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

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Despite its detractors, it appears that irony is an inescapable facet of modern life.  Indeed, 120px-TV_Land-1ironical 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 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 well asconsulting and coaching. www.manage2001.com   jim@manage2001.com

 

 

 

 

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8 Responses to Food for Thought on HCAHPS: Should Hospitals Increase Nurse Staffing or Buy Better TV Sets?

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  4. I overheard a conversation in a local hospital not long ago where one person was saying what a great hospital it was because, “You can get a lobster roll at any time, even in the middle of the night”. I’d never want to deny anyone any comfort measures, but I couldn’t help but wonder how much it cost to ensure the 24/7/365 lobster rolls and what else might have been compromised in order to do so. Perhaps it comes down to priorities. As a nurse, I want to see enough staff with the skill mix, supplies, and time to provide care safely.

  5. I’ve often wondered about a paradox in promoting assertiveness in nursing and think you are both touching upon it. Assertiveness to advocate for patients is an easier sell to leaders, but there seems to be some resistance to promoting assertiveness that involves self-care. I see this kind of assertiveness as equally important and if not addressed, ends up being a mixed message that may limit both. What I’m getting at is that nurses need to advocate for more staff and for setting limits about working overtime in addition to speaking up when a physician is about to amputate the wrong body part or order a medication a patient is allergic to. Sometimes I wonder if HC leaders are afraid of the power that a truly assertive nurse population would bring to the table. I also worry that nurses need to be very respectful in their assertiveness and willing to compromise and delegate. These tricky communication patterns are quite solvable, but not on a superficial level. Does this make sense?

  6. Thanks for this thought-provoking post, Jim. I think that you are making crucial points that consumers and healthcare leaders should understand if, IF we are ever going to have safe health care as a priority in the USA. These efforts aren’t bad per se, but are more likely to make patients more content with a lower level of quality or less likely to sue in the event of an error rather then preventing errors with enough skilled staff and overall attending to supports for staff so that they can provide safe, quality care and go home at the end of the day, knowing it. I think we take care of those things and patient experience will be improved b/c care is better. If we have enough money left over, then sure let’s get the frills. With 750 billion/year wasted, who knows?

    • Patrick Conway says:

      Great post by Mr. Murphy and more impressive comments from Ms. Boynton. The most satisfied experience I’ve encountered was when my wife was admitted to a hospital and upon arrival on the unit she was immediately attended to by five staff members (two nurses and three aides) whose sole purpose was to make my wife as safe and comfortable as possible. This occurred late at night and of course did not last. The next day was a reality check where there was one overworked and crotchety nurse and a couple of stone faced nursing aides. Call bells for assistance were answered after a minimum of 15 to 20 minutes, but the t.v. and meals were excellent. So patient satisfaction, along with safety and quality service can be attained, but I suspect the t.v. and the food come much cheaper.

      • Jim Murphy says:

        Good observation, Patrick! Organizations frequently tend to take the easy way out and address secondary rather than primary factors. Leaders may find it hard to improve the organizational culture but easy to provide some frills. So instead of more and better trained nurses, we get upgraded televisions and added menu choices.

What are your thoughts?