Does your hospital go by the Press Gainey survey? And if so, what do you all think about it? Are you for or against its use in the ER?
I have mixed feelings about it. It's frustrating to know that I have bent over backwards to give "very good care" to all of my patients and then to have our manager send out an email telling us that our scores are in the 20th percentile.
I guess it is those only "good" score we get that bring our scores down, but I also know it is those infrequent "bad" experience that really kills us. Course, those come on nights when there is literally standing room only in the ER waiting room and the wait can only be likened to the wandering in the wilderness for 40 years; anyone over a certain age doesn't live to see the promised land, er, the doctor! :chuckle
And I am ashamed to admit that I sometimes have a really hard time caring what someone thinks when this is the tenth time they have been in this month for the same minor complaint and their loudly complaining about everything from the wait to see the doc to the nurses not getting them a cold drink fast enough. In the meantime, I am trying to take care of the acute MI that was just put in my trauma room, plus a patient with N/V/D all day, and the sweet little old lady brought in because of a fall at an ECF.
To add insult to injury, our admitted patients don't even count in our percentile, but count only for the floor they went to.
I guess I just get discouraged about it and have heard many a comment made that Press Gainey isn't a good rating tool for the ER. With the increase we are seeing in (in our ER at least) the number of people who are on medicaid, or have no insurance so they have no choice but to use the ER because we don't require money up front, I'm not so sure that it is fair to "rate" us.
We got our Press Gainey stats for the period running from 1/04 to 6/04.
In that time period we recieved back a grand whopping total of 302 surveys!
Out of those 302 surveys 50% came back with "very good." Total number of patients seen in that time period? 15,000! One of the ER docs added a note to the paper that had these stats, basically said that oh yeah, 2% is a real good sampling of how we are doing! :chuckle
Press Gainey is such a pain!! yes, we use it here - "to monitor our level of excellence in the patient satisfaction arena" Unfortunately, the other hospital in town ( with whom we are merging) is enthusiastic about P/G as well, so I am assuming it will be a thorn in my side for years to come.
A few of my cohorts and I actually took some authentic P/G responses and found ways to skew them to say any number of things! Besides the fact that the clients who had a good visit rarely fill out the surveys and the ones who were P.Oed for whatever reason ( no matter how insignificant) seem to fill them out in triplicate, the results can be manipulated rather easily --
So, HMMMM! Do I think P/G are a reliable measure of customer satisfaction? Do I think they are a useable tool to help improve customer satisfaction? NOPE!
Want better patient satisfaction scores? Here's a novel thought: How about we staff the units with adequate numbers and correct skill mixes! How about reducing the mandatory overtime events? How about holding Dr.s accountable for illegible handwriting and rude, unacceptable behaviors? How about giving merit raises and tuition reimbursements to nurses who are doing well and working hard to improve themselves? How about sponsoring groups of nurses to attend conferences and explore cutting edge technologies? How about providing up to date equipment in good repair to assist those providing patient care?! HMMMMM! I am thinking it is time to crawl off my soap box and head to a meeting w/ the directors - - guess what's on the agenda?! P/G -- pt. satisfaction goals.
Has anyone thought of the cost? Our hospitals have to contract and pay Press Gainey and that costs lots of money. I find it amusing that we can't replace broken or lost equipment, or have merit raises because "we don't have the funds", yet the same hospitals participate in Press Gainey and other professional consulting firms. I don't know the costs, but surely a satisfaction survey could be done in-house by a nurse manager without spending big bucks on consultants...........C
We have had ( and I am not exaggerating) about 5 different "consulting firms" for various areas of the system within the past 6 months!!!! Yet there are not funds to update some computers or hire a JCAHO consultant to help prepare for survey time!
I think I might be in the wrong field -- we read the reports that came back from these consultants -- they often just repeated our comments, threw in some legal lingo and POOF! got paid some BIG BUCKS!!!!
We have had ( and I am not exaggerating) about 5 different "consulting firms" for various areas of the system within the past 6 months!!!! Yet there are not funds to update some computers or hire a JCAHO consultant to help prepare for survey time!
I think I might be in the wrong field -- we read the reports that came back from these consultants -- they often just repeated our comments, threw in some legal lingo and POOF! got paid some BIG BUCKS!!!!
You're right-the costs is about 10-20 thousand for each area they survey. PLUS they charge 75cents for each self addressed envelope they include w/the survey.A big fat waste! We have a survey that we hand people, but the questions are dumb, like "how friendly were the nurses?" "what degree of concern did the doctors show you and your family?" Lets' not get started on that thread of all the ammenities EDs are expected to offer!
These surveys are set up to measure a variety of issues, some of the issues measured do not actually reflect the care the patient received but how well their needs were met. I am very much for keeping patients and families apprised of what is going on, of trying to keep them comfortable as possible, and of being empathetic, but there are always those insatiable patients for whom even Jesus could not do enough. It doesn't take many of these to drag down a score.
This sums it up in a nutshell: asking "is there anything else I can do for you? I have the time." is akin to asking a teenager who is going to the mall if he or she wants 100 bucks. What do you think the answer would be?
It's too bad that there have been enough uncaring nurses throughout the years that we had to come to this. In a sense I blame the profession for not having done what they should have been doing all along. They have really messed it up for those of us who do care and who work hard.
It's funny that the "tool" is used to show the nurses all the areas where they could use their 3rd arm and 2nd head to "work a little harder and strive for 5" or whatever other insane sound-byte they teach us.
When is it used show upper management areas in which their influence could be improved to drive the staff satisfaction that prevents nursing burnout and improves our performance naturally? Hmmmmmm
Well, I happen to think that in the ED, PG does have a high serum porcelain level. Especially at night , the patients who really need to be here are stressed out to the max, and often sleep deprived. They are all worried they are dying or have cancer, as well as the usual worries of "How much will it cost? How long will it take? Do these people know what they are doing ? Am I going to get contaminated medicine from China?" (this last actually expressed by a nurse who was happy her husband was getting Lovenox instead of heparin) Note that I am mainly concerned about the folks who actually need us. Can such stressed out people be relieable? The level 5s should be considered outlyers.
That being said I believe that reading the PG scores and comments DOES help us increase our awareness of how we are perceived, whether it is accurate or not. PG should not be used for evaluations.
The PG is mostly used by our frequent flyers and seekers, not only know how work the system but the PG as well to get what they want and for free no less. Unfortunately, we don't always have specials on Dilaudid and Phenergan, or have chocolate cake, beef and potatoes with gravy available, not to mention the soda of choice (for the patient, family and the 4 intoxicated friends with them). Hence, bad bad bad nurse and care. Translation falling PG scores.
My husband and i are both nurses and I think he has an excellent response on raising patient satisfation scores in the ER. First, during the triage process explain what the ER is for, give realistic wait times, and set clear expectations regarding
the care they can expect to recieve. Inform patients that the ER is not the place to get a clear diagnosis but rather to rule out the possibility of a life threatening condition. (i.e. - they are not going to find out WHY they have had a headache for the past two weeks, just that it is NOT a tumor, bleed, etc), and that chronic conditions (i.e. "i need a RX refill for back pain due to a car wreck three years ago")will not be given any priority unless it can be determined that it directly relates to an EMERGENT condition. Once expectetions are set, only then can they be met.
- guess what's on the agenda?! P/G -- pt. satisfaction goals.
or whatever other insane sound-byte they teach us.
RNin92
444 Posts
just reponded to a similar thread...
like i said before...we are NEVER going to make people happy in the er.
it is not a happy place to come to...people are sick...they are in pain...they are dying.
we have to jump thru all the same hoops...
we have spent a huge amount of money to put tvs in the exam rooms (can you even believe it!!)
hired staff to walk around and "make nice-nice" to the pts and families
play atations and tvs and books in the waiting rooms
thank you notes for the pts on d/c (let me just say OH MY GOD!!)
we started having...you'll love this..."walmart" meetings every week on a new customer satisfaction focus
again i say...we will NEVER make them happy
can we just spend the money to hire more nurses so we can at least save their lives...to come and haunt us another day?