In 2009 I wrote about my first-hand frustrations as a physician with Press Ganey patient satisfaction surveys. At the time, I was blogging about healthcare reform, the problems in our healthcare system and how we could fix it. In particular, I loathed the unscientific sampling of random numbers that made up the Press Ganey surveys.
It turns out I wasn’t alone. In response to the post, I received a diverse array of responses. Still, the feedback was primarily one-sided: Most respondents hated the surveys.
So, a decade on, has my Press Ganey hell gotten worse? Well, it’s complicated.
The biggest thing that’s changed over the past decade actually has nothing to do with healthcare: We now measure the experience for virtually every consumer transaction in our economy. And while it’s certainly creating a lot of data, most of it isn’t actionable. It’s also setting us up for collective disappointment when an otherwise acceptable experience wasn’t exceptional.
For example, I recently stayed at a Marriott property. Afterwards, I gave my stay four out of five on a survey. As a result, I received a personal email from the manager asking what was wrong. Nothing was wrong, I told the manager. The rooms were clean, the beds were comfortable and the service was typical. Still, nothing was exceptional enough to rate my stay a five. But that didn’t diminish my experience, I said. My experience was just fine — but nothing more.
But “fine” today is not considered acceptable — in the hospitality business or in healthcare. Doctors are now providers and patients are now customers, and a lot of the emphasis in healthcare is responding to these consumer pressures in real time, in service of the surveys, not necessarily the patients.
Much of the feedback these surveys provide remains arbitrary. I remember a meeting recently where we discussed bad satisfaction scores. But really, when you dug into them, they weren’t that bad — pretty much everyone had fours or fives. Then, the next month our scores improved dramatically. What had changed? Not much, other than flu season had ended and our volume dropped. Is that all? We’ll never know, as the survey doesn’t grade us on what we do; it grades us on a curve against everyone else.
Complicating matters, we also now are in the midst of an opioid crisis. As a physician, if I don’t justify an opiate prescription in multiple ways, I get letters from the state. So, my colleagues and I can either spend the five extra minutes per patient it takes to now prescribe an opiate, or we simply prescribe an NSAID that takes no additional time.
So, yes, we now prescribe fewer opioids, which doesn’t make patients happy and satisfied either. I don’t believe in giving super strong pain meds to get better scores, just like I don’t believe in giving antibiotics to treat viruses or ordering CT scans just because patients are demanding it. With the sword of Damocles over your head, however, it gets harder and harder to pay the price of poor Press Ganey survey numbers to do the right thing.