Is There Ever Anything More Important Than Patient Satisfaction And Hospital Profits?

[Birdstrike]

This question is only for hospital administrators that oversee Emergency Departments. Is There Ever Anything More Important Than Patient Satisfaction And Hospital Profits?

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[MechEDoc]

No. They can't find a fast or cheap way to measure quality of care nor are they rewarded for good care. So they pursue the things they are rewarded for and you're stuck in the middle.

Remind me why I didn't go to evil medical NP or MBA school?

 

[RustedFox]

No. They can't find a fast or cheap way to measure quality of care nor are they rewarded for good care. So they pursue the things they are rewarded for and you're stuck in the middle.

Remind me why I didn't go to evil medical NP or MBA school?

I can't begin to estimate how many times I've imagined a situation in which I have to explain to some admin why metric "x" is too high and I simply hand them my stethoscope and pause for a second before saying: "Oh, you don't know how to use one?" Then you're of no help here. Byeeee."

 

[MechEDoc]

I have been in a place (terrible ER) on a locums contract where someone was giving me grief that they want me to click on this box, that box, or some other little thing in the EMR to make their data collection easier. I pointed out that all of the relevant information was contained in the note, that I prefer to focus my energies towards patient care and appropriate documentation, and I really wasn't interested in doing their bidding. I noted that someone (e.g. the coders) could do this at approximately $20 per hour whereas my fully burdened cost was probably $300 per hour. They looked stunned when they realized I wasn't going to acquiesce to another stupid request. I helpfully offered that they are more than welcome to fire me at the end of my shift. Not surprisingly, nothing ever came of that. The hospital was so desperate for physicians that they apparently decided to let it slide.

Like Nancy Reagan said "just say no".

 

[LebronManning]

they want me to click on this box, that box, or some other little thing in the EMR to make their data collection easier. I pointed out that all of the relevant information was contained in the note

HPI click boxes? lol. Those are the worst.

 

[Vandalia]

This question is only for hospital administrators that oversee Emergency Departments. Is There Ever Anything More Important Than Patient Satisfaction And Hospital Profits?

Depends. If you work as an EM physician for free, then it is not important. If you expect to get paid, then that money has to come from somewhere. Money doesn't grow on trees and the feds frown on printing it yourself.

 

[Birdstrike]

Depends. If you work as an EM physician for free, then it is not important. If you expect to get paid, then that money has to come from somewhere. Money doesn't grow on trees and the feds frown on printing it yourself.

Nice try. You really didn’t think I’d pick up on the fact that you moved the goalpost from, “Is there anything more important than profits?” to, “Do profits have any importance at all?”

They’re not the same thing. Reread the thread title.

 

[Vandalia]

They are one and the same. One of our very rural critical access hospitals closed last year due to financial issues. The worst, most bureaucratic, fraud-ridden, crazy CEO led hospital ED will save one more life than that closed ED.

You can provide a miracle-cure for every patient who comes through the doors, but if the checks bounce, the lights aren't on, the supply companies won't deliver anything, then it doesn't matter... a very bad ED has a chance of actually helping someone, a closed ED has no chance. And this reality is a lot closer than many EM physicians think.

Now it depends on how you define the terms, because your statement is ambiguous: if you are speaking in generalities, then profit is the only thing that matters, because without it, nothing matters. If you focus down a bit, then profit is not a consideration. One of my mottos is "doing the right thing is also the best thing for the bottom line." Hiring low quality physicians will cost you money in the long term. Understaffing - both in terms of quantity and quality - will hurt the true profit. Buying poor quality equipment/supplies is not cost efficient in the big picture.

Profit - in its fullest sense - is the only thing that matters in the end. However, "profit" as often used in medicine as a substitute for "being cheap", should be given little weight.

"Patient Satisfaction" also admits of two meanings. Short term, Press-Ganey "satisfaction" is meaningless. However, if everyone in your community says "don't go to the X hospital ED because they kill everyone who walks in" and everyone is driving to the hospital 50 miles away... and you are seeing 3 patients a day, then, yes, that is an issue that is more important than almost anything else.

Properly understood, "profit" and "patient satisfaction" are the most important factors in running an ED. The same words in a different context should be of no concern.

 

[Birdstrike]

They are one and the same. One of our very rural critical access hospitals closed last year due to financial issues. The worst, most bureaucratic, fraud-ridden, crazy CEO led hospital ED will save one more life than that closed ED.

You can provide a miracle-cure for every patient who comes through the doors, but if the checks bounce, the lights aren't on, the supply companies won't deliver anything, then it doesn't matter... a very bad ED has a chance of actually helping someone, a closed ED has no chance. And this reality is a lot closer than many EM physicians think.

Now it depends on how you define the terms, because your statement is ambiguous: if you are speaking in generalities, then profit is the only thing that matters, because without it, nothing matters. If you focus down a bit, then profit is not a consideration. One of my mottos is "doing the right thing is also the best thing for the bottom line." Hiring low quality physicians will cost you money in the long term. Understaffing - both in terms of quantity and quality - will hurt the true profit. Buying poor quality equipment/supplies is not cost efficient in the big picture.

Profit - in its fullest sense - is the only thing that matters in the end. However, "profit" as often used in medicine as a substitute for "being cheap", should be given little weight.

"Patient Satisfaction" also admits of two meanings. Short term, Press-Ganey "satisfaction" is meaningless. However, if everyone in your community says "don't go to the X hospital ED because they kill everyone who walks in" and everyone is driving to the hospital 50 miles away... and you are seeing 3 patients a day, then, yes, that is an issue that is more important than almost anything else.

Properly understood, "profit" and "patient satisfaction" are the most important factors in running an ED. The same words in a different context should be of no concern.

Let me explain my point in more detail. I understand we all want and need a paycheck. I understand that businesses, including hospitals, aren't in business to lose, money. I'm a shareholder in my own physician "corporation," although we are not a hospital, but instead a (mostly) outpatient physician group.

Let me spell it out for you: As a business, as corporation, you can have a VISION, GOALS, and a MISSION, in addition to the obvious, which is the necessary profit. As a hospital, or medical business, I'd go so far as to say you not only can have such other visions, goals and a mission, but that you should, do so.

If your mission, as a hospital, physician corporation, professional organization, or physician, is only to make a profit. You've lost your soul.

Worse yet, if in your actions, it becomes obvious to your staff, physicians or patients, that you place what's important and best for them, so far aside, that you'll sacrifice it for every last penny, you've lost your way. You become a soulless robot doing nothing but spitting out widgets in exchange for coins to make more widgets.

There are reasons that some corporations continuously climb to the top of the "Best To Work For" lists. Those aren't the companies that decide to burn their employees souls to a crisp, to discard them as fast as possible, to replace them with another, cheaper.

I see from the inside, now. As someone on the board of directors of my group, I see from the inside how the fish can either rot from the head down, or lead the organization with simultaneous goals and guided principles. For example, there's no reason that a CEO or board of directors can't simultaneously have as their primary mission, more than one thing. There's no reason you can't simultaneously strive, 1) For profit, AND, 2) To provide a work place you'd want your closest friends and relatives to work at, AND, 3) To improve the health of the community you serve.

The mission does NOT have to be, "Strive for profit at the expense of all else. Strive for profits at the expense of our employees' job satisfaction and mental health. Strive for profits at the expense of our community's health, as long as their urges are satiated."

Profitable companies do not have to be run that way. Not all highly profitable companies are run that way. A company doesn't even have to sacrifice profit at all, to be run in a mutually beneficial way for their employees and customers (or "patients"). In fact, some would argue, you can profit more, by running a more well rounded company. And let's be real here. The most aggressively for-profit hospitals, the one's we all know that treat their employees and "customers" the most soullessly, are not exactly teetering on the edge of insolvency.

I understand a lot of businesses are run that way and can be run that way. But the best business, and certainly the best hospitals are absolutely not run that way. The best businesses are run with multiple goals, and with a mission and vision more complex than, "Only Profit." "Making huge profits while making it clear with our actions we don't give a ---K about our employees" does not have to be a company's vision and is not required to maximize profits. That's a very narrow view, and a view of a very unskilled and one-dimensional businessman. Companies don't have to be run soullessly like a Martin Shkrelli or Enron. They can be run like Berkshire Hathaway, where you're fabulously profitable, people like to work for you, AND without sacrificing your soul.

Ever hired someone that didn't offer the cheapest price, because you trusted them more, or because they seemed to take more pride in the work they do and how good they do it? Or do you always hired the guy that's the cheapest, fastest, pay and treats his workers like crap and seems not to care about anything more than the bottom line?

That's the difference.

 

[southerndoc]

Patient satisfaction is important for trends, but taking away physician pay because of one quarter's bad performance should not be allowed. Factors outside our control weight heavily on patient satisfaction. The physician takes the hit when time to be seen is too high because not enough nurses are working, if a patient doesn't get antibiotics because they aren't indicated but the patient wants them, because they didn't get the MRI they didn't need, because the plastic surgeon didn't come in to repair their 2 cm laceration.

We are nearing a crossroad where patient care is being compromised because of patient satisfaction. I think the Press-Ganeys of the world will not be around in 10 years, but I'm hoping they fall out even sooner. No physician should get poor marks because a patient asked a nurse for a blanket and didn't get it, because our coffee tasted horrible, etc.

 

[emergentmd]

This question is only for hospital administrators that oversee Emergency Departments. Is There Ever Anything More Important Than Patient Satisfaction And Hospital Profits?

Hospitals always put the well being of the physicians ahead of all other including metrics and profit........

Atleast that is what I have always been told by admin.

I remember when admin sent out physician surveys, asked everyone to be truthful. Once they got the negative surveys in, the next time around we got the directive from our ED leadership to just give all admin top scores.

 

[Angry Birds]

I work per diem and love the fact that I get paid the same no matter what I do. And they desperately need coverage so I’m unfireable.

 

[throckmortonDO]

The corporations that own us are indeed soulless. You have a corporation that functions purely to show revenue to shareholders, many of which are international. Metrics are the only thing that they define me with. They have no understanding of the definition of a Doctor. They preyed on our altruism, and in our infinite wisdom, we handed these MBA wielders the keys. They have reduced our noble profession to that of assembly line workers and hospitality agents - without PTO, due process, reasonable benefits, sick days, etc that even most jobs have.

I thought business people knew some basic things - staff a place adequately - then your satisfactions scores will go up when we can actually spend time talking to patients. Word of mouth is big, trust me - "That hospital has a long wait but they treat you well, spend time with you and explain things and you get good care" - guarantee you are going to see more patients going there vs "staff running around always busy, spent no time with me, care mediocre/poor, didn't explain anything, but got me in and out quick". That's a laymans perception, even if the medical management is exactly the same. People wait in line hours for a restaurant with good food and good service. If you are going to judge us on customer service, then give us the Go****mn opportunity to provide a good product.

Doctors are some of the hardest working people on the planet. We sacrificed alot to get here, and we aren't afraid of putting in the work. Instead of milking us to the core and stretching us thin, how hard is it to treat us humanely, and let us have some professional satisfaction, and how about the concept of letting us make the clinical decisions and do our effing job, you know - the one we trained ~11-15 years for. If you did that, we'd probably work even harder for you.

sorry for the rant. fresh from 'updates' from the corporate brass.

 

[bravotwozero]

The corporations that own us are indeed soulless. You have a corporation that functions purely to show revenue to shareholders, many of which are international. Metrics are the only thing that they define me with. They have no understanding of the definition of a Doctor. They preyed on our altruism, and in our infinite wisdom, we handed these MBA wielders the keys.

Saying that we 'handed the MBA weilders the keys' would suggest we had a choice in the matter. I'm not so sure about that. When TeamHealth and EMCare expanded into texas, AAEM sued them for violating the prohibition on the corporate practice of medicine. They lost. The seismic shifts in our healthcare system are well above our pay grade. CMGs and insurance companies have a much bigger warchest then you and I will ever have, so donating money to this or that PAC and voting the right way is simply a losing battle as long as we have the private financing of our elections aka money in politics....

 

[GeneralVeers]

The government has actively promoted consolidation in the healthcare industry through HMOs, and ACOs. It is always argued that this consolidation will result in "efficiencies". More efficient, typically means less time for patient care.