what isn't there, this is a function of what the hospital has on hand. When demand is for more nursing care, then they will meet that demand by hiring more nurses because that is what customers want.

I was hospitalized when I had my son as well. Nursing care in the rural hospital where he was born was one to one care in L&D and two patients to one nurse in postpartum. It was there that nursing first truly appealed to me. My expectations were the same both times but I found they weren't met the second time and no, I didn't expect the nurse to wait on me hand and foot.

I did expect that my nurse would:

1. respond to my call bell within 45 minutes, (The one single time I pressed it asking on my second day postpartum for help with my pain since I went for a nice walk around the floor),

2. not have to constantly apologize to me because she intended to take my cath out, change the dressing, etc. but was delayed by hours because of another patient or patients,

3.not have to have my baby weighed at 2:45 in the freakin' morning because that is the only time the nurse is available to do so (standard time to weigh babies in this facility),

4. shift her weight from foot to foot and sigh like crazy when I asked what my baby's blood type was and then complain that she would have to go "all the way back" to the station to see and why did i need to know that anyway (no, I didn't mentionn that in the survey. I am not stupid. I can she was stressed way beyond the limits of normal human capabilities) and

5. not be met with "Your nurse is busy. What do you want?" when I inquired as to her whereabouts (since she was apparently planning to return to do whatever it was she said she planned to do when she introduced herself at 6:45 and I would hate to be doing something that would require to return once again)

6. finally and more intangibly, to have the sense that the person who is supposed to be overseeing my recovery from major abdominal surgery has some idea of whether or not I am alive and well, laying on the floor in a pool of my own blood or if I am adjusting to life with the baby but most of all that the baby is eating, pooping and in no distress!!

I don't know much about postpartum nursing but I can tell you that I had a lot of problems breastfeeding my son and I got a lot of support from my nurse which really made the difference. With my daughter, I can honestly say not a single nurse even observed me breastfeeding. They certainly asked but I wondered, is this how its supposed to work or is it the other way, like the first time?

For the record, I agree that the present system does not set up realistic expectations. I don't think we should be selling care but that's what our system does. Forprofit and "nonprofit" institutions rake in tons of cash selling their services. There is an awareness of this fact by the general public. The natural extension of that is the creation of the expectation that customer service will be provided.

Also, about the food: I mentioned before that this would have been the money we spent on a family vacation so naturally, how does the food compare? Its another natural complaint.

Again

Press Ganey is and has always been a tool for management to use how they choose. If you have a management where positive scores are useful to their overall goal this can be gleaned from the report, the opposite is also true. In the whole a Press Ganey report means nothing. It becomes valuable in the interpretation. This is driven by the end goal of that interpreter. In other words it means many things to many and nothing to the welfare of patients.