fighting press ganey

[mtDNA]

obviously this is really really bad in the ER. Anyone know of any physicians who are doing anything to fight it? Any ideas how? I know there has been at least one large study linking it to increased mortality.

I had this idea that maybe a large survey study asking physicians their opinions on press ganey and how it affects patient quality of care, unnecessary testing, admissions, abx, narcotics, ruins the triage process, etc. would likely show overwhelmingly that physicians are finding these surveys to be terrible for our patients. Such survey studies would poll them anonymously, which is good too because docs wouldn't have to worry about voicing an opinion that could get them in trouble with administration. I am curious to see what others think of this idea or any other ideas that are out there.

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[gutonc]

You are correct that such a study would find universal physician hatred for P-G, both in and out of the ED. What you aren't taking into account however is that nobody in clinic/hospital/ED administration gives a flying f*** what the docs think about P-G.

 

[Birdstrike]

This is how I'm fighting Press Ganey:

 

[RustedFox]

Phuck the Press-Ganey, comin' straight out tha underground.
Unhappy docs don't make admins frown.

Take it away, folks.

 

[gutonc]

I fought it the last 2 weeks by drinking a bottle of wine at lunch and a bottle of wine at dinner in Paris and Tuscany.

 

[TooMuchResearch]

By prescribing narcotics for everyone.

Kidding.

 

[alpinism]

With hunger code carts.

SAN DIEGO – According to hospital administrators, Code Blue carts are now being outfitted to meet a new and growing medical emergency. Effective 1 Jan 2015, Drawer 2 in all Code Blue carts at Sunshine Community Hospital will contain freshly made turkey sandwiches and mini ginger ales.


“Medical emergencies have really changed over the past 20 years,” said Hospital Administrator Jeremy Brighton. “Today’s real and more frequent emergencies in the ED and on the floors deal with irate hungry patients. We like to call it a Code Hangry around here. If a patient is hungry or thirsty, they might fill out a negative patient satisfaction survey. That my friends, would be worse than an actual death.”

Drawer 1 will still contain normal ACLS drugs such as epinephrine, vasopressin, and amiodarone. Instead of overrated airway equipment, Drawer 2 will now contain mini ginger ale cans and at least 4 freshly made sandwiches. Two of the sandwiches need to be turkey sandwiches to be used as a first round agent. After the first round of hunger resuscitation has been performed, ham and roast beef sandwiches can be used as alternative treatment modalities.

Sandwiches are required to have stickers placed on saran wrap with the date and time. According to the Joint Commission, writing the date and time with a Sharpie directly on the saran wrap will be forbidden as it must be written on a white label. Sandwiches will expire 24 hours after preparation, and will need to be replaced in the code cart. The sandwiches will be wrapped in such a way that nurses will be able to open and unwrap the sandwich in less than 3 seconds in order to administer them quickly to patients.

Ginger ale must be in mini-sized cans in order for the drawer to close, and must be delivered via a 5mm 12-inch straw with a flexible end within seconds of administering a sandwich.

“We are excited about bringing these new life saving adjuncts to our medical teams,” stated Brighton. “Next on our list is to mandate turkey sandwich making classes for our nurses and medical assistants, to ensure continued high quality medical care. We don’t want to suspend licenses like we did last year to a nurse for making an incorrect and sub-par sandwich. ”


http://www.gomerblog.com/2014/12/code-carts/

 

[gro2001]

I think there is something we can do about it. But we won't beat PG by complaining about it, or showing how much we all hate it. I don't think the administrators really care about that. Not because they are necessarily evil-corporate-overlords types (although of course some of them are) but because it's just not high on their priority list. Imagine for a second you were a hospital administrator and you got what you thought was useful information from PG AND every other department in the country was using the same tool or something similar. Would you care about the complaints of some ED docs? I think the answer is no. I think you would treat it like most high school teachers treat students complaints about the unfairness of exams. Sure, there may be some truth to the complaint, but really they just have a job to do.

So instead of complaining our strategy should be something different. Ideally some group of ER docs with research/stats/IT experience should come up with a competing patient satisfaction product that's better. But it has to be better not just from the ER perspective but from the hospital admin perspective too. You'd think that we'd be in a prime position to figure out how to make a better product, right?

A group of residents at my program are experimenting with their own little bedside, tablet based, real time patient satisfaction survey. If they can do it, why can't these larger "EM doc run groups" (say, EMA) come up with a product?

 

[xaelia]

A group of residents at my program are experimenting with their own little bedside, tablet based, real time patient satisfaction survey. If they can do it, why can't these larger "EM doc run groups" (say, EMA) come up with a product?

Just to be clear – we all care, at least a little bit – whether our patients are having a crappy experience in our ED. It's good to have pride in your place of work and want it to be a place you'd recommend family go for care.

What we really hate about PG is the survey seems to reward bad care – patients are happiest when they're harmed by pandering, narcotics, overtesting, etc. – and the patients we frequently take the best care of are admitted, and excluded from our scores. Good docs get bad scores, and bad docs get good scores. A pill mill RVU-fest ED with gleaming, fancy art is going to get great scores and the semi-urban meat grinder pulling folks back from the precipice will get poor scores. Being measured isn't the problem – it's how.

So, what someone really needs to do, is come up with some set of questions that's reasonably correlated with measures of good ED care – and somehow call that "satisfaction", and get it out there.

 

[erdoc00]

Press ganey serves as a convenient metaphor for the entire field of emergency medicine... everyone hates it, yet we shut up and go along with it because it makes us good money.

If that business model sounds familiar, it's because its the same one used by prostitutes.

 

[Janders]

Don't push the elephant, ride the elephant.

I think it is important to establish some ground rules. (1) P-G, especially when looking at small sample sizes, has poor statistical power. So insist that month-to-month variations aren't blown out of proportion. (2) P-G very well may reward poor patient care decisions. For example, excess providing of narcotics and antibiotics. Draw a big old line in the sand on this. You don't care what the surveys say, you are NOT giving substandard care. It is unethical and unprofessional and unsafe. Most others working in hospitals will agree with you here; perhaps the most egregious evil emperors won't...

Now with just those two ground rules, look at your PG results. What can YOU and your HOSPITAL do to improve them? Usually the #1 thing that decreases PG scores is increased waiting time. What controls ED wait time? Hospital flow. ED physicians are a tiny part of wait time. Often there are many other issues such as nursing staffing, transportation, ineffective sign-out, poor throughput systems, etc etc. Your hospital wants to make their PGs better? They need to drop their door-to-doc and door-to-room times. They need to HELP you do this. Get them on your side, fixing issues. Need more u/s coverage? Need more RN staff at peak times? Need a better patient transport system? Have an ineffective lab? THIS is what is holding up your PG scores, not "mean ER doctors" or "ER docs who don't give out lots of oxys." One you are on the same team, you can make reasonable, GOOD changes to your local system that WILL increase your PG scores without becoming a pill pusher.

This assumes you work with reasonable people who actually care about patient care

 

[mtDNA]

The idea of the survey would not be to show that physicians dislike press ganey, it would show that ED physicians believe that press gainey results in unnescessary testing, increased mortality, increased narcotics in the streets/increased narcotics for abusers, increased unnecessary antibiotics and antibiotic resistance, less time available to spend caring for actual sick patients due to the time requirement needed to satisfy patients who are not sick. If large numbers of ER physicians were included, it seems reasonable that this would be evidence that Press Gainey is having a negative influence in the emergency department.

Also, I disagree with the idea of using a better patient satisfaction survery to replace press gainey, because the fundamental idea of having patients grade us in the ER based on their satisfaction is simply not useful for the ER because it causes the problems listed above and because patients dont know what good ER care is. Satisfaction surveys belong in the service/hospitality industries, not in the ER.

The nurses at my shop tell me that all they talk about in meetings is patient satisfaction...this is disturbing, and I hate to say it, but I can already see the influence in my ER with the newer nursing grads, they are all up on me when a patient is unsatisfied, trying to get me to spend lots of time in those rooms, but when a sick patient is in the department, I have to be constantly checking up on them to make sure that treatments are given in a timely manner, otherwise they take forever, and nobody bothers to inform me of delays in treatment for these truly sick patients.

Anybody else noticing this? My real fear is that this is just the tip of the iceberg...think about it, all of this Press Gainey stuff is relatively new, but imagine if we keep going with this and have nothing but doctors and nurses in the ED who were raised on this garbage.

 

[Birdstrike]

The problem is much greater than Press Ganey, Gallup, or any of the other private survey groups. The government is enforcing this now with its own surveys tied to reimbursement and our pay. The cancer has metastasized.

"HCAHPS Replaces Press Ganey Survey as Quality Measure for Patient Hospital Experience"

http://www.aahs.org/medstaff/wp-content/uploads/HospitalSurvey2013.pdf

Apparently it doesn't matter to them that JAMA has shown:

"Conclusion In a nationally representative sample, higher patient satisfaction was associated with less emergency department use but with greater inpatient use, higher overall health care and prescription drug expenditures, and increased mortality."

http://archinte.jamanetwork.com/Mobile/article.aspx?articleid=1108766

 

[gutonc]

The idea of the survey would not be to show that physicians dislike press ganey, it would show that ED physicians believe that press gainey results in unnescessary testing, increased mortality, increased narcotics in the streets/increased narcotics for abusers, increased unnecessary antibiotics and antibiotic resistance, less time available to spend caring for actual sick patients due to the time requirement needed to satisfy patients who are not sick. If large numbers of ER physicians were included, it seems reasonable that this would be evidence that Press Gainey is having a negative influence in the emergency department.

Again, you're missing the point. Everybody in the hospital administration knows this, they just don't care.

 

[gman33]

The CEOs etc are business people. They are running a business.
They care about clinical medicine only in the sense that it is a product.
Things are run based on the premise that satisfied patients will choose to come back to your hospital in the future.
Return business = more revenue.

If you want to become a hospital CEO and try to change this, go ahead.
Otherwise you will have to adapt to working in this environment.

I really wish our job was just taking care of sick patients, but it is not.
I have come to accept this fact.

For the non-sick patient, I just ask them why they came to the ER and what they want/expect to happen.
If it won't cause significant harm and they understand the risk/benefit, I usually just do it and move on.

I won't give narcs to the repeat offenders, but other things that are reasonable, I just do it.

 

[em1234]

Know your enemy!
At my current CMG outpost we were tired for being the hospital system's P-G whipping boy. The other 6 hospitals in the system are in much more affluent areas, with good payer mix and generally pleasant people. My hospital is the urban poor, knife and gun club, uninsured is our primary insurance kind of facility. Some refer to it as county-plus.
Our medical director, sick of monthly graph and charts that said we were all terrible Press-Ganey-tologists, set out to demystify the system. Too much hearsay and old wives tales about who gets a survey and who doesn't. Diagnose them with X and they won't get a survey, put drug seeking behavior on the chart, no survey, etc.
It has turned out that knowing our enemy has been the key to winning the war.
Who actually gets excluded:
1. AMA, LBSW, medical screen out
2. admitted and transferred pts
3. DOA pts
4. peds pts dc'ed to custody of DCFS
5. pts who are dc to jail/police
6. Pts who threaten staff with physical harm
7. Repeat visit in the last 3 months, provided they had received a survey already.

There you go. That's the list. Primary or secondary psych disorder diagnosis? Survey. Rape or physical assault victim? survey. Drug seeking behavior/high utilizers? survey. Homeless? Survey. Miscarriage? Survey.

In light of the new information and finding out most of our assumed P-G exempt pts were getting survey's all along, we have made some changes. Oh, and in case anyone was worried, Santa also is not real, but it wouldn't stop P-G from sending him a survey.
Screening out patients has increased. An example: Generally well pt, nl vs, no SI or HI who comes in thinking there is a parasite or animal crawling around inside of him. Wants labs and a scan to "find what's wrong with him!!" Screen out. not enough labs and scans in the world to make this guy happy. Don't risk the bad P-G when the work up inevitably comes up negative.
I recognize screening out pts, isn't for everyone. One of the joys of working in Texas. My old job, this never would have flown, MSE didn't even exist.

The second battlefield in this two front war we are waging on P-G is nothing short of good old fashion Chicago-style ballot box stuffing. I see 300-350 pts per month and my monthly PG eval is based on 1-8 surveys per month, thus we have taken to using their pitiful sample sizes against them. Invariably, everyday there are plenty of patient encounters that are great. Appreciative, happy patients, good results that we bemoan "if only THESE people got a survey". Well who knows? Maybe they do and like any normal person when they get a call from a telemarkety number and some disinterested clown on the phone asking to get them to fill out a survey tells said clown no or pretends their house just caught fire and hangs up. We have taken to asking these happy appreciative people to keep an eye out for the patient satisfaction phone call that may come in the next 6 weeks and should they get called, I ask them to do me a favor and take the call, do the survey and hopefully they thought we did a "Very good" (but not an excellent) job. I tell them that it helps me out greatly and without fail they seem genuinely happy and excited to do it. It even appears as though people are actually following through, the first 3 months of our new PG "initiative" (Read:ballot box stuffing/screen out bonanza) has led to a marked improvement in our scores across the board and a lot less chalk talks about how to better kiss backsides.

As has been previously stated, we let the genie out of the bottle when we as a profession sat idly by and were complicit in letting the patient satisfaction cancer become part of our practice. Unless someone has a delorean that can go 88mph with a Mr. Fusion and a flux capacitor there is no way to put the genie back in the bottle. That cancer has metastasized, we are now going to be reimbursed based on lay people's perception of our care. In the same way that I should be able to judge my airline pilot for getting me to my destination safe and alive, but somehow should be able to deduct money from the cost of my ticket because they ran out of coke zero, didn't play the movie I wanted and I felt the flight attendant's overhead announcements were too loud. To quote the great Jimmy V, all we can hope to do is "survive and advance". Hope this was helpful to some. Attached is the actual PG list of inclusion/exclusions.

Know the rules, play the game, and play to win,
-1234

 

[EM_Rebuilder]

I fought Press Ganey by controlling it.

I am building two of my own ERs...

I believe in patient satisfaction, but disagree with tying it to reimbursement.

 

[Birdstrike]

I fought Press Ganey by controlling it.

I am building two of my own ERs...

I believe in patient satisfaction, but disagree with tying it to reimbursement.

Like x 1,000

 

[mdpre001]

Know your enemy!
At my current CMG outpost we were tired for being the hospital system's P-G whipping boy. The other 6 hospitals in the system are in much more affluent areas, with good payer mix and generally pleasant people. My hospital is the urban poor, knife and gun club, uninsured is our primary insurance kind of facility. Some refer to it as county-plus.
Our medical director, sick of monthly graph and charts that said we were all terrible Press-Ganey-tologists, set out to demystify the system. Too much hearsay and old wives tales about who gets a survey and who doesn't. Diagnose them with X and they won't get a survey, put drug seeking behavior on the chart, no survey, etc.
It has turned out that knowing our enemy has been the key to winning the war.
Who actually gets excluded:
1. AMA, LBSW, medical screen out
2. admitted and transferred pts
3. DOA pts
4. peds pts dc'ed to custody of DCFS
5. pts who are dc to jail/police
6. Pts who threaten staff with physical harm
7. Repeat visit in the last 3 months, provided they had received a survey already.

There you go. That's the list. Primary or secondary psych disorder diagnosis? Survey. Rape or physical assault victim? survey. Drug seeking behavior/high utilizers? survey. Homeless? Survey. Miscarriage? Survey.

In light of the new information and finding out most of our assumed P-G exempt pts were getting survey's all along, we have made some changes. Oh, and in case anyone was worried, Santa also is not real, but it wouldn't stop P-G from sending him a survey.
Screening out patients has increased. An example: Generally well pt, nl vs, no SI or HI who comes in thinking there is a parasite or animal crawling around inside of him. Wants labs and a scan to "find what's wrong with him!!" Screen out. not enough labs and scans in the world to make this guy happy. Don't risk the bad P-G when the work up inevitably comes up negative.
I recognize screening out pts, isn't for everyone. One of the joys of working in Texas. My old job, this never would have flown, MSE didn't even exist.

The second battlefield in this two front war we are waging on P-G is nothing short of good old fashion Chicago-style ballot box stuffing. I see 300-350 pts per month and my monthly PG eval is based on 1-8 surveys per month, thus we have taken to using their pitiful sample sizes against them. Invariably, everyday there are plenty of patient encounters that are great. Appreciative, happy patients, good results that we bemoan "if only THESE people got a survey". Well who knows? Maybe they do and like any normal person when they get a call from a telemarkety number and some disinterested clown on the phone asking to get them to fill out a survey tells said clown no or pretends their house just caught fire and hangs up. We have taken to asking these happy appreciative people to keep an eye out for the patient satisfaction phone call that may come in the next 6 weeks and should they get called, I ask them to do me a favor and take the call, do the survey and hopefully they thought we did a "Very good" (but not an excellent) job. I tell them that it helps me out greatly and without fail they seem genuinely happy and excited to do it. It even appears as though people are actually following through, the first 3 months of our new PG "initiative" (Read:ballot box stuffing/screen out bonanza) has led to a marked improvement in our scores across the board and a lot less chalk talks about how to better kiss backsides.

As has been previously stated, we let the genie out of the bottle when we as a profession sat idly by and were complicit in letting the patient satisfaction cancer become part of our practice. Unless someone has a delorean that can go 88mph with a Mr. Fusion and a flux capacitor there is no way to put the genie back in the bottle. That cancer has metastasized, we are now going to be reimbursed based on lay people's perception of our care. In the same way that I should be able to judge my airline pilot for getting me to my destination safe and alive, but somehow should be able to deduct money from the cost of my ticket because they ran out of coke zero, didn't play the movie I wanted and I felt the flight attendant's overhead announcements were too loud. To quote the great Jimmy V, all we can hope to do is "survive and advance". Hope this was helpful to some. Attached is the actual PG list of inclusion/exclusions.

Know the rules, play the game, and play to win,
-1234

Wow! One of the best posts I have EVER read on SDN! Thank you!

 

[gman33]

Know your enemy!
At my current CMG outpost we were tired for being the hospital system's P-G whipping boy. The other 6 hospitals in the system are in much more affluent areas, with good payer mix and generally pleasant people. My hospital is the urban poor, knife and gun club, uninsured is our primary insurance kind of facility. Some refer to it as county-plus.
Our medical director, sick of monthly graph and charts that said we were all terrible Press-Ganey-tologists, set out to demystify the system. Too much hearsay and old wives tales about who gets a survey and who doesn't. Diagnose them with X and they won't get a survey, put drug seeking behavior on the chart, no survey, etc.
It has turned out that knowing our enemy has been the key to winning the war.
Who actually gets excluded:
1. AMA, LBSW, medical screen out
2. admitted and transferred pts
3. DOA pts
4. peds pts dc'ed to custody of DCFS
5. pts who are dc to jail/police
6. Pts who threaten staff with physical harm
7. Repeat visit in the last 3 months, provided they had received a survey already.

There you go. That's the list. Primary or secondary psych disorder diagnosis? Survey. Rape or physical assault victim? survey. Drug seeking behavior/high utilizers? survey. Homeless? Survey. Miscarriage? Survey.

In light of the new information and finding out most of our assumed P-G exempt pts were getting survey's all along, we have made some changes. Oh, and in case anyone was worried, Santa also is not real, but it wouldn't stop P-G from sending him a survey.
Screening out patients has increased. An example: Generally well pt, nl vs, no SI or HI who comes in thinking there is a parasite or animal crawling around inside of him. Wants labs and a scan to "find what's wrong with him!!" Screen out. not enough labs and scans in the world to make this guy happy. Don't risk the bad P-G when the work up inevitably comes up negative.
I recognize screening out pts, isn't for everyone. One of the joys of working in Texas. My old job, this never would have flown, MSE didn't even exist.

The second battlefield in this two front war we are waging on P-G is nothing short of good old fashion Chicago-style ballot box stuffing. I see 300-350 pts per month and my monthly PG eval is based on 1-8 surveys per month, thus we have taken to using their pitiful sample sizes against them. Invariably, everyday there are plenty of patient encounters that are great. Appreciative, happy patients, good results that we bemoan "if only THESE people got a survey". Well who knows? Maybe they do and like any normal person when they get a call from a telemarkety number and some disinterested clown on the phone asking to get them to fill out a survey tells said clown no or pretends their house just caught fire and hangs up. We have taken to asking these happy appreciative people to keep an eye out for the patient satisfaction phone call that may come in the next 6 weeks and should they get called, I ask them to do me a favor and take the call, do the survey and hopefully they thought we did a "Very good" (but not an excellent) job. I tell them that it helps me out greatly and without fail they seem genuinely happy and excited to do it. It even appears as though people are actually following through, the first 3 months of our new PG "initiative" (Read:ballot box stuffing/screen out bonanza) has led to a marked improvement in our scores across the board and a lot less chalk talks about how to better kiss backsides.

As has been previously stated, we let the genie out of the bottle when we as a profession sat idly by and were complicit in letting the patient satisfaction cancer become part of our practice. Unless someone has a delorean that can go 88mph with a Mr. Fusion and a flux capacitor there is no way to put the genie back in the bottle. That cancer has metastasized, we are now going to be reimbursed based on lay people's perception of our care. In the same way that I should be able to judge my airline pilot for getting me to my destination safe and alive, but somehow should be able to deduct money from the cost of my ticket because they ran out of coke zero, didn't play the movie I wanted and I felt the flight attendant's overhead announcements were too loud. To quote the great Jimmy V, all we can hope to do is "survive and advance". Hope this was helpful to some. Attached is the actual PG list of inclusion/exclusions.

Know the rules, play the game, and play to win,
-1234

Thanks for including this document.

The explanation of why they include drug seekers is terrible.
Maybe I'll start telling all these patients that they need to be admitted for drug rehab.
When they disagree, I'll sign them out AMA.
AMA = excluded
if they agree to be admitted = excluded

 

[Daiphon]

Know your enemy!
At my current CMG outpost we were tired for being the hospital system's P-G whipping boy. The other 6 hospitals in the system are in much more affluent areas, with good payer mix and generally pleasant people. My hospital is the urban poor, knife and gun club, uninsured is our primary insurance kind of facility. Some refer to it as county-plus.
Our medical director, sick of monthly graph and charts that said we were all terrible Press-Ganey-tologists, set out to demystify the system. Too much hearsay and old wives tales about who gets a survey and who doesn't. Diagnose them with X and they won't get a survey, put drug seeking behavior on the chart, no survey, etc.
It has turned out that knowing our enemy has been the key to winning the war.
Who actually gets excluded:
1. AMA, LBSW, medical screen out
2. admitted and transferred pts
3. DOA pts
4. peds pts dc'ed to custody of DCFS
5. pts who are dc to jail/police
6. Pts who threaten staff with physical harm
7. Repeat visit in the last 3 months, provided they had received a survey already.

There you go. That's the list. Primary or secondary psych disorder diagnosis? Survey. Rape or physical assault victim? survey. Drug seeking behavior/high utilizers? survey. Homeless? Survey. Miscarriage? Survey.

In light of the new information and finding out most of our assumed P-G exempt pts were getting survey's all along, we have made some changes. Oh, and in case anyone was worried, Santa also is not real, but it wouldn't stop P-G from sending him a survey.
Screening out patients has increased. An example: Generally well pt, nl vs, no SI or HI who comes in thinking there is a parasite or animal crawling around inside of him. Wants labs and a scan to "find what's wrong with him!!" Screen out. not enough labs and scans in the world to make this guy happy. Don't risk the bad P-G when the work up inevitably comes up negative.
I recognize screening out pts, isn't for everyone. One of the joys of working in Texas. My old job, this never would have flown, MSE didn't even exist.

The second battlefield in this two front war we are waging on P-G is nothing short of good old fashion Chicago-style ballot box stuffing. I see 300-350 pts per month and my monthly PG eval is based on 1-8 surveys per month, thus we have taken to using their pitiful sample sizes against them. Invariably, everyday there are plenty of patient encounters that are great. Appreciative, happy patients, good results that we bemoan "if only THESE people got a survey". Well who knows? Maybe they do and like any normal person when they get a call from a telemarkety number and some disinterested clown on the phone asking to get them to fill out a survey tells said clown no or pretends their house just caught fire and hangs up. We have taken to asking these happy appreciative people to keep an eye out for the patient satisfaction phone call that may come in the next 6 weeks and should they get called, I ask them to do me a favor and take the call, do the survey and hopefully they thought we did a "Very good" (but not an excellent) job. I tell them that it helps me out greatly and without fail they seem genuinely happy and excited to do it. It even appears as though people are actually following through, the first 3 months of our new PG "initiative" (Read:ballot box stuffing/screen out bonanza) has led to a marked improvement in our scores across the board and a lot less chalk talks about how to better kiss backsides.

As has been previously stated, we let the genie out of the bottle when we as a profession sat idly by and were complicit in letting the patient satisfaction cancer become part of our practice. Unless someone has a delorean that can go 88mph with a Mr. Fusion and a flux capacitor there is no way to put the genie back in the bottle. That cancer has metastasized, we are now going to be reimbursed based on lay people's perception of our care. In the same way that I should be able to judge my airline pilot for getting me to my destination safe and alive, but somehow should be able to deduct money from the cost of my ticket because they ran out of coke zero, didn't play the movie I wanted and I felt the flight attendant's overhead announcements were too loud. To quote the great Jimmy V, all we can hope to do is "survive and advance". Hope this was helpful to some. Attached is the actual PG list of inclusion/exclusions.

Know the rules, play the game, and play to win,
-1234

This thread should get sticky'd just for this response. Epically awesomesauce.

-d

 

[em1234]

glad you guys enjoyed it. It's no birdstrike , but I hope it helps some of you defeat the beast.
-1234

 

[Birdstrike]

glad you guys enjoyed it. It's no birdstrike , but I hope it helps some of you defeat the beast.
-1234

Your post was very good, and thanks for the "shout out." While it's a shame the practice of Medicine has been reduced to silly games like this when we thought we were choosing a scientific field, it's true that you have to take charge of it as opposed to being perpetually frustrated and victimized by it. It absolutely is true that you can practice the best medicine and end up ranked worst on these time-metrics reports and patient satisfaction surveys and websites, especially if others are gaming the system. You have to decide what you think is the most appropriate response and how far you want to go with it. It's just like these websites where doctors that have lost their licenses and you look them up online and they have 5/5 star ratings, because they can go online and rate themselves repeatedly. These metrics are severely flawed, not scientific and are overemphasized, but like you said, they certainly appear here to stay.

We got into this a little bit before, on the "LOS...How are some so quick?" thread. Your ED director obviously is on top of this. Also, keep in mind not every site uses Press Ganey for their surveys, so the exclusion criteria could be different at different locations of they use a different survey company. Do what you think is most appropriate.


http://www.forums.studentdoctor.net...how-are-some-so-quick?.1048662/#post-14770993

Sure you can get faster, more efficient and all that good stuff, and you should, but you're missing something. "That guy" knows the rules of the game and is playing to win. There's a numbers manipulation game and a "management of averages" here.

(Disclaimer: See the emergencies first, and don't compromise patient care. I'm not suggesting you do this, but with the increasing obsession with these numbers by your "keepers" here is something I've seen done by people who are determined to play the game at all costs. Do with this information as you wish.)

You work a 8 hour shift, your average LOS is 120 minutes. That's 1920 minutes for 16 patients (2 per hour in an 8 hr shift). At some point in the shift, "Mr Efficiency" snags a chest pain of the top of the list and a chief complaint: "work note" (LOS 15 min) disappears off the bottom of the list at the identical time without anyone noticing. All anyone notices is that the abdominal pain comes off the top, as it should. He picked it up, and cherry picked the "work note" simultaneously. You come along and pick up "Peds dystrophic with trach/peg, fever, sedation/LP and needs disimpaction" (LOS= eternity) like a trooper.

An hour later, "Mr Efficiency" comes along and snags a "weak and dizzy" off the top and that "29 yo chronic back pain" (LOS 15 min) halfway down the list you've been avoiding disappears off the list simultaneously, and mysteriously.

At the end of the shift, your length of stay is right at 1920 as always, for an average of 120 min or 2 hr for your 16 hard fought patients at 2.0 per hour.

"Me Efficiency" has seen 16, plus he's cherry picked 2 super quick patients. His length of stay is also 1920 for his first 16 patients, and he's added 2, at 15 minutes each. He clocks in at 1950 for 18 patients. He's done virtually no more work than you, but the average LOS drops to 108 min for him. Not only that, his PPH jumps from the group average of 2.0 to 2.25.

Since most of the group is bunched tightly around an average of LOS 120 min and 2.0 PPH,

"Mr Efficiency" moves way up the bell curve for both LOS and PPH.


How has he done it?


"Clock management."

Math.

Making the numbers look good.

Knowing the rules of the game.


Mr Efficiency also knows how important "patient sat" is to admin. He doesn't seem to treat his patients different than anyone else. But he constantly gets 3 "great job!" letters for every complaint letter you get. Also, admin has noticed that his Healthgrades.com, ucomparehealthcare.com, vitals.com and ratemds.com scores are through the roof, averaging 4.5-5/5 stars across the board with comments such as "Dr Efficiency is great! Would go back to St. General any time!" Though it doesn't directly increase his PG scores the amount of free advertising it gives to his hospital tickles admin pink. How does he do it?

He walks in to every room ready. When he has a patient say, "Thanks doc, I appreciate your help," somebody who he knows had a good experience, he whips out a pre-printed sheet of paper that says,

"Your comments and feedback are very important to Dr Efficiency and St. General Hospital. Please take the time rate Dr Efficiency and to tell us about your care at one or more of the following ratings websites:

Healthgrades.com
Ucomparehealthcare.com
Vitals.com
Ratemds.com

Also, a quick note to Joe Tool CEO sharing your thoughts would be greatly appreciated as well. Thank you!"

Only 1 in 5 follow through, but it's enough so that his averages, ratings, and stature with admin go through the roof with very little effort and at nost cost to him or the hospital. Dr Efficiency has brought positive and free internet advertising and publicity to the hand that feeds him.