What is this Press-Ganey business?

Published

Never heard of it until I started using this site. I've seen it referred to a bunch of times on here. My facility doesn't use this, so I have no clue. I googled it -- apparently it is some sort of QA/QI company that sends out surveys to patient post-discharge....and what exactly do the hospitals do with this information? From what I've seen on here, it makes nurses lives miserable.

So internal QA/QI departments aren't good enough anymore?

So everyone thinks that patients just go to whatever hospital is closest in their insurance plan?

Customer service or more importantly the "patient experience" has 0% bearing on the hospital's census?

I wonder why hospitals ever close down or get sold off if they have their own captive populations?

Up Vote Up Vote ×

Interesting poll. http://www.gallup.com/poll/19402/healthcare-panel-how-people-choose-hospitals.aspx

I think people choose their hospital a lot more than what you would think. Even if the percentage of those who choose is 15%...15% is a LOT of patients.

I do not think anyone would be surprised if I said that a large percentage of those in L&D chose their hospital.

I do not believe people research which hospital to go to very much but rather refuse to go back to certain ones.

Up Vote Up Vote ×
Specializes in adult ICU.

Lessee. Illegal aliens often don't pay their bills. The uninsured often don't pay their bills. Unfortunately, a "captive population" doesn't mean a paying population.

***disclaimer*** not intended to be a political statement of any kind.

It has nothing to do with the paying healthcare consumer walking down the street to the next hospital because they don't like the service.

Up Vote Up Vote ×
Specializes in Health Information Management.

When one of my family members needs anything other than emergency care, I investigate the hospitals my fairly crummy insurance plan allows us to use. We live in a rural area about an hour from a mid-size city with a huge state university and associated teaching/research hospital, so there are a lot of options available under the plan's regulations. Our local community hospital has a (deservedly) terrible reputation, so most locals avoid it like the plague. Doctors from the city area tend to have privileges at several facilities, so there's a decent amount of choice there too. I investigate each hospital's background and reputation (for instance, qualitycheck.org is often a decent place to start, and healthgrades.com is also very useful) to get a sense of its overall standing, what outcomes are like for the type of treatment I'm investigating, and what the patient experience ratings are like.

I'm not alone in this sort of behavior. When I talk to friends and relatives about situations in which someone has to be hospitalized, they often mention seeking out the area hospital with the best apparent outcomes for a particular procedure. However, service experience often seems to count the most towards their choice of facility. My friends who live in the area will ask me if I've ever had to go to Hospital A and how the staff behaved compared to Hospital B. No one wants to go to a hospital where a friend or relative ran into problem after problem with rude staff members or poor or rushed care.

Now, that's simply what my friends, my family members, and I do when seeking medical care. It's anecdotal evidence. However, we're average people, not wealthy and able to seek out the most luxurious facilities or dirt-poor Medicaid recipients. At least around here, people do in fact research hospitals and carefully choose those they use. And those choices are influenced by the service experiences of others, both through reported statistics and person-to-person conversations.

I have serious reservations about Press-Ganey's methodology and the types of questions they ask. However, I think it's inaccurate to dismiss out of hand the idea that customer service has any significant bearing on the hospital's census. Just like people have the ability and often the desire to inform themselves about their existing or possible health conditions today than they did 30 years ago, IMO it seems likely they will do the same with regard to evaluating hospitals more and more often as increasing amounts of information (both clinical and service-oriented) about facilities and providers become available.

Up Vote Up Vote ×
Specializes in M/S, Travel Nursing, Pulmonary.
I don't know why it would. I think Press Ganey makes a really big assumption in that they think that people are actually able to shop around for their health care. We live in a country where HMOs rule the roost. In heavily populated, urban areas, maybe you have 9 or 10 hospitals to choose from in your plan, but the reality is that you are probably going to choose your doctors, clinics, and hospitals from the ones that are closest to you, which have already been narrowed down from the ones your insurance covers. For me (Minneapolis/St. Paul), that leaves two viable choices when there are about 15 large community and/or teaching hospitals in the metro area. I have chosen for my care a 500+ bed academic medical center about 10 miles from my house (also connected to a pediatric hospital should my children need it) as opposed to the ~250 bed community hospital about 6 miles down the road. I chose between these two based on the breadth and level of services they offer, not on their customer satisfaction (I don't even know if they have scores, actually.) All the other hospitals my insurance covers are 15+ miles away. In some rural areas, you are lucky if you have one hospital to choose from within 50 miles. Those "customers" aren't going to drive another 30 miles down the road to get to the next best hospital because PG says they have better scores.

I live a mere 75 miles from the Mayo Health System -- hugely wonderful reputation in every way. Would I prefer to get my care there? Yes. Do I get my care there? No. Why? 1. I can't afford to take an entire day off whenever I want to see a doctor 2. I don't want to drive 90 minutes every time I need to see the doctor 3. It's impractical to drive 90 minutes if I need urgent care or emergency services 4. If I need to be hospitalized, I am 75 miles away from my entire family. If I wanted them nearby, they would have to take time off work and stay in a hotel, which is extremely expensive and 5. (probably the most important) -- my insurance doesn't cover them as in-network.

I brought this up to my current manager once actually. I, like you, don't think PG has much effect on who goes where. Next person I meet who is over 60 who goes online to compare PG scores and decide where to have their gallbladder taken out is the first.

The insurances tell you where you go, and you choose from within your little circle. To go outside said circle costs hundreds of dollars. No one is going to drive past the hospital that is accepted by their insurance.........drive 20 miles farther down the road.......to get to another hospital........so that they can pay $800 dollars more.........simply because the PG scores say the second hospital has nurses who smile better and make coffee faster.

Up Vote Up Vote ×

Whether the hospitals are using Press Ganey or another data collection survey company to collect patient satisfaction scores, the facility was required beginning with July 2007 discharges to collect this information as a Medicare Certified Healthcare Provider.

They could have opted out of this requirement however beginning in 2008 their reimbursement rate from Medicare would have then been reduced by several percentage points which is why most decided to participate. You can thank Center for Medicare and Medicaid Services (CMS) for this requirement.

For more information regarding the required questions on the survey and the Hospital Consumer Assessment of Healthcare Providers (HCAHPS) visit http://www.hcahpsonline.org/files/HCAHPS%20Fact%20Sheet,%20revised1,%203-31-09.pdf.

You can also see the hospital compare ratings as published by CMS at http://www.hospitalcompare.hhs.gov/hospital-search.aspx?AspxAutoDetectCookieSupport=1. Look up your facility and see how it rates.

So while the discussion on this is about Press Ganey know that CMS and another organization National Quality Foundation (NQF) are the forces that are impacting the quality and daily operations at the facility level.

Up Vote Up Vote ×

There's a whole lot of this kind of stuff out there that has never been research-proven to be effective, or to be any better than something like simply walking in the rooms and asking the patients a few questions.

But, people fall for it, anway... never asking for their backup research, or questioning its effectiveness, since it looks official on paper.

If they have research that shows their surveys get more accurate results than other techniques, and also that it does... in the end... actually improve business for the hospitals... that's a different story.

This type of unproven stuff of all kinds is rampant throughout all industries, and is particularly bad in our educational systems.... whereby they've never proven that it's effective at the very end desired result.

But, they're good at selling it, anyway....

Up Vote Up Vote ×

I work in the ER and feel that the PG surveys shoot us in the foot. The ER scores are tallied using ONLY feedback from patients that are not admitted to the hospital. Generally speaking, the pts admitted are usually more acute and require more time / attention. The majority of those surveyed for the ER have no business being in the ER and also have unreal expectations of what an ER visit should be. If the patient arrives with the expectation that we are going to "cure" their chronic back pain that has been going on for 3+ years within 30 minutes and give them all the dilaudid they want then, needless to say, we are not going to receive a great score from them. Our raises are based upon the feedback from the very ER abusers that caused the facility to drastically slash our retirement benefits in order to avoid layoffs due to all of the "write offs". (that would be the people with no insurance using the ER for free pregnancy tests, yeast infections, colds, med refills, etc., etc. etc) GRRRRRRRRRRRRRRRRRRRRR!!

Up Vote Up Vote ×

Yes, customer service scores are a "necessary" evil in life. These scores are required parts of various accreditation processes and action plans to address low scores are a part of life for administration as well as the "trickle down effect" to the various departments involved (not just nursing).

There are many companies that provide this 3rd party service for a significant fee. Press Ganey is one company but another big player is Avatar. Avatar differs from Press Ganey in several ways, most notably the concept of "every area builds on the experience for the customer" and ALL scores are assigned to the discharging unit. Doesn't matter if the patient complains about billing, parking, food, etc the various scores are owned by the unit of discharge. Unit of discharge could have cared for the patient for 8 hours or 80 days. . . no matter.

These are random surveys but there is a great deal of difficulty in stopping a survey from going to patients that are risk management or legal issues as well as no way to guarantee in any survey that is it the patient who fills it out or the family member who had a 15 minute visit and was irritated or loved the place.

The companies that send out surveys must be able to validate that the hospitals are ensuring a representative sample of patients. They must show to CMS that hospitals are not "cherry picking" their survey customers and only good folks with happy experiences are getting the surveys. So, it does take an act of G-d to stop a survey from going to a patient that was a legal issue, psychotic, or just plain obnoxious with unrealistic expectations or even drug seeking or whatever.

Most surveys arrive 4 weeks or so post discharge. . . about the same time as the hospital bill.

Surveys typically have validated questions but not all patients may receive the same question in the same general content area. It can be like comparing the apples and oranges part of the experience if the questions are not the same. Surveys also guarantee anonymity so I have no way to track down comments that are concerning unless the patient has checked the "contact me" box and I can see the name. Typically, when that box is checked and I have to stop and call the patient, the complaints are not about the nursing care but about a meal or something similar. On a rare occasion it is a nursing complaint and yes I do get as many details as possible and address the patient concern with the person involved if I can identify them or with staff as a whole if it seems to be part of a trend (ie loud voices at night discussing personal issues that could be heard in rooms).

The other problem with surveys is that standards/expectations are unrealistic. Nursing units that have mainly prescheduled admissions for pre-planned surgery may have an advantage if they hold pre op classes to teach patients realistic expectations. Other units who have the majority of patients admitted following catastrophic or unplanned events may have different expectations for care in their disrupted lives.

Why do we not do surveys while in the hospital? Well, actually we do. Manager and charge nurse rounds occur daily and the night charge nurses round as well. We generally hear great comments about care. On the occasion we don't have the opportunity to do customer service repair. I have a great staff but we occasionally make a mistake or have a lapse in service. We do service recovery on the spot. However, patients may be AFRAID to share bad things because of a fear of retaliation while still an inpatient. Sad, but true.

There is value in hearing customer experiences and hearing the story from their perspectives as it can show areas of great care as well as areas that can be improved. There is limited value in having the surveys considered to be the ONLY way to get these comments.

Up Vote Up Vote ×

I'm bothered by the fact that the hospital's Medicare/Medicaid reimbursement is based on PG scores. What's best for the patient (ie early ambulation after joint surgery) is not always popular with patients and families. I find myself apologizing over and over so the won't hammer in the surveys. There's enormous pressure on providers to bring up scores on a survey with highly skewed and unscientific results. some at my facility have been fired over bad surveys. I can understand reimbursement being based on quality improvement measures like bringing down hospital acquired infections and preventing pressure ulcers and such, but to link that to whether or not a patient "liked" their stay is dangerous. who likes hospitals? I mean one of the questions rates the food! And who's gonna give rave reviews to a pureed low sodium diet? There are things we do that dot make patients happy, but are medically necessary for best outcomes. These surveys shift the focus from objective outcomes to patient opinions and I believe are harmful to patient care.

Up Vote Up Vote ×
i work in the er and feel that the pg surveys shoot us in the foot. the er scores are tallied using only feedback from patients that are not admitted to the hospital. generally speaking, the pts admitted are usually more acute and require more time / attention. the majority of those surveyed for the er have no business being in the er and also have unreal expectations of what an er visit should be. if the patient arrives with the expectation that we are going to "cure" their chronic back pain that has been going on for 3+ years within 30 minutes and give them all the dilaudid they want then, needless to say, we are not going to receive a great score from them. our raises are based upon the feedback from the very er abusers that caused the facility to drastically slash our retirement benefits in order to avoid layoffs due to all of the "write offs". (that would be the people with no insurance using the er for free pregnancy tests, yeast infections, colds, med refills, etc., etc. etc) grrrrrrrrrrrrrrrrrrrrr!!

okeedokey, i'm no statistician, but that is beyond stupid. what genius decided that the only opinion that matters is that of a group who is, by definition, not acute? if you worked in the convenient speedy free care for people with lots of free time and no common sense department, this approach would make sense. those who are admitted clearly are inapopriate for that department, and not the target "customer."

you work in an emergency department.

i also work in an er.

those looking at pg's in the er are missing the point. the low scores pont to the need for more primary care and clinic type facilities. these non-acute pt's are going to the wrong place. the er serves two distinct populations: emergent, and non-emergent. by not looking at these group separately, the pg is of little value. by focusing on non-emergent patients, the pg results are skewed, misleading, and dangerous.

i would be interested to see the following study. go through a years worth of er visits to select those who had true emergencies, send surveys out to those patients to gauge how emergency care in the er is perceived.

http://www.pressganey.com/galleries/ed_pulse_2009_files/2009_ed_pulse_report.pdf this comprehnsive study ignores patient acuity as a factor. this would be like surveying a town about it's fire department, and ignoring anybody whose house caught on fire.

if i cared about pg scores, i would:

- pay very little attention to anybody incapable of advocating for themselves, with no family or other advocates. they can't write a negative survey.

- focus on perceived needs, rather than medical needs. mrs smith believes that a second pillow is very important, while mrs jones has no idea how critical her 80 mg of lasix is. prioritize the pillow.

- advocate strongly for the medications the patient wants, regardless of the harm they will do. push hard for antibiotics for little johnnie’s virus- his mother wants them. in fact, the more resistant bacteria we breed in johnnie, the more likely he is to come back so it's good for business. jane's pain is 10/10. why bother documenting that she is eating pizza, texting, and watching tv? i should push hard for the dilaudid despite her growing drug addiction. hell, our facility does detox, so it's good for business.

- if a pt is elderly or demented, why waste my time? i'll send her back to the nsg home soiled. if they call to complain, i'll tell them she was clean when she left. lazy paramedics.

the fact is, when i am not busy, i tend to pt's percieved needs, unless i feel they are detrimental. i don't mind getting blankets, pillows and drinks. i don't mind listening to long, irrelevant stories. i will put on a pot of coffee for a family member. though i don't care about survey results, all of that contributes to high scores. but when things get busy, my focus changes. my priorities are medical needs, at the expense of the convenience and comfort of non-acute patients. that brings scores down. while i was maintaining mrs smith's airway, i couldn't get blankets and drinks. too bad she didn't do a survey.

a note to any administrators who might be reading this:

  • i try my best to provide good patient care. if you have ways for me to improve patient outcomes, i am all ears. if it results in high survey scores, that's fine with me.

  • if an er patient has unreasonable expectations, they won't get met. if they are dissatisfied, they may go elsewhere. i'm good with that.

  • you are concerned with patient care as a business. you have introduced phrases like "customer" and "market share". i understand your concern with business, and hope you understand my concern with patient care.

  • hospitals are a business. as a business the hospital pays for many commodities- electricity, bedpans, nursing, are all commodities, purchased at market value. if the hospital makes more money, i doubt they will pay any more than they need to for any given commodity. i just don't buy that my financial well being is linked to customer satisfaction.

  • have you considered why most nurses, including nurses who you consistently give excellent evaluations, detest basing pt care on pg scores? c'mon out on the floor and show us how it's done. focus on the things that will raise scores without a loss in pt care. lead by example.

Up Vote Up Vote ×

Here's a sick example of PG encouraging patient appeasement over outcomes and best practices.

Reimbursement at Risk | IMPROVING HEALTH CARE

Up Vote Up Vote ×
+ Join the Discussion