How has the Patient Satisfaction push effected your practice

In the past 2 years Patient Satisfaction scores have led to a major change in priorities in Emergency Departments. I have written about some of the ways ED’s are changing here. Many feel the patient survey is biased toward the less sick (read Ron Elfenbein's editorial in ep monthly) patient because it excludes admits and transfers and is based on relatively a small percentage of returns from very low acuity patients. Regardless, survey results are on the Web and in the newspaper which can lead to a major competitive advantage or disadvantage depending on where you fall. Perception is more important than reality in our sound bite world. Nothing evidences that more than some of the consulting groups offering seminars on how to change the patients perception (not the care itself) of their experience. Have you been studerized? Another example is the willingness of some hospitals, Sutter Health Alta Bates Hospital in this case, to target 3 employees from each unit who are "Not onboard with our service expectations" for disciplinary action to improve their Press Ganey scores.


Perceptions aside, has this emphasis changed practice for the better or worse in Emergency Departments? Below is an unscientific survey for “Providers” regarding how the patient satisfaction push in Emergency Departments has effected your practice in the past 2 years. I am starting with Providers but will follow-up with Nurses and Managers. I have weighted the score based on things generally considered good practice based on my experience. Do not consider, for the sake of clarity, other factors that have changed in the past 2 years such as new research, guidelines, institutional policies, and legal climate, only consider the effect of the Patient Satisfaction scores in your answers. Only Yes Answers get scored. Everyone starts at 0. Now lets take the test.

1. Do you see patients sooner than you did 2 years ago (quicker door to provider time)? Add 5
2. Do you cut short exams or procedures to achieve seeing new patients sooner? Subtract 5
3. Do you spend more time with your patients than you did 2 years ago? Add 5
4. Are you more likely to keep the patient informed of delays and explain procedures? Add 5
5. Are you more likely to troubleshoot delays in admission and testing to reduce the patients waiting time to admission and improve ED flow? Add 5
6. Do you provide a higher level of personal service to those who are included in the survey as opposed to those who are excluded? Subtract 10
7. Are you more likely to prescribe antibiotics upon patient request when the clinical indications suggest a viral etiology of infection or otherwise are not indicated? Subtract 10
8. Are you more likely to prescribe narcotic pain medication, stronger narcotic pain medication, or a larger quantity upon patient request when the indication is weak or a NSAID would be the better medication choice? Subtract 10
9. Are you more likely to order expensive tests such as CT Scans or MRI’s upon patient request when the indication is weak? Subtract 5
10. Are you more likely to directly dispense take home medications from the ER upon patient request, especially narcotics? Subtract 5
11. Are you more likely to tolerate disrespectful behavior or verbal abuse to avoid a complaint or negative survey? Subtract 5
12. Are you more likely to encourage or pressure Nursing or Ancillary staff to tolerate disrespectful behavior or verbal abuse to avoid a complaint or negative survey* Subtract 10
13. Are you more likely to avoid educating patients about negative health behaviors to avoid offending them and getting a negative survey? Subtract 5
14. Are you more likely to pressure Nursing to avoid educating patients about negative health behaviors to avoid offending them?* Subtract 10
15. Are you less likely to report suspected conditions such as domestic violence, child, or elder abuse to avoid angering patients and risking a negative survey?* Subtract 15

Now add up your score. Here is Murse's take on how the patient satisfaction push has effected your practice.

+5 to +20 – You are the bomb. Come work in my ED. You truly care about doing what is best for your patients and have not been pressured to make bad decisions to get a better score. You are ethical. The Nurses love working with you. Its not very likely that you’re the director of your ED group.

0 – You’re a solid practioner but you probably have been asleep for 2 years or on an extended sabbatical or trek in Tibet. Nothing effects you. Your probably the type that does not even look up from the desk when a patient is totally going off just on the other side. You operate at one speed regardless of the activity in the department. Also not likely influenced by bean counters or Pharmaceutical reps. Probably wears the same type cloths and prescribes the same type of medications you did 15 years ago. You could be an Attending in many academic medical centers riding out your tenure to retirement. The Nurses ignore you except to look at your cool vacation photo’s that you frequently load up on the department computer and show even during busy times.

-5 to -15 – You don’t like confrontation especially from bean counters or demanding patients. Have a little bit of a backbone problem. Perhaps your testicals have not fully descended if your male. Your not dangerous but just a little bit irritating. You give wishy washy answers to keep everyone happy. You like being peoples friend and generally are but are not someone to go to for support.

> - 15 – You would sell your sole to the devil. You sell out your peers for political expediency. Your either trying to impress some bean counter with the bump in scores at the expense of safe practice or you or your ER group is getting a financial bonus for improving their patient satisfaction scores which drives your actions. You probably do unnecessary procedures under the cover of poorly supported guidelines to increase your reimbursement. You likely prescribe every new expensive medication after sucking up freebie trips and dinners from the Pharmaceutical rep. You just might be the Director of your ED group. The Nurses dislike you.

*If yes to any of these questions then mandatory failure regardless of final score. Some Nurse is likely to drop a dime to on you to the State Licensing Board if you ever screw up.