The Michelinization of Healthcare? (How many stars would you give this post?)

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We’ve mentioned the HCAHPS many times on this blog.  The Hospital Consumer Assessment of Healthcare Providers and Systems survey, based on twenty-seven questions put to patients about their hospital experience, was designed by the Centers for Medicare and Medicaid Services of the US Department of Health and Human Services to “capture uniform information on hospital care from the patient’s perspective”.

HCAHPS has been billed as a “call to action to healthcare leaders and staff” for improving service delivery.  For example, Hospitals in Pursuit of Excellence has produced a “Health Care Leader Action Guide to Effectively Using HCAHPS”. (HPOE is “the American Hospital Association’s strategic platform to accelerate performance improvement and support delivery system transformation in the nation’s hospitals and health systems”.)

These score literally mean money to hospitals: their federal reimbursement rates will depend on them.  Naturally, then, consultants are offering to help raise hospitals’ scores.  In addition to consultants, many players are getting on this bandwagon; for example, Human Resources wants a part of the action.  Nurses, too, certainly have a valid claim to be instrumental in affecting these ratings.

Already hospitals are advertising their HCAHPS ratings.  And of course if they don’t publicize them, others will.  Patients, too, are said to be using them to make choices regarding hospitals.

But all those statistics can be confusing and their validity has been questioned.  So a simpler solution has been proposed. It could be called Michelnization.

In a move which is already inspiring puns and ridicule, CMS is considering “graphical display” of this information, i.e., star ratings.  It works for restaurants, plays and movies – so why not hospitals, which after all have been urged to consider themselves in the entertainment business?  How long before we see listings such as these

gold stargold stargold stargold stargold starAMALGAMATED MAJOR HOSPITAL –  First rate in everything from cardiology to urology.  But we especially recommend the appendectomy – it’s the best anywhere.  And every discharged patient gets a free candy bar.

gold stargold stargold starFANCY MODERN CLINIC –  Some specialties may be a little below standard. We particularly would urge you to avoid heart surgery; there have been just too many deaths.  But whatever they lack in other respects, they make up for in amenities: the largest TV channel section, first rate cuisine, and complimentary hair care.

gold starNEIGHBORHOOD MEDICAL INSTITUTION –  Really dull care in a very drab building. Maybe OK for something minor like an ingrown toenail, but don’t risk your life on major surgery here.  And the nurses’ uniforms are really tacky.

Well, it could happen.  And it is all part of a trend of number worship.  You can see the same tendency in education, where emphasis on tests score has spawned an industry of consultants, led often to cheating, and very likely been detrimental to actual learning.

Let’s hope health care doesn’t experience cheating scandals!  Using numerical measures certainly can be valid, but too much of anything is a bad thing.  Even for choosing a restaurant, it’s not all in the stars.

Jim murphyJim Murphy has a solo consulting practice called Management 3000, focusing on organizational development and change management. Formerly he led the Massachusetts Bay Organizational Development Learning Group, was Human Resources Director for the City of Boston Assessing Department, and served as a consultant with the Boston Management Consortium.  His consulting practice includes management coaching as well as research and writing on employee relationships, leadership, healthcare and collaborative practices.  Having produced newsletters for several organizations  and being a frequent content writer for the”Confident Voices in Healthcare” blog, he is interested in writing and research opportunities, as we all consulting and coaching.





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8 Responses to The Michelinization of Healthcare? (How many stars would you give this post?)

  1. Pingback: Food for Thought on HCAHPS: Should Hospitals Increase Nurse Staffing or Buy Better TV Sets?

  2. Pingback: May the Stars Be With You, Hospital Executives!

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  4. Enjoyed your post, Jim. As a former director of customer service at a large healthcare practice, I second the concerns you raise. It sometimes feels like the point system used to judge Olympic gymnastics. Everyone gets a 9 point something. It’s really the tenths of point (or hundreths) that separates the winners from the could-have-beens. This misses the point – it’s not about chasing points, its about building a culture that rewards and supports excellence, in how we treat our patients, and yes, how we treat and engage staff. If the culture is there, the rest is (relatively) easy.

    • Hi Mike,
      Great point and so true! When the culture supports the work and workers, everything is easier and better. And I can’t help but think that ALL those gymnasts were, no wait, almost ALL those gymnasts were really good, a few could be coached into betterness and maybe a few should do something else. This seems like a great goal in healthcare…i.e. competition so that all are providing great care with maybe a few facilities going out of business….something like that!

  5. I second Beth’s comments about this being a great post.
    You have to wonder about how valid these patient satisfaction surveys are. I read about hospitals in PA giving their patients limo rides and star concerts.
    We’ll hope for the best with all of this!

    • Jim Murphy says:

      Thanks, Martine!

      Limos and concerts: So the cheating has already started!

      Any incentive system can lead to cheating and, if cheating is too easy, does not work. It remains to be seen whether HCAHPS will be a good or a counterproductive incentive system.


  6. Great post, Jim. You really get us thinking and questioning. I bet some of those one star facilities would offer really good basic care to folks that wouldn’t get past the waterfall in the 5 star facility b/c of lack of or underinsurance. I also think we need to be very careful about NOT oversimplifying healthcare and ensuring high standards of care are provided for all patients all the time. Some will be able to recognize and gauge this better than others and that is another challenge for survey efforts.

What are your thoughts?