Satisfaction scores

[Sassy5d]

I've seen the first wave of management getting pressure for low scores, not getting raises and so they are coming down on us.

Realistically, how do you raise satisfaction scores? Especially in this environment? I could be the best nurse, with the best doctor and people are still not going to be happy. I guess our pts just weren't filling them out, or giving false addresses so they don't get them anyways.. Or the few that did return them were angry.

So many people think you should just get whisked in, have all your tests back in 30 minutes or less, catered meal and a diagnosis and complete resolve if symptoms/pain before they leave. When you lack a magic wand, people are angry.

[exit96]

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.

Ummm...why didn't you leave? This one is on you...

[Anonymous865]

Ummm...why didn't you leave? This one is on you...

I won't take the blame for trusting the surgeon who told me me he was sending me to "the most brilliant, naturally gifted surgeon" he had ever seen. I also won't take the blame for agreeing to be transferred to a well-ranked research/teaching hospital. I also won't take the blame for trusting licensed medical professionals to tell me the truth and to follow the law.

I was operated on shortly after my transfer and awoke from surgery to a vertical, mid-line incision from my xyphoid process to my pubic bone. It was after the surgery all the lies and poor care occurred. At that point the physicians wouldn't release me, and if I had signed out AMA I would have been responsible for the $70K medical bill instead of my insurance. I don't know about you, but $70K didn't fit into my budget. I had to smile, be cooperative, and do what I had to do to get released.

I discovered most of the lies, the misread tests, etc. after I was released and got a copy of my record.

Blaming me because I received poor care from professionals is ridiculous. Before you say that that is my non-medical opinion - my PCP and 2 surgeons reviewed my records and described my care as "poor" and "sub-standard." They said that it made them "very angry," and they encouraged me to sue or at least file a formal complaint.

[Anna Flaxis, BSN, RN]

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

Maybe.

I work for a small rural hospital that is struggling to keep its doors open. I care about that, and I care about the community and think it needs a hospital. I don't want the closest resource for the community to be the big monolithic corporate structure 20 minutes up the freeway.

So I cooperate with the various reimbursement schemes, such as capturing charges through charting, and by plugging the patient survey- because I don't feel like it's me vs. the powers that be. I care about this hospital and this community and want to do what I can to keep the doors open and the lights on.

Now, this is not to say that I kowtow to ridiculous patient requests. I do not. I am able to say "No" when it's appropriate, in a way that is professional and courteous.

[Technicolourhobo]

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.

This!! If you don't work in your own best interest, you will never feel better. Your failure to do this is not my fault.

[psu_213, BSN, RN]

I've never actually seen a survey, but it seems, based on the written responses, that it is a bit confusing and does not specify who your grading. For instance, a recent report of comments from PG surveys about our ER included the comments "the paramedics who picked me up at my house were rude. The disrespected me while I was in the back of the ambulance." Another was "my husband went to the cafeteria and the cashier there didn't seem interested and his order at the grill was screwed up." Really?? We are being judged on this? We are going to be downgraded by someone who thought the medics--who are in no way related to our hospital--were not what she expected?

[psu_213, BSN, RN]

I discovered most of the lies, the misread tests, etc. after I was released and got a copy of my record.

First, let me say, they is no excuse for them to lie to you and not respect your privacy nor your values....and you are right to be upset about it.

However, what medical training do you have? Was that just the computer interpretation of the EKG that was printed on the top of the paper?

Sure you gained weight from the fluid, but were you third spacing? That can cause a relative hypovolemia. Perhaps this is why you were being given fluid. What was your urine output during this time? Even though you got all these fluids, did you feel short of breath? What were your serum electrolytes at this point?

I didn't ask all this to be rude. I'm not raking you over the coals. Your experience sounded bad, however I'm just illustrating the point that people unfamiliar with nursing/medicine should not be making comments on the clinical side of things, especially based on their interpretation of medical records. As a customer, however, you do have the right to comment on the poor customer service you received.

[Technicolourhobo]

I've never actually seen a survey, but it seems, based on the written responses, that it is a bit confusing and does not specify who your grading. For instance, a recent report of comments from PG surveys about our ER included the comments "the paramedics who picked me up at my house were rude. The disrespected me while I was in the back of the ambulance." Another was "my husband went to the cafeteria and the cashier there didn't seem interested and his order at the grill was screwed up." Really?? We are being judged on this? We are going to be downgraded by someone who thought the medics--who are in no way related to our hospital--were not what she expected?

This is why wages and the hospitals income should not be based upon those surveys. Ridiculous.

[Anonymous865]

First, let me say, they is no excuse for them to lie to you and not respect your privacy nor your values....and you are right to be upset about it.

However, what medical training do you have? Was that just the computer interpretation of the EKG that was printed on the top of the paper?

Sure you gained weight from the fluid, but were you third spacing? That can cause a relative hypovolemia. Perhaps this is why you were being given fluid. What was your urine output during this time? Even though you got all these fluids, did you feel short of breath? What were your serum electrolytes at this point?

I didn't ask all this to be rude. I'm not raking you over the coals. Your experience sounded bad, however I'm just illustrating the point that people unfamiliar with nursing/medicine should not be making comments on the clinical side of things, especially based on their interpretation of medical records. As a customer, however, you do have the right to comment on the poor customer service you received.

I understand the point you are making. My opinion that I received poor care is based on the comments of several physicians who had my hospital medical records. Most physicians are very hesitant to criticize another medical professional. In this case my internist said while looking at my hospital records, "You received very poor care. What I see here makes me very angry." She went on to explain all the deficiencies she saw. The surgeon at the wound care clinic stated very bluntly "you got bad care." Another surgeon was even more expressive about what he thought of the care I received.

I really didn't mean to hijack this thread to gripe about the awful care I received. I was trying to explain from a patient's perspective why a hospital would get a good or a poor review. I gave 3 examples where I was extremely complementary and one example where I was very critical.

I'm sure it seems very unfair that people who do not have the extensive training and experience you have are rating you on the quality of the care you provide. Unfortunately the patient's perception of the care they receive is what affects how well a hospital does financially. Patients talk to family, friends, and coworkers about what they thought of their care. These comments affect whether another person choses hospital A or hospital B.

Doctors are business owners. They can get privileges and send patients to either hospital. Do you think they want to listen to patients complain about the care they got? Do you think a doctor will maintain his affiliation with a hospital if patient after patient tells him "Oh, I don't want to have surgery at that hospital."

If you read the studies from the various research groups/think tanks, they are estimating anywhere from 15% to 30% of hospitals are going to fail in the next 5 years. This is why hospital management is worrying so much about surveys. That's why hospitals are advertising that they are a Magnet Hospital, or their ranking in US News, or that they are a top heart hospital, or whatever they can think of to affect the community perception of the care they provide. They are trying frantically to avoid being one of the hospitals that has to close their doors.

[mcknis]

Anonymous, most of us do understand the role that the PG/Patient satisfaction surveys play in the financial makeup to an organization and we do understand that patients do occasionally have bad circumstances and/or poor care. This forum is designed to allow those in the profession, and those outside of it, to have a glimpse into this realm and help to share in its' growth. The majority of the nurses/healthcare staff on here are good people who desire to provide the best care possible for their patients, no matter the are of healthcare they serve in. The ED setting, however, is one of the more challenging areas and many of us get defensive when someone speaks negatively or positively regarding our neck of the woods. It is not meant to be bashing or upsetting towards any one individual, but it is just a callous many of us build up after working in this setting for a few years. The ED, as you have seen, gets knocked down by all department and patients because of the front sidewalk not being pretty, or the meal tray not having enough options. These are things nursing is not able to control, but the powers that be feel financially it is easier to decrease (or eliminate) wages to frontline staff regarding any complaint. PG unfortunately is around for the long haul, and like the others have stated, it's yet another game that we, frontline staff, must play in order to get our raises and ensure patients have a voice. PG shouldn't be related to finances although it is, but associate opinion surveys (of management and physicians) shouldn't be either, however they are. That's a rant for another day...

[Sassy5d]

I wonder what people would think/do if all the hospitals that people complained about just closed.

It's a possibility. I've seen it.

Then it was just 'not fair' that it was closed. Removing access to care, inconveniencing people to go to another place. Then that other place closes.

Our scores are really low.. Our ER is small and our volume is high. Repeatedly get told daily by countless people that they come to us because we're all 'so good', 'so nice'. But yet our feedback reflects that we are horrible.

[psu_213, BSN, RN]

Repeatedly get told daily by countless people that they come to us because we're all 'so good', 'so nice'. But yet our feedback reflects that we are horrible.

That's the problem with almost any type of customer service survey or online "rating" forum. I went to an apartment site to look at ratings of potential places to live. Just for "fun" I went to my current apartment. I thought it was a pretty nice place to live. However, it got slammed in this particular forum. One of the comments said "they didn't have fresh ice at the pool. Because of this I gave them a zero for everything!!!!!!!" (their exclamation points). This illustrates the problem with PG: the dissatisfied are far more likely to comment on their care than the satisfied, and those that are dissatisfied with one part of their care (even an inconsequential part) let that leak into the scores they give for other areas, even if the hospital did well in those other areas.

[OldDude]

Besides.....admin doesn't need to dump a bunch of money into a bunch of useless surveys. They can run the times themselves. Of course there are some exceptions but the longer the stay in the ER the lower the satisfaction. Quick ER visits make for happy ER patients. Just sayin.....you know the KISS methodology.