One bane of emergency physicians are patient satisfaction scores, which some hospitals use in part to determine physician salaries.
Often times, if patients are denied, say, opioid medications, they’re more likely to give low scores, which the hospital administration can then use to penalize doctors. Of course, this creates an incentive to give patients everything they want, sometimes to the detriment of good medicine.
But Shadowfax, an emergency physician-administrator, delves deeper into how his group uses these scores, and finds that, in most cases, low scores were correlated with valid patient complaints. Long waiting times and whether the medical staff listened to patients, for instance.
He goes on to detail his hospital’s turnaround, which required cooperation with hospital administration: “There may be a need for additional resources: If the ER is so understaffed that nurses can barely provide safe patient care, it’s going to be hard for them to spend time getting warm blankets. If half the beds are full of boarded patients, then wait times will remain long and scores will never improve.”
In order to improve, there has to be some kind of quantitative yardstick, and patient satisfaction scores provide one way for doctors and hospitals to measure year to year gains. But it’s an imperfect tool, and as such, should only be used in conjunction with other means of evaluation.
Related posts:
- Patient satisfaction and physician compensation
- Patient wait times vs time spent with the physician
- My take: Colon cleansing, patient satisfaction
- When pandering to patient satisfaction can harm
- Are doctors pressured to prescribe opiate drugs?
- Physician assistants and nurse practitioners are staffing rural ERs full time
- Patient satisfaction vs pain relief
{ 9 comments }
Compensation should not be dependent on patient satisfaction. Doctors cannot be held accountable for every facet of the patients experience yet the patient can take it out on the Dr out of frustration. The Dr may have done a great job taking care of the patient and following protocol yet, the patient didn’t get the outcome they wanted so they are going to give the Dr low marks whether there is merit to do so or not. This is also a deterrent for Dr’s to take on more complex cases that are not likely to have an optimum outcome.
The press-ganey is better at showing overall trends with the whole emergency department, and is less useful as an individual physician barometer. It is a seriously flawed non-evidenced based rating system, as I have pointed out in my blog: http://drbrenner.blogspot.com/2009/08/my-own-private-press-ganey-hell.html
Emergency physicians, in particular, treat emergencies as their primary concern. Yet the press-ganey only grades physicians on the “urgent” patients (e.g. patients that are discharged from the hospital). To even consider linking the PG to salary, you need to include the sicker, admitted patients as part of the source pool, since they took up the majority of the physician’s time.
Shadowfax’s piece made me realize the real benefit of volunteers in the ER: about the only things we *can* do are fetch blankets, cups of water, snacks, etc. and present a pleasant, caring face to patients. Having an extra set of hands to make up rooms helps a little bit with throughput, too.
I suspect the number one patient complaint in most ERs is the wait time. It’s a valid area of concern and probably pretty reasonable as a quality of care measure. But the MD attending the ER is rarely the cause of slow patient flow. Might make sense to link the pay of the ER administration as a whole to such measures, but not the clinician!
“…But the MD attending the ER is rarely the cause of slow patient flow. ”
How about considering the number of patients and the severity of illnesses? Also, are we running a Hilton or a medical service? This “inmate running the asylum” is being carried a bit too far. Show me the connection between patient satisfaction scores and real measures of clinical outcomes.
Should we also base the reimbursement of middle school and high school teachers on the satisfaction of the students?
If you are going to the ED for something that does not result in an admission, do you even belong in the ED? Maybe it would be better to assess the outcomes of patients by as objective measures as possible. Injury Severity Score, for trauma, for example.
We are told that doctors with better bed side manners will be sued less often than others, regardless of the competence of the doctors. Do we need to come up with another way to reward something other than a doctor’s ability to treat emergencies?
Aren’t we rewarding the wrong behaviors?
This just adds one more reason as to why physicians should be the dominate controling force in health care institutions–they are the ones held responsible for the entire process of care.
Not only are only the “urgent” or “non-urgent” patients the ones that have their satisfaction scores counted, alot of the people in this group who use the ED as primary care. Many of these are “Self-Pay”. So, theoretically, an ED’s salary is lowered by patients who do not pay their bill and by patients not seen for emergencies which is what the ED doc is trained for. Where else in the world does this happen?
Now there are some people who are go the extra mile to improve their “scores”. And they are usually great MD’s and very personable, and we can learn alot from them. But lowering salaries is not the right incentive.
I agree with Kim. I did an volunteer internship at a major urban hospital and the volunteers held a vital role in patient care. The number of patient techs often times could not handle the overflowing number of patients. But the volunteers were able to ease the stress the E.D. felt. Hospitals that are understaffed need to realize that they have a labor force willing and ready to work for near nothing. The hundreds of thousands of pre-medical and pre-health students who all need both a job, and experience in the hospital could fill the void in these understaffed E.R.s. My internship was unpaid, but it was invaluable in experience. The hospital benefited as well as the volunteer team helped ensure patients had someone to get the lesser important items for them as they waited. More emergency departments should take advantage of the undergraduate student population. The students would greatly benefit from the experience, and the hospital would plug the holes that exist in care.
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