Why is EM so obsessed w/ customer service metrics?

[Perrotfish]

So I just finished a month of Peds EM, still strongly considering the fellowship, but I have to admit I was flabbergasted by how much time and mental effort was spent on customer service. They had RNs whose full time jobs were to soothe irritated 'customers'. The working nurses were also very on edge about customer satisfaction, if any customer didn't leave the room smiling I heart about it immediately. The amazing thing is that the hospital even seemed deeply concerned about the satisfaction of patients that, from a business standpoint, you'd think they'd want to leave unsatisfied: non-sick non-payers. Something about this isn't adding up for me.

This has been a theme at every ER I have rotated through since medical school, and I don't get it. I've rotated on the floors at all the same hospitals, and while patient satisfaction isn't a non-goal its definitely not nearly as emphasized. I have yet to hear a hospitalist group discuss their scores on anything resembling a PG survey, and the standard floor nurse response to a visibly dissatisfied patient seems to indeference. So why is EM so much more interested in patient satisfaction than the rest of the hospital? It can't just be a financial thing, this is impacting turnover time, attracting non-payers, and creating the cost of dedicated customer service staff. So what is the administration's motivation here?

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[Daiphon]

So I just finished a month of Peds EM, still strongly considering the fellowship, but I have to admit I was flabbergasted by how much time and mental effort was spent on customer service. They had RNs whose full time jobs were to soothe irritated 'customers'. The working nurses were also very on edge about customer satisfaction, if any customer didn't leave the room smiling I heart about it immediately. The amazing thing is that the hospital even seemed deeply concerned about the satisfaction of patients that, from a business standpoint, you'd think they'd want to leave unsatisfied: non-sick non-payers. Something about this isn't adding up for me.

This has been a theme at every ER I have rotated through since medical school, and I don't get it. I've rotated on the floors at all the same hospitals, and while patient satisfaction isn't a non-goal its definitely not nearly as emphasized. I have yet to hear a hospitalist group discuss their scores on anything resembling a PG survey, and the standard floor nurse response to a visibly dissatisfied patient seems to indeference. So why is EM so much more interested in patient satisfaction than the rest of the hospital? It can't just be a financial thing, this is impacting turnover time, attracting non-payers, and creating the cost of dedicated customer service staff. So what is the administration's motivation here?

In many ways, it *is* financial.

1) Increasingly, the ED is the portal of entry for admitted patients. Direct admits are plummeting. So, a hospital CEO realizes that keeping the ED patients happy will keep people in the system.

2) With Obamacaid and the PQRS system, reimbursement is changing and will be tied to "customer satisfaction" scores. Bunch of hooey, but is the reality.

3) The only PG scores that matter for the ED are the discharged patients... it's like a game of hot potato. Admitted patients will be happier (for the most part), but you're graded on your discharges. Makes it important to gussy up those patients.

4) With the above, keep in mind that your group can be replaced at any time; so your ED director has a vested interest in kowtowing to the morass that is PG analysis. Cost the hospital enough money on PQRS and <poof!> no more contract.

So yes, it's entirely financial. Aggravating as hell, too.

Cheers!
-d

 

[ruralsurg4now]

Got news for you, it's not just the ER. Everyone gets graded on patient surveys and if you fall below normal, you get dinged and reamed out (and can even be disciplined or fired). It's total B.S., but you have no power over it because the medical system has forced most physicians into being hospital employed. And when you're an employee, you have no control. That's the reason they did that. That's why medicine sucks these days. You spend your time catering to non-paying "customers" while being reimbursed pennies on the dollar for your time and always under the threat of a lawsuit while nurse adminstrators walk around reprimanding you without even understanding what they're talking about. Pretty sweet, huh?

 

[southerndoc]

Many CEO's bonuses are based on customer satisfaction scores. When a CEO doesn't earn a $1 million bonus because patients were unhappy, then the CEO is unhappy.

 

[WilcoWorld]

As above, it is financial. In my opinion, it is also unethical.

 

[DeadCactus]

I would argue that it's mostly because emergency physicians don't really build a "practice". Physicians that build a practice have clear evidence of their customer satisfaction in their ability to attract referrals and keep patients. The fact that they would take their patient's with them if they left to another hospital provides additional shelter from hospital administration. As hospitalists and acute care surgeons transition to an employee based model, the obsession with customer service metrics will become just as widespread though EM remains particularly vulnerable as it is just entering an era where the job is not filled by any vagrant with a medical license who wanders in.