Many other nurses and docs have blogged about Press-Ganey and the appropriateness of the measuring sticks the organization has chosen to evaluate "good" care in the hospital. Sane people want accountability in health care, and JCAHO does not provide that sanity. Patient satisfaction surveys were inevitable. However, choosing useful measuring sticks for 'good' can be problematic.
What is a 'good' hospitalization from the patient's perspective? A patient with a total knee replacement has a wildly different view of 'good' hospitalization than the patient with an acute psychotic break.
You will not find a serious discussion on this in my post today.
Instead, the following chosen criteria cracked me up. Hospitals are evaluated on the following:
* Percentage of patients who thought their nurses "Always" communicated well.
* Percentage of patients who thought their doctors "Always" communicated well.
There is a world outside of Oz. In this world, my patients look like this:
Sidenote: We had a guy two weeks ago who threw a snowball of poo 15 feet outside of his room. What was most impressive about that is that his hands were tied down at the time.
* Percentage of patients who "Always" received help as soon as they wanted.
Nurses love this measuring stick. I understand the need to ask a question like this on a patient satisfaction survey. However, the gap is that the question does not account for the fact that the patient is not the best evaluator of the professional RN or MD's priorities. Jane and John Doe are so ignorant of the workings of the health care system and the professionals within that system that they simply don't know how much they don't know. They do not understand how insignificant their desperate need to pee becomes in comparison to the often more critical needs of other patients. Most patients will desist on the call light if they hear the loud noises and see flashing defibrillator paddles, because that's what tv tells them saves lives.
But most will still answer the surveyor's question with 'No, I didn't actually get to pee the second my bladder twitched cos there weren't enough nurses to help me get up to pee and while the other nurses were tryin to get a pulse on that other guy.'
Some great rant examples...please see: Madness of an ER nurse, ERNursey, ERMurse, my friends in the UK at Mental Nurse, a new blogger I found at ER-Life.
Personally, I don't know what the big fuss is about. I always put mints on my pillow, bring fries with that and ask grieving families whom I have counseled through the death of a loved one if they'd fill out a satisfaction survey to let my boss know that they liked me.
* Percentage of patients who thought their pain was "Always" well controlled.
I love that one. Open-heart surgery won't hurt a bit, sir. We will keep you totally pain-free all of the time. All this making you not dead won't hurt a bit.
And as a NOC-shifter, I love this one, too:
* Percentage of patients who reported that their room was "Always" quiet at night.
I had a guy once who was pissy about all the "damned noise happening down the hall." I admit I was fried, having just come down the hall from the ugly code that was happening. It wasn't my best night. So instead of being all soothe-y and pillow-fluffy and sympathetic, I was human. I snapped at him: "I'm sorry, did that woman dying DISTURB your beauty sleep?"
I'm sure he complained about me on his patient satisfaction survey.
What's stunning about this website isn't that such a tool should exist to evaluate hospitals. After all, baby boomers want to know the cushiest hospital in which to receive their joint replacements because their bottoms have gotten too large for their knees to support any longer. I'm really okay with that, with economic natural selection.
It's the choice of some of the measuring sticks that Press Ganey utilizes.
It's the lack of context in which real illness actually happens. We in health care know that it's nothing like on tv. The public really doesn't.
It's the clash of capitalist economics and socialist economics: we want competition to weed out the better provider of service, but we also need to take care of the elderly, the drug- and alcohol-addicted (and their children), the sick who belong to a low-income tax bracket, the middle income bracket who can't afford the copays until it's too late.
Press Ganey's survey is not a bad idea. It chose some strange rulers. Today, I'm only ranting.
The real issue is that I'm wondering what some better rulers would be.