Teaching for the Test: Do Some Patient Satisfaction Efforts Hurt More Than They Help?

In some soon-to-be published research that I’m probably not supposed to be talking about yet, three-quarters of hospital nurses say they feel pressured to influence patient satisfaction surveys.

That alone isn’t a bad thing–nurses should be mindful of making the patient experience as happy and pleasant as it can be. But we’ve heard some anecdotes about the coaching nurses receive that make us cringe a little. Things like encouraging them to use the word “always” because that’s the desired answer to each of the HCAHPS survey questions. And some nurses feel pressured to the point of discomfort to repeatedly direct patients to favorably complete the surveys.

Such attempts to finesse higher survey scores seem to be aimed in the wrong direction. Here are some things I promise will improve my experience as a patient: Don’t leave me on a gurney for four hours outside of the ED waiting for a bed. Don’t have nurses who spend hasty, distracted time with me at bedside because they are so occupied making calls and roaming hallways checking for patients and resources. Don’t extend my stay by a day and waste my time with my doctor because you double-booked an outpatient in my slot for a scan. Don’t frustrate me and my family because we have no idea where I’m going to be for what care activities at any time of any day.

These aren’t just window dressing issues that will go away if nurses say the word “always” a lot. These are fundamental activities of care. It’s like when schools train kids to do well on standardized tests, but fail to adequately educate them. Hospitals should focus on adopting logistics to efficiently coordinate the care of all patients in the hospital, all the time. It’s the core business of every hospital–the simultaneous coordination of quality care for all patients. If hospitals can reliably get that right and keep improving, happy and satisfied patients will naturally follow. Always.

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