What is this Press-Ganey business?

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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?

I am 'justavolunteer' at a hospital that uses the Press-Ganey reports. There is always something posted in the break area about how fast call lights get answered, the latest survey scores etc. The 'customer services' part of all this is nice, but some things that patients complain about are medically necessary. I have seen enough patients on restricted diets because their blood sugar, cholesterol, etc. are through the roof. They will scream at the nurses, food service (and occasionally even me) because they can't get a cheeseburger & fries or a large piece of cake for dessert. I would imagine these same people would rip the hospital but good on the survey.

I am always willing to do what I can to make pts comfortable, but some of them need to realize that their habits are what got them admitted in the first place. Ignoring all medical advice & refusing all tests makes me wonder why they even bothered to come in.

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Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
has anybody actually proven that press-ganey scores increase business for hospitals? it seems to be that is what you are trying to get at with the "fighting for patients" quote, am i correct?

alternatively, i wonder how much of the health care dollar goes in press-ganey's back pocket for these types of evaluations....?

i seriously doubt p-g scores have anything to do with our business -- we're a large teaching medical center and get referrals from all around. i'm thinking the pooh-bahs use press-ganey as a club with which to beat nurse managers over the head. "well 2 east had much better p-g scores than your floor, so what are you going to do about it?" two east is our super-luxurious floor for vips. they have catered meals from top restaurants rather than food from the cafeteria, rooms that look like the hilton and their nursing staff is hired for their pulchritude, not their brains. of course they got better p-g scores than our floor where the rooms hold six patients, the food carts are the last stop from the kitchen and the nurses were hired -- and stay employed -- because of their aptitude, not their pulchritude.

nurse managers also use p-g scores for things like raises . . . .

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Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
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.

my biggest problem with this post (and it's a huge one) is that i'm unable to give it more than one "kudos". if i could, i'd give you 50 or 60!

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Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
you seem very entitled.

thank god the patients have the blessed luxury of being able to have a moment of your time.

you provide a service, they are purchasing a service. no different than the plumber or roofer or auto mechanic. if you hate dealing in customer service then move to a profession that does no require you to deal with people.

i'm thinking you don't get it. patients are purchasing health care, not customer service. there's an enormous difference, and they don't understand the difference between making grandma happy (by bringing her chocolate pudding despite her blood sugar of 600) and helping grandma get better so she can go home and live independently (by having her use her incentive spirometry and get out of bed after surgery which hurts). the p-g folks -- and many of our managers don't seem to get it either, so you're in good company.

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my biggest problem with this post (and it's a huge one) is that i'm unable to give it more than one "kudos". if i could, i'd give you 50 or 60!

i agree, 150%!! extremely well written, and pretty much sums up how i feel, more eloquently than i probably could have..

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Well I am a new nurse, and our hospital....unfortunately is all PG....well this is what customer service means.....Families have total run of the ICU meaning even if we have important things to do...or we the nurse feels the patient needs to rest the family can hang out in the ICU room 24-7 and I mean hang out...cell phones, loud conversations, unhealthy food to a new CABG, little children running in an out. It means a patient with horribly uncontrolled diabetes who has little concern with taking responsibility for there health can make nurses run back and forth alternatively for high sugar fruit juice and 10 sugars for their coffee and then the medications and rapid responses to treat unbelieveably high blood sugars....but can have what they wants because it is customer service. I watched a new young nurse try to explain why these things were not good for his health and he laughed in her face grrrrrr! Customer service also means that we have a patient on droplet and contact isolation for numerous bugs with a fan in the room on high and the door wide open cause that is what the patient wants even though the doctors and nurses have tried to explain nicely that this is not a good idea. Press Ganey whatever....good customer service does not always go hand in hand with appropriate or safe medical care and it is very frustrating to spend your time, and probably be ignoring another patient who does not have crazy requests or family making a fuss about things unrelated to their health care and probably actually needs your attention for their care!

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Not sure about hospitals but in home health we were forced to do this. The governement wants ratings data so that they can inform people about quality including patient ratings of quality. We always sent our own surveys out but were told that we had to choose certain companies to do this in a certain way. I guess they want to insure objectivity in reporting. I know they were fighting this, not sure if it has been resolved.

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.how many surveys were not even filled out by the person who was hospitalized I wonder.

Management on my unit regularly admits when scores are talked about that the surveys are most likely NOT filled out by the patient themself, but a family member. Which is why we bend over backward to accomodate not only patient requests but also family requests. (Giving them our chairs from the nursing station so the 10 family members can sit at the patient's bedside and eat McDonalds while we stand up to chart, giving them free "gust trays" whne they are perfectly capable of going to the cafeteria like we have to for something to eat, etc.....)

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I'm sad to say that one of the hospitals I volunteer at is on a big Press Ganey push right now........ ugh.

Funny thing is, they observed what we did, then never asked what we would suggest to improve the "customer service", though we could offer a ton of suggestions. Can't "improve" something if you don't know what needs to be fixed.

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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.

Next shift, look around at your patient population. Very few of them are NOT medicare recipients, and as far as I know, Medicare pay your way to ANY hosptial (JCAHO accredited), so this insurance argument is really of little consequence. It is the old folks with outdated expectations which are most likely driving these scores.

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Specializes in M/S, Travel Nursing, Pulmonary.
Next shift, look around at your patient population. Very few of them are NOT medicare recipients, and as far as I know, Medicare pay your way to ANY hosptial (JCAHO accredited), so this insurance argument is really of little consequence. It is the old folks with outdated expectations which are most likely driving these scores.

Eh, my manager said that. I don't even know how to look up what someone's insurance coverage is. We do have a lot of elderly on our specific unit.........but I don't believe they are the driving force behind the PG scores any more than anyone else. I'd have to see hard data before buying into that one. For every middle aged person who is too busy, there is a younger person who isn't interested and for every one of them, there is an elderly person who thinks it's too much hassle ("Filling in all those dots hurts my arthritis").

I also wonder if smiling nurses and fresh coffee is really that important to the elderly, as the PG people would have you believe. If I had to venture a guess, I'd say its location. The hospital easiest to get to while they are sick is going to be the one they go to. No one worries about "Am I going to be an active member in the care plan decision making" while they are driving to the hospital SOB and turning blue. After ease of access/convenience, I would think they also consider visitors ease of access. I do see elderly on our unit frequently who insisted on coming to us because "Its so close to my daughter's house, it'll make things easier on her, she worries so much when I am sick."

So, while the elderly may have the most freedom to move, I have my doubts they truly exercise it................and/or that "smiling nurses" is what they are focused on.

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Next shift, look around at your patient population. Very few of them are NOT medicare recipients, and as far as I know, Medicare pay your way to ANY hosptial (JCAHO accredited), so this insurance argument is really of little consequence. It is the old folks with outdated expectations which are most likely driving these scores.

I have to disagree. The Center for Medicare and Medicaid Services (CMS) mandated to hospitals that the survey had to be completed by anyone above the age of 18 and they DO NOT have to have Medicare coverage. I am surprised that when the proposed regulations came out why hospitals did not challenge this requirement.

In Home Health this requirement was challenged during the proposed regulations process in 2009 with the argument that if Medicare is not paying the bill why should we be required to survey NONMedicare patients. At this point in time, home health patient satisfaction scores are based entirely on Medicare patients.

Interesting how CMS and its regulations impact the entire industry. It is easier to implement across the board then trying to change practices to address only certain insurance requirements or segments of the population ie Seniors.

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