Despite its detractors, it appears that irony is an inescapable facet of modern life. Indeed, ironical observations frequently breed sardonic or paradoxical offspring, with life so frequently providing real examples of what we imagine.
We thought it ironically humorous that the government would propose rating hospitals like restaurants, with a star system. We saw even more irony in the fact the researchers compared on-line reviews of hospitals with HCACAPS and a found a correlation . We speculated that perhaps hospital food ratings might also be compared with their patient satisfaction scores.
That speculation may have been meant ironically but it does seem as if could become reality. For example, Food Management magazine has asked, “Is Room Service the Way to Order Up Great HCAHPS Scores?” It reports that the Lakeland Regional Medical Center, by eliminating a call center and sending patient tray tickets directly to the kitchen, “generated an additional two to three percentage increase in the hospital’s Press Ganey patient satisfaction scores.” Likewise, Texas Health Presbyterian Hospital in Dallas implemented room service (though with a call center) and was able to lower food costs and “overall patient satisfaction scores have increased 18%.”
Of course this trend has been surveyed. Foodservice Director magazine’s 2013 Healthcare Survey reported that “because of HCAHPS the majority of hospital directors—at 69%—have made changes to their foodservice programs.” These included expanding and upgrading menu options (57%), hiring additional tray deliver staff (14%), and new foodservice uniforms or dress codes (32%).
Does it seem ironic that dress would seem to get more attention than then staffing? But Cleveland Clinic, arguably the exemplar of hospital reform, has found that “color-coded nursing uniforms improve patient satisfaction.” In fact, the impact of nurses’ on patients has been studied and surveyed for some time, an article on that topic between one most downloaded from the journal Applied Nursing Research.
Nor should EVS (still called housekeeping in more backward circles) be overlooked as an action area for improving HCAHPS ratings. For example, Hospital Housekeeping Systems says that “within the first 12 months of implementing our programs, our acute-care hospital partners can expect to see an HCAHPS Top Box increase of seven percentage points with respect to patient room and bathroom cleanliness.” They note that their system employs methodologies from the Disney Institute, presumably answering the question “if Disney ran your hospital”.
One might say that if they make patients feel better, than better food, nicer uniforms, and shinier bathrooms are worth it and if takes HCAHPS to bring such improvements about, so much the better. Yet the problem is that such score-driven attention detracts from core values and leads to abuse. How else would one categorize the use of limousines by the Cancer Treatment Centers of America in Philadelphia?
Compared to all the advertisements and studies on what might be called the superficial or secondary aspects of healthcare, there is considerably less emphasis on more fundamental matters. Back in 2009, Health Affairs carried an article on “Nursing : A Key to Patient Satisfaction”. It detailed research showing that “improving nurses’ work environments, including nurse staffing, may improve the patient experience and quality of care.” How many institutions have gone in that direction, as opposed to, say, upgrading their televisions? Perhaps our readers can furnish some examples of good or of bad ways organizations have chosen to win the HCAHPS race.
–Jim 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 well asconsulting and coaching. www.manage2001.com firstname.lastname@example.org