Tuesday, September 28, 2010

Press Ganey scores are meaningless

But hospitals keep using them despite the unintended consequences. This eye opening article in Emergency Physicians Monthly looks at the many flaws in Press Ganey methodology and reports survey data that reached some chilling conclusions about the unintended consequences of patient satisfaction surveys. Although this article is primarily about emergency room providers I believe its conclusions have some applicability to hospitalists. Here are some key points the article made:

The pressures to improve emergency department satisfaction scores may create a significant dilemma with emergency department staff. An online survey of 717 respondents performed by Emergency Physician’s Monthly on its medical blog “WhiteCoat’s Call Room” showed that more than 16% of medical professionals had their employment threatened by low patient satisfaction scores.

That's astounding. We all know these scores have little to do with how good a doctor you are.

Another question in the Emergency Physicians Monthly survey asked respondents to rate on a 1-10 scale how patient satisfaction scoring affects the amount of testing that they perform. Forty one percent of medical professionals decreased the amount of testing performed while 59% increased the amount of testing they performed due to the effect of patient satisfaction surveys. From a numerical standpoint, with “1” representing a “maximum decrease” in testing performed and “10” representing a “maximum increase” in the amount of testing performed due to effects of survey data, the change in amount of testing performed due to satisfaction data averaged a score of 6.3 – a mild increase.

That one's a little more difficult to interpret. Did docs understand that every possible answer on this question indicates an increase or decrease in testing, with a “5” indicating a slight decrease and a “6” indicating a slight increase? Whatever the case, with 717 respondents and some likely scatter in the results an average score of 6.3 raises concern that patient satisfaction surveys drive over testing. Unless you subscribe to Berwick's model of radical consumerism your treatment decisions should be based on evidence. This is the first data I've seen that addresses the influence of patient satisfaction surveys on adherence to evidence. In terms of over testing and over treating it's analogous to defensive medicine and certainly is an area that deserves further study.

Now here's the kicker:

In the Emergency Physician’s Monthly survey, 48% of health care providers reported altering medical treatment due to the potential for a negative report on a patient satisfaction survey, with 10% of those who altered treatment making changes were medically unnecessary 100% of the time. Examples of medically unnecessary treatment provided to improve satisfaction scores included performing unnecessary testing, prescribing medications that were not indicated, admitting patients to hospitals when they did not need hospital admission and writing work excuses that were not warranted. More importantly, 14% of survey respondents stated that they were aware of adverse patient outcomes that resulted from treatment rendered solely due to a concern with patient satisfaction surveys. These adverse outcomes included allergic reactions to unnecessary medications, resistant infections and clostridium difficile colitis from unnecessary antibiotic prescriptions, kidney damage from contrast dye, and medication overdoses.

Patient satisfaction has turned into a performance game. And according to this survey it's a game that wastes resources and could harm patients.

GruntDoc said:

I have No Idea why hospitals pay for this service, when they could do it themselves for a lot less moolah, have much higher data capture rates, and get actually usable data.


Anonymous said...

Of course the scores are meaningless. Do hospitals really need to spend upwards of 100K annually to be told wait time and communication are the most important issues to patients? Seriously? Also, in the 20+ years PG has been in business, have the most important factors affecting pat. satisfaction changed? The surveys are a waste of health care resources.

Anonymous said...

The question is then, why do certain hospitals tout their scores out to the public? It is all a matter of the deception played by the greedy Corporations. Greed is so rampant in healthcare. Unfortunately I can remember a time when it really was NOT the primary motive. But what was it that changed? Oh yeah, we have more nonclinical people in administration running the show. Telling doctors and nurses how to do their job. Big difference.

Anonymous said...

While Press Ganey scores may not be the perfect solution for measuring a doctor's performance, there is still valuable data there. Doctor's maybe experts in the technical skills needed to perform their role, but are they applying their skills in the best way possible. Doctor's should not consider themselves to be "good doctors" just because they "know what they are doing." Every individual that enters a health center for care has a unique story and needs an equally unique treatment plan. Patients need to not just receive adequate care, they need to receive great care to ensure a great recovery.