Satisfaction scores

Anonymous865 · Apr 15, 2014

I'm a patient not a nurse. Unfortunately this past year because of 1 major illness I had a lot of interactions with hospitals and medical personnel. I responded to a lot of surveys. Most of my responses were extremely positive. One was extremely negative.

Here's why:

I went to the NP at my PCP's for 102 temp and severe abdominal pain. She immediately sent me to the ER. She explained that I needed an immediate CT and probably surgery. The ER had a CT dedicated to the ER. They would be able to do the CT in the ER faster than she would be able to get it scheduled through the hospital. She said she'd call the ER and let them know she was sending me over.

I arrived at the ER 5 minutes later expecting a long wait. Much to my surprise I was taken to a room after a 5-10 min wait. By that time the ER had my records from the PCP. The nurse reviewed my meds and history with me. Everything they had was correct.

I gave them a urine sample, changed into a gown, got hooked up to all the monitors, had blood drawn, and got an IV. Told them my pain was a "5". Saw the Dr. The nurse came back a few minutes later with pain meds! I hadn't expected to get anything for pain until they determined what was wrong. I was so greatful for the relief.

The nurse explained what tests they would be doing and why. Periodically the nurse would come check on me, ask my pain level, and tell my what would happen next or what they were waiting on.

After about 8 or so hours the Dr. told me that I definitely had a major infection, but they didn't seen anything on the CT. She said that I did have a lot of bacteria in my urine, so they thought I probably just had a UTI.

What they did right:

1. They and my PCP seemed to be communicating, since they had all my records and when I saw my PCP a few months later she had the a report from the ER

2. They told me what to expect.

3. The nurse checked on me periodically. Assessed my pain level and updated me on what was going on.

4. They didn't make me feel dumb for coming to the ER for "just a UTI"

5. They treated me kindly and like an intelligent, educated person.

6. This is the most important one - They made a point of telling me that if I wasn't feeling better after a few days on the antibiotic or if I started feeling worse, that I should come back to the ER.

After 3 days I was much sicker - 103.5 temp and pain of a "9"

I went back to the ER. Same procedure. Labs, monitors, IV, CT, etc. Pain level of "9".

Of course I saw a different Dr this time, but the Dr who had treated me before came to my room a short time after I arrived. She said, "I saw your name on the board. I just wanted to come by and see how you are. I'm so sorry the antibiotic didn't work." Another thumbs up for that ER.

This time the CT showed "an extremely large pelvic abscess and peritonitis." The first Dr came to see me after the current treating Dr had told me about the abscess. Dr. #1 said that she and Dr. #2 had gone back and looked at my records and previous CTs and the first set definitely hadn't shown anything. Another thumbs up for the ER. They had made the effort to go back and see if they had missed anything the first time.

If Dr. #1 hadn't made a point of telling me to come back if I wasn't feeling better in a few days, I wouldn't have returned to the ER. I would have continued taking the antibiotic and gone back to my PCP when I completed the antibiotic. They told me after surgery that the infection had spread to every organ in the abdomen and there was a lot of necrotic tissue. They kept telling me how lucky I was to be alive. I probably woudn't have lived if they hadn't made a point of telling me to return if I felt worse.

What they didn't do so great this time.

The nurse came in regulary to check my vitals, ask my pain level, etc. Although I kept reporting a pain of "9" and I had tears running down my cheeks, they never gave me anything for pain. I kept thinking that they would give me something as soon as they could. After about 10 hours and after they told me about the abscess, they still didn't give me anything for pain. I finally asked the nurse if I couldn't have something for the pain. She seemed surprised and said "I don't know. Let me ask the Dr." She did come back with pain meds.

This hospital doesn't send a survey. They call you a few days after your visit and do a survey on the phone. After the first visit I gave them rave reviews. They asked what they did well and I said the nurse kept me updated on what to expect and what they were waiting on. After the 2nd visit I gave them a really good review. They asked if there was anything they could have done better, and I said "they could have addressed my pain better."

Unfortunately the surgeon that the wonderful ER called in to see me felt I needed a surgeon with more training than he had and sent me to his friend at the hospital from h---.

I gave that hospital the worst review I have ever given anyone. Here's why:

1. Every attending and every resident at that hospital lied to me.

2. I told them I had an atypical reaction to one class of drugs. I don't have an allergy to them, but it does have the opposite of the intended effect on me. This is known to occur in a small percentage of patients. They assured me they wouldn't give me any drugs in that category. They did. Twice. Both times they injected it in my IV while I was asking what it was. After they gave it to me, they told me what it was. Both times I had a bad reaction.

3. They performed a test on me that I had refused because it has poor sensitivity and poor specificity and it wouldn't provide any information they didn't already have

4. They treated me like I was stupid. They actually told me I shouldn't read scientific papers because I wasn't qualified to understand them. (I have a graduate degree in science and 30 years of experience.) This was because I was questioning what they were recommending.

5. The nurses did interventions on me that I repeatedly refused. I stated repeatedly that I was a competant adult and had a legal right to refuse an intervention and I was refusing that intervention. They just ignored me.

6. They gave me so much IV fluid that I gained 40 lbs. in 5 days.

7. They documented that I was maintained on SCDs/PAS during my entire hospital stay. I hope I had them during surgery. I definitely didn't have them on the floor.

8. I have nerve damage in my forearm/wrist probably from the way I was positioned during surgery.

9. They didn't respect patient privacy.

10. They didn't respect my values.

11. They interpreted my ECG as showing an inferior infarct, but didn't tell me about it. I found out about it when I got my records for my PCP. My PCP and a cardiologist both say they interpreted the ECG incorrectly. I have no heart damage.

Notice that none of my complaints have to do with food, noise, nurses not bringing me water. In fact the food at the hospital from h--- was delicious. The CNAs regularly brought me water. The rooms were quiet. My call bell was answered promptly.

My complaints were:

1. They didn't respect patient autonomy

2. They lied to me

3. They provided poor care

I then had to go to a wound care clinic because a hematoma kept my incision from healing. I gave that facility rave reviews. because I received excellent care.

They asked if there was anyone who had cared for me that I specifically wanted to mention. I named the 2 nurses that I saw each time I went. They were so warm and friendly and funny that I actually started looking forward to going to the clinic because I would get to see them. Let me tell you it takes a really special person to make you look forward to having someone digging around in your abdomen w/o any pain meds.

Sassy5d · Apr 15, 2014

Thank you for your feedback.

It's almost unheard of for a pt to be in my care for 8+ hours unless they are requiring a transfer, typically to a mental health facility.

I'm sorry for your frustrating experience.

Guests · Apr 15, 2014

One tact that I take with patients who are expressing gratitude or satisfaction -- which is the majority of the people I take care of -- is to shamelessly plug the survey and ask them to fill it out, return it, and... mention me by name.

I even ask them to drop a note to my boss.

Hey, I didn't create the system but I'd be stupid not to work it as best I'm able.

turnforthenurse, MSN, NP · Apr 15, 2014

One tact that I take with patients who are expressing gratitude or satisfaction -- which is the majority of the people I take care of -- is to shamelessly plug the survey and ask them to fill it out, return it, and... mention me by name.

I do the same thing. In fact, we are encouraged to. If the patient was satisfied with the care I gave them and their experience in the ED, you bet I am going to give them a comment card for them to fill out. Some fill it out right then and there, others opt to fill it out at home and return at a later time. I write my name on there, too, along with the provider's name or anyone else they want to recognize.

I feel as if most people won't say anything unless they had a horrible experience, hence the reason why I also shamelessly plug the comment card

OP, thank you so much for your reply. It was definitely eye opening to hear something from a patient's perspective. We do get Press Ganey scores and comments for us to read but I enjoyed being able to read something in detail.

Anonymous865 · Apr 16, 2014

Thank you for your feedback.
It's almost unheard of for a pt to be in my care for 8+ hours unless they are requiring a transfer, typically to a mental health facility.
I'm sorry for your frustrating experience.

Sassy5d, I hope that my comment didn't sound like I was complaining about Drs and nurses or about my entire experience this year. I am very greatful for the excellent care I received from some very intelligent, concientious professionals. I was just trying to explain from a patient's perspective why a hospital would get a great or an awful survey.

I'm also not complaining about the 8+ hours in the ER. At that hospital I spent only about 5-10 minutes in the waiting room From what I read the average wait in an ER waiting room is many, many hours. I was taken to a room almost immediately. They started the tests. While they waited on test results, I waited in a comfortable, quiet, private room instead of a waiting room filled with contagious people. Who could complain about that?

They were obviously taking care of people who they thought were sicker than I. (I could hear the ambulance crew when they were bringing a patient in. Occassionally I would hear another patient scream in pain.) I knew what their plan for me was, and I knew that it was progressing.

The extended stay on my 2nd visit was because they had to call in a surgeon to see me. We had to wait for him to finish a surgery. Then when he decided to send me to another hospital, he had to get the other Dr to accept me as a patient, then that Dr had to get me admitted at the other hospital, they had to find me a bed, and I had to wait for an ambulance to transfer me. All that scheduling and coordination between Drs, hospitals, and ambulances takes time.

I appreciate you and the other professionals like you who do a job that I wouldn't do for a salary 10 times what you make.

Anonymous865 · Apr 16, 2014

I read on here a lot of complaints from nurses about Press Gainey surveys and about how unreasonable the complaints from patients are. I suspect from my own experience that what the patients are complaining about on the PG survey isn't what they are really unhappy about.

The hospital from h---- sent me a PG survey. The questions on it had nothing to do with what I was unhappy with. The PG questions were like:

1. My room was quiet at night (stongly agree to strongly disagree)

2. The food was good

3. My call bell was anwered promptly

4. The room was clean

5. The decor was pleasing

6. My pain was well controlled

7. I will recommend this hospital to friends and family.

I was unhappy because I had been lied to. My decisons hadn't been respected. I recieved poor care.

I struggled with how to complete the survey. They actually would score quite well on these questions. If I answered these questions honestly, it would look like I was very happy with the care they provided. I didn't want the survey to suggest that. I chose to answer these questions honestly and attach a letter to the survey. I also sent a letter directly to the hospital administration describing my complaints.

I suspect that most people would just score the questions low to reflect how unhappy they were with their care even though the questions didn't address what they were unhappy about.

I liked the way the 2 good facilities surveyed their patients. They called you a few days after you were released. They first asked how you were doing. Did you have any questions about your condition or treatment that you hadn't thought to ask when you were at the hospital. Did you have any questions about your medications. Etc.

Then they asked if they could ask you about your experience. They didn't ask about the food or about the noise or the decor. (They would have scored very high on these.)

Their questions focused on the quality of the care you received, how well people communicated what to expect, how well you understood your care plan, how well you understood what to do when you left the hospital, how well you understood your role in getting better. They did ask about how well your pain was controlled. They also asked what they did well and what they could do better. Their final question was if there were any employees that you wanted to specifically mention.

The first survey seemed to suggest that the patients weren't really smart enough to comment on the quality of the care. They were only intelligent enough to rate the food and decor. It seemed the hospital was just doing the survey because they had to. They didn't really seem to want to identify areas of improvement.

The second example reflects a hospital that is really interested in providing good care for the patient even after they are released. It seemed that they were really interested in knowing what they were doing well, so they could keep doing it. They also seemed interested in knowing how they could improve.

If you feel the surveys aren't reflecting the quality of care you are providing, look at the questions they are asking. Try advocating for better questions. The surveys aren't going away, but you might be able to transform them into tools for improvement.

vianne · Apr 16, 2014

Thanks for raising this Sassy5d, we have satisfaction scores here, but not so salaries are affected by it, very interesting to read and think about, also helpful to read of patient views glad to hear youre back on road to recovery and always learn from your experience. I can't believe they'd tie in satisfaction scores with salaries, what's next? Charging patients more because they don't recover according to policy? Bah?!

Sassy5d · Apr 16, 2014

For the past year, there are ER specific surveys. These ask things such as, respect my privacy, nurse cares about discomfort felt during blood draw, ect.

I assume these are sent out just to people who were seen in ER and not admitted.

The big ones are pain control. I try to educate pts that I wish I could make them pain free but realistically, the goal is to make them comfortable. If ur pain is 10/10 upon arrival depending on the cause of pain, I might only be able to take the edge off.

We were for seeing surveys reflecting salaries because it starts from top and trickles. If your results are poor, then managers are viewed as not managing well.

OldDude · Apr 16, 2014

When you only add weight to one side of a scale it will always tip that way. If the "suits" would/could really analyze those surveys they would likely find out that the positive results are associated with a patient that participated in some vestige of personal/parental responsibility. Those patients who demand everything from you and offer little or no cooperation or personal responsibility will never be satisfied; especially if the cost of the visit or stay is not coming out of their pocket. So if you only have demands from staff and require nothing from the patient/parent the satisfaction scale with always tip to the negative side.

Anna Flaxis, BSN, RN · Apr 17, 2014

I think when it comes to patient satisfaction, communication is really the key.

Establishing rapport immediately is crucial. It's true that you can start off on the wrong foot with a patient and end up turning it around by the end of their visit, but it's a lot of work that is completely unnecessary when you can just start off on a good footing to begin with.

Most people are capable of understanding what we can and cannot do, what is a realistic expectation and what is not, when it is explained to them in a way that respects their dignity and intelligence.

Keeping them informed on what's going on really helps a lot, like if it's a busy day and the lab is running behind, so their results are going to take a little longer than normal, etc.

I think that sometimes when things get really busy, communication can fall to the wayside. But even if you're just poking your head in on your way back from the med room with an arm full of fluids and meds and IV tubing for a sicker patient just to say "we haven't forgotten about you", it means a lot to the patient, and it only takes a second. Most reasonable people understand that if you're busy with someone who is sicker than they are, then they will have to wait, and that's okay because if they were the sicker one, they'd want to be your priority.

I also plug the patient survey, especially to the ones I know are pleased with their experience. I mention that it's a postage paid return envelope, so it's easy to just fill it out and pop it in the mail, and that we'd really appreciate it because of how reimbursement is tied to patient satisfaction these days. This works pretty well because we are a small community hospital that community members feel invested in and they want to keep the doors open.

exit96 · Apr 20, 2014

It's all Corporate BS...quit playing along...it's out only way OUT