Our medical system in the US wasn't set up to facilitate true patient /doctor relationships, which can make the patient experience worse and even reduce health outcomes. Yes, our physicians are overworked. Yes, our system needs to change. The practice of "secret shoppers" is a temporary solution to highlight poor bedside manner and start a dialogue to work towards improvement.
Treating patients like people (or not doing so) can greatly change their health outcomes. Having myself personally suffered from physicians not taking my healthcare needs seriously (both a problem of short visits and physicians that didn't listen), I can attest to the improvement in my physical and emotional wellbeing I experienced when I encountered a doctor that was courteous and genuinely listened to my experiences.
The benefit of secret shoppers vs. real patients is that their health is not a risk and thus they can raise issues without fearing repercussions for their health outcomes. Improving bedside manner should be taken seriously and I am surprised to read so many criticisms by members of the healthcare community. Emotional health is tied to physical health.
1
This type of research should be done at nursing homes! Having lived thru my parents convalescence at 2 different nursing homes, the "care" they received was horrible, insufficient, and downright frightening.
6
One of the most basic skills that is often lacking in medical personnel is that of constantly bearing in mind that what is all in a day's work for them is often alien, unfamiliar, and frightening for the patient, who, furthermore, is likely to be already weak, disoriented, frightened and in pain due to the presenting illness, or the procedure or preparation for it.
It takes patience, compassion and imagination to repeatedly adjust one's behavior to the fact that for the person you are dealing with, something which for you is routine, familiar, and banal is new and confusing.
9
WHY isn't more of this coming to light in feedback from actual patients?? Is actual patient feedback taken less seriously than from 'planted' informers? And/or are patients not taking advantage of opportunities to give feedback?
Every hospital (etc) I've been in actively invites this, many automatically sending out surveys afterwards asking about a person's experience. If a person just dismisses these (admittedly, easy and tempting to do), they're missing a chance to help improve things.
It seems an element missing here is patients not speaking up for themselves when given the opportunity. Though many may feel that they've tried to do this but have been dismissed, they still have options - write a letter to the hospital, follow up, be persistent, even if you have to wait till you are recovered enough to do so.
Secondly, though it shouldn't be the case in an ideal world: Note the experience of the person in old clothes and not freshly washed, and take a hint!
I see grown people all the time at doctors' offices who are dressed like kids at the beach, not like adults going to see a professional.
Although not an option in an emergency, if people want to be treated more professionally, why not put a few extra minutes into getting cleaned up and looking a little more professional yourself? It can't hurt, and just might help!
4
@Ambient Kestrel
I imagine it's mostly that "secret shoppers" do not have the distraction of actually being sick -- in pain, scared, unable to concentrate, etc. They can focus exclusively on observing their experience and recording it.
7
@herzliebster
Good point!
2
The real issues that no one wants to address are time and money. Hospital administrators and hospital CEOs have created a system to force hospital workers to care for more patients in less time to increase productivity and revenues. The medical notes are not meant for clear and concise communication. They are constructed to document irrelevant data in order to code for a higher visit level (1-5) which are then reviewed by coders and compliance officers. Things which can be done to free time to care for patients, enhance communication, and reduce cost include paying hospital and doctors a flat fee for all visits and according to the complexity of social and medical conditions, capping salary in non profit institutions, and changing the structure of the medical notes to simply reflect data synthesis, diagnoses, and plan. That would automatically eliminate most the army of billers, coders and hospital administrators, compliance officers and would free time for meaningful care. Patient experience via gimmicks is not the way to increase the quality of care and reduce costs.
9
"“Keep your eyes up. Socialize with patients instead of talking about patients. "
-Randy Peterson
What a joke. The hospital isn't a restaurant and you're not instructing waiters. This isn't how good healthcare is practiced.
1
@Laidback:
Really? Doesn't a good clinician need to pay attention to her patients in order to help them?
2
@heliotrophic
Does it say "pay attention to her patients"?!?
No, it says "socialize" with them
1
I see a great deal of outrage in the Comments — most of it from clinicians and others involved in healthcare. While I understand their feeling of betrayal, I don’t know how many — if any — have been evaluated or treated as patients (without being identified as healthcare professionals) in the last 10 years. I’ve experienced good practice, and some really questionable practice. I get Press Ganey surveys for individuals and practices who are adequate and competent, but interestingly enough, not usually for facilities or practices where I’ve experienced lapses. Most of them don’t know that I’ve been through 16 JCAHO surveys, have QI training, and have reviewed services provided in different facilities. Clinicians are under tremendous pressure lately, but unless a 3rd party looks at all the factors — including the results of how that pressure affects care services, clarity of communication, and basic respect — those who can shape changes in facilities and group practices may not be able to hear what’s needed where.
6
@Stuffster
" those who can shape changes in facilities and group practices may not be able to hear what’s needed where."
Those who can shape changes are administrator/executive types, not clinicians. And they don't really care to listen except when it affects the bottom line.
6
Listen to patients. LISTEN TO PATIENTS. What does it say that medical administrators will lie to their own staff, take up valuable clinical resources, and put non-ill individuals at risk because they think someone being paid for their time is more credible than someone experiencing actual illness? Foucault unpacked all this nonsense for us 75 years ago and we still haven’t changed a thing.
Yes, we healthcare providers all have biases. Yes, too often we have biases against people for no reason other than illness. The beautiful thing about bias is that it can be unlearned. Patients know what they’re talking about. Their subjective experience matters. We don’t always have to give people what they think they want, but if we want to give good care, we have to listen. For twenty years I heard providers complain about “drug seeking” patients. If we had been listening to patients — yes, even these least-likable and least-credible folks “allergic to everything except dilaudid” — we might have caught the opioid epidemic a LOT sooner. If we listened to their pain, we might have a solution by now. Not the solution they might like or that would raise Press Ganey scores (Percocet bowl by the ED, anyone?), but a solution based on what the patient actually needs, not what the providers think they need. It’s past time for everyone in the healthcare machine, from admins to bedside providers, to actually listen to what patients have to say about their experience.
8
@LA
You can listen to patients as much as you want to- but it's not gonna change how hospitals or the business of healthcare is run at all
1
@LA
You could also you know just realize that most people in pain never have any issues with addiction and treat their pain with the many medications at your disposal that effectively manage pain. I have PTSD, actual PTSD, because of undertreated extreme pain from surgeries done by doctors who thought I would be a great case to write up in a medical journal. Little thought was given to the trauma a child would experience from surgeries that provided no benefit and only left pain. Now as an adult who have severe pain I had to go through so much to even get a small dose of pain medication. Fortunately I have a doctor who is willing to prescribe them but for years I did not and I suffered. I spent most days in my room crying and sometimes throwing up from the pain that doctors left me in once I wae no longet interesting to them. Now I have a life and gasp no addiction. Just like almost every other person who is prescribed pain meds for a legitimate medical condition. You already have solutions. Address the root causes of addiction in general (poverty, abuse, social isolation, mental illness) for people with actual addiction issues and provide pain meds to people like me who have medical conditions that will always cause pain and/or have suffered harm from medical professionals leading to life long pain. But that is a lot more expensive than denying pain patients medications that help. And there is no appetite to truly address poverty or mental health.
3
This is an abhorrent breach of medical ethics. We take an oath to do no harm—even IVs have complications. And you think you can force me into unethical practice with this subterfuge??
If it’s unethical for me to give my patient a placebo— it is unethical for my patient to BE A PLACEBO. This is not even gray area!
This is what happens when physicians lose control of healthcare in the country. Administrators without the same oath treat healthcare like a restaurant where customer service is king.
10
@CJ A secret shopper is nothing like a placebo ("a harmless pill, medicine, or procedure prescribed more for the psychological benefit to the patient than for any physiological effect").
The secret shopper is there to collect information from a patient perspective.
I find it disturbing how many (apparent) clinicians are complaining about the practice here in the comments. It makes me wonder what kind of care they provide.
5
So hospital administrators would rather pay a secret shopper and write off expensive and unnecessary supplies instead of simply listening to employees? Ask us; we know what needs to be fixed and how. We're there at the bedside "where rubber meets the road". Here's an idea to start: stop requiring nurses and physicians to spend the majority of our time in front of a computer away from our patients, documenting to regulations instead of to patient needs and outcomes.
Incivility and unprofessionalism has no excuse, but heaping more expectations on staff instead of drilling into WHY they're acting this way only adds fuel to the fires that are obviously burning there.
19
Caveat emptor describes much of our consumer society where monetization and short term gain are the primary motivators. In a society as ignorant as the US, it behooves each individual to become an advocate for themselves. Some are up to the task, most not so much. In a for profit medical system the stakes can be enormous. For that reason alone, a humane and care centered health system is essential as a first go at developing a hybrid society where capitalism is balanced by social programs for people who fare poorly in a dog eat dog scenario that seems to be favored by those who would cement in place the lopsided nature of the current status quo.
3
@Thomas
I stopped reading your comment after I read "In a society as ignorant as the US."
What a ludicrous thing to say.
1
There is a book/movie idea in this.
2
Talk about stating the obvious. Do hospitals really need a consultant for this revelation?
2
These “patients” are taking time and resources away from actual patients. Instead of doctors and nurses being able to spend time helping those who need it, they are spending time on fake symptoms and fake illnesses. Take it from an overworked doctor, don’t waste our time! Someone else is needing me while I’m in a room with an actor. There must be a better way.
12
I don't have an issue with this so to speak. Personally I was a secret shopper for a while in my youth. It's how I got paid meals, beer, and even start up money in casino moneys launching a side career into poker and blackjack games. Sometimes I'd get room and board as a secret shopper for hotels/motels. The rest of the time I house sat. Only wish property guardianships were available in the US... nonetheless I digress.
My only issue really with this is it would be nice if a firm could devise a way to get people who actually need the help into these jobs so to get said help & be paid for it. Perhaps the pay goes down a bit but at the same time the coverage is available. I doubt that's all that difficult, just a bit of creativity and free markets would enable this.
3
This is a horrifying practice. Basing payment on customer satisfaction scores shows a deep misunderstanding of the job people in our healthcare system do. We are not trained to smile and hold your hand. We are professionals. We have college degrees. We have in-depth understandings of the human body and how illness affects it. We witness unspeakable tragedy. We deal with emotional burnout and secondary trauma. I am a nurse and my job is to assess my patients and to advocate for them, and I have saved lives because I take that part of my job seriously. A secret shopper with zero medical background who is not sick is not only wasting resources but contributing to an atmosphere that is increasingly putting smiles and being nice above life saving care. Customer satisfaction surveys led to nurses being told to offer opioids to patients every three hours, whether or not they asked for them. Think about it. I am a nurse and when I am in the hospital, I don’t want my nurse to hold my hand, or smile, or ask me if I need to go potty. I want that nurse who sees that I’m not responding to treatment, gets on the phone and starts calling everyone they can because they know I can get dangerously sicker. When administration puts smiles as the biggest priority, when they disempower nurses and create cultures that value being nice above being competent, people die. We are dealing with lives, not widgets. Any hospital who utilizes secret shoppers should be ashamed as well as avoided.
24
@Sacha
No, this is desperately needed. While you may be a consummate medical professional, other's are not.
In the last two weeks, my mother was given without my knowledge, (I have her Medical Power of Attorney) a high blood pressure drug without my being asked or told ahead of time. I was told two hours later as I was picking her up. This was despite the fact that in her records it was noted that she was NEVER to be given high blood pressure medicine as she has naturally low blood pressure and giving her high blood pressure medicine would cause a reaction where her blood pressure would sink to a dangerous level.
I barely got her inside the door of the lobby of her assisted living facility when she collapsed (less than 45 minutes after we had left the hospital) and 911 was called. Her bp was 88/62 and continuing to fall which triggered her tachycardia. We ended up spending the next 7 hours in the ER as they attempted to stabilize her. The drug also caused massive diarrhea that lasted about six hours.
Mom was hospitalized and three days later after she had gone for a walk which temporarily elevated her blood pressure and pulse, a different doctor tried to bully me into giving her the very same drug that caused the original reaction. This time I was there to say "No". If her symptoms last longer than 20 minutes, give her her regular drug to break it. They continued to push before stomping out angry.
Yes, secret health shoppers ARE needed desperately.
17
@valerie the scenario you describe would never be encountered by a secret shopper. Because as the article describes, they are only able to evaluate how nice people are or whether or not there is blood on the sheets after an IV placement. And that focus removes power from the nurses who would be the professionals asking about why they are giving a blood pressure med that is not indicated on your mom. I’m sorry about your mom, but a non sick patient in a bed does not fix it. It actually could make her in more danger of poor care because the people who are at the bedside are encouraged to put customer service above life saving care. Secret shoppers are evaluating satisfaction, not safety.
6
@Valerie
Your one individual case does not mean that "secret health shoppers ARE needed desperately".
3
Does the public realize that hospital reimbursement is related to patient satisfaction scores rather than medical outcomes?
That is backwards.
As an RN in a hospital, the focus on satisfaction reminds me of hotel ratings. I have been trained and am experienced in assessing and implementing patient care to help prevent medical emergencies, treat illnesses, assess for changes in patient status along with the rest of the medical team. Our goal is to deliver patient care with compassion and competence.
With focus on what patients ( or planted observers) deem as satisfying, is not what our roles should be, in my opinion.
Hospitals are running banks where bottom line is money (reimbursement) not patient care and medical outcomes.
That is a shame.
16
Exactly. I am an MD and I would much rather you treat me according to your training and experience and knowledge. When I am the patient, I am not expecting my nurses and doctors to be my best friends and make me happy. I want the best medical care for me and for my family, not some half-baked illusion of satisfaction.
15
@Sherrod Shiveley — I don’t expect you to be my best friend, but — especially with your knowledge and experience — I expect you to treat me with the courtesy and patience that will most fully elicit an accurate picture of my chief complaint. I expect you to take 5 minutes to explain a procedure clearly enough for my consent to be actually informed, and for me to understand why it’s medically necessary if that wasn’t certain originally. Taking the time to explain surgical complications and any resultant need for additional treatment isn’t ‘friendship.’ If you don’t want to take the time to explain, give me a copy of the operative report. Explaining why a long-standing medication regimen has been changed, other than saying, “so you’re refusing your medication?” or having a pharmacist state ”because it’s not on our formulary, but it’s the same thing” (when, chemically, it is not), is what I expect of nursing and other healthcare professionals — not friends. Reviewing enough of a record — especially after a patient has been transferred from one service to another — before prescribing and treating with a contraindicated, delirium-inducing medication that is clearly listed as problematic for the patient, is not a job for our friends. But it isn’t unreasonable to expect these things of trained medical professionals.
13
Excellent article. Eye opening. But it is encouraging that the secret shoppers can lead to positive changes. And I doubt the volume is secret shoppers affects patient wait times.
4
Please explain the ethics of this to me. Are we really now going to make real patients wait even longer for fake patients to be seen in the emergency departments or busy specialists’ offices?
18
If only “secret shoppers” could be sent into hospitals unbeknownst to the facility. The community hospital whose ER serves the county in which I live is notorious for abysmal patient care. People seeking care for emergent but non-life threatening conditions go to the next county to a hospital where the care is reliably superior.
Some years ago, my mother a stroke victim, fell in her home. It was clear she was hurt badly so she was taken by rescue squad to the community hospital. Shortly after I arrived there, a doctor came out of the examining area and in a very annoyed voice told me that he could not examine her because she would not answer him when questioned. I explained that she’d had a stroke and was aphasic. He asked me what kind of doctor I was, When I told him I was not a doctor he asked how it was that I’d diagnosed that she’d had a stroke. The answer was that she’d had the stroke five years previously. This woman was paralyzed on 50 per cent of her body - she couldn’t move a finger or a toe - and she could not form words, but she did typically try to. Somehow all this got past this guy and took him quickly to rude and heartless. She had a broken hip.
Two years ago my husband suddenly became very ill with a high fever and rigors. The same hospital did one blood test and said it was leukemia. 12 hours & no treatment later I got him to the hospital that diagnosed sepsis and saved his life. We need help.
33
@TeriS
"If only “secret shoppers” could be sent into hospitals unbeknownst to the facility. "
This is exactly what happens in the article if you read it.
2
@Laidback I think TeriS means that it would be nice if secret shoppers evaluated hospitals without hospital administration requesting them (as is implied in the article)
1
@sealow nailed it. Most of us are scurrying around so that a very small percentage of people are making too much profit. Living and working conditions are very difficult for a majority of people. And, too many people can’t make a living wage, access education and health care. All of this is well documented and we need to change the basis of how our economy and hence our jobs, housing and sanity- essentially how we connect and love whether at home or work. Please vote to change the status quo as its not working for most us. The US is set up for a few individuals and not the collective good.
20
As a long time ER and critical care nurse (RN), I've never had a bad "patient satisfaction" review from a patient who was critically ill or injured. They all come from the ones who waited hours in the *Emergency* Dept, for a non-emergency; while we were saving others' lives.
35
@Elizabeth Anheier - I remember the time I was taken to a Seattle hospital after being found on the street passed out from a grand-mal seizure. I was homeless at the time.
I came to with two i.v.s in me and they were pumping me full of Larazapam which makes me quite suicidal. I know because I attempted suicide after being given the stuff. After a while, the doctor came in and said he was going to discharge me. I told him that if he put me on the street I was going to hurt myself. He had security walk me off the property and told me if I came back, I would be arrested. I had a digital recorder with me so I wandered around for 36 hours still in a daze crying and recording my thoughts. I then took all of the pills I could find and ended up in the psyche ward at the same hospital.
I told all of my case managers that if ANYONE ever took me there again, I would sue them. I won't even walk on the same block that major Seattle hospital is on.
I have quite a few stories about the numerous ER visits I have had due to my severe epilepsy. And I have made it abundantly clear to anyone in my life that in the event of a grand-mal seizure or a complex seizure DO NOT take me to the hospital because they simply make things worse. I seriously received better healthcare from homeless meth addicts than I did the doctors. They listened and they spotted seizures a mile away. And they cared.
2
When I worked in the hospital they required every health care worker to take "The Patient Care Experience" in service where you were shown how to interact with patients and to say "Is there anything else I can do for you?" at the end of every interaction. Which prompted me to ask why administrators were not required to attend "The Patient Care Provider Experience"? I was looked at like I had two heads. You want to know why the care is so scary in hospitals. When the people who viewed health care as a calling are shown the door and replaced by people who see it as a job, it might give you a clue as to why things are the way they are. Led by people who sit in front of a computer all day and have absolutely no idea what it is like to take care of the problems a health care worker has to deal with. These 'secret shoppers' don't need to see how the worker interacts with THEM. They need to see what it is like to deal with the 'actual shoppers'. the ones who are confused and trying to get out of bed every 5 minutes. You know the ones who yell at, swear at, strike, and throw their urine at the health care workers. There is a reason there is a shortage of health care workers in America. The job is hard, frustrating, stressful, and impossible to complete with any sense of feeling you have done what you set out to accomplish. And when that is pointed out to administration....they send in help in the form of 'secret shoppers'.
48
I wrote a comment suggesting secret shoppers pretend to be cigarette smokers if they want a real eye-opener on disparate treatment- but the moderator didn’t like it. Perfection required in comments as well as in hospitals. So much for - reality.
12
Too bad secret shoppers can’t experience being woken up every hour in a cancer ward so the drug companies can pump another product into you and bill your insurance company while your health steadily declines from lack of sleep.
12
@Skip Bonbright
Cancer is a terrible disease & a painful death. While the treatments have side effects they also have proven effects on the disease allowing people to longer &/or more comfortable lives. Lack of medication will kill you unlike the lack of sleep. Please realize how lucky you are to live in a time & place where treatment, although not perfect, is at least available.
8
If the managers run hospitals with an eye heavily out for the bottom line, they will individually get their huge bonuses, but departments will always be short-staffed and workers--from doctors to schedulers-- will be chronically overused and exhausted. This does not make for optimal bedside manner. And this is the modus operandi of hospital medicine. Health care should not be a for-profit endeavor And don't forget--if the care is suboptimal or poorly thought out, or workers try to change this order of things , there is an army of well paid and intimidating lawyers backing up every major medical center.
26
Never leave anyone alone in a hospital. Have someone to take notes of when meds were given, when staff checked on the patient, and how much and what info was shared .Be nice to your nurse, the nurses really run the place.
45
@Tom, this is the best advice. My mother, after she retired (she was an RN) did this for relatives and many of her friends, reading the chart and checking the needs and care of the patient. Our medical system expects patients to be alert, energetic, engaged and educated in all aspects of their own care, even when deathly ill or comatose. Her stories about hospital mistakes and indifference would make your hair stand on end. We all need an advocate when going to the hospital.
19
How many opiate addicted secret patients do we get with this approach. When I went in with an appendicitis the ER doctor kept offering me opioids, to shut him up I finally asked for a Tylenol.
Slightly off topic, but ideally, every patient should have a family member or other advocate in the room at all times. I’ve had numerous run-arounds with physicians regarding hand washing (or lack thereof); with nurses deviating from orders and withholding meds; with orderlies trying to make “helpful” suggestions. (“If you drink all the water in that pitcher, Mr. Thompson, you’ll get to go home that much sooner.” What the what?? The man just had both kidneys removed and isn’t scheduled to receive dialysis for at least three days, every single drop being monitored.)
When one is tethered to bed with multiple IVs, monitors and leg compression devices while on pain meds or unable to speak for oneself, no telling what could go on. Our family has a pact to NEVER leave one of us alone in the hospital. Too scary.
28
@Michelle Thompson I was that person for my folks several times in the past decade, totalling about 6 months of full days.
You know what's depressing? I asked so many questions, and received useful quality answers only about 50% of the time. You do too much of that, you annoy the nurses, which is not a good strategy unless you're willing to take it way up the ladder. Even then, the folks up the ladder usually leave by 4pm.
My conclusion is never to go into a hospital. Somebody please convince me otherwise!
16
@Michelle Thompson Best advice I have read. Thank You!
4
Very interesting to read. I think it’s one part of the story wherein the hospital owners are very much interested to find out where they stand in taking care of the patients, so nice indeed. The other part is where hospitals are neck deep in swindling patients by unnecessarily getting all sorts of investigations and operations done on the patients. This story might not be that serious in America but it’s quite normal and scary in the so called super specialities in India.
1
I worked in hospitals for more than 30 years. I’m always amazed when I go to a medical office and an employee invites me to an exam room and doesn’t tell me his/her name and role. If the employee doesn’t introduce himself, I ask - who are you? The preferred answer isn’t “I’m John.” Explain your role before you ask me questions or touch me. So many times staff use titles of doctor and nurse to refer to people with lesser qualifications, like I won’t notice. It’s misleading to refer to a nurse tech as a nurse. I was recently asked if I came to be seen by a doctor. I said yes. A physician asst came to care for me. I don’t mind, but let’s be clear about who is what.
37
I’ve been an RN for 36 years, also with an advanced degree. I focused my career on management. Two years ago I called my supervisor and told her i wasn’t coming back. Why? Patients posting half truths on social media about their care. Hospital administrators siding with a disturbed couple that threatened to kill the nurse in the parking lot. That made the couple feel better but left the nurse on my staff feeling betrayed, at the least. Nurses come and gone with such frequency that it is impossible to build a strong clinical team. Patients being admitted at 10pm via the ED being discharged less than 12 hours later because they had no reason to be hospitalized. That creates tremendous amount of work and talk about the waste of time that could be devoted to sick people ? Why admitted in the first place? Good question. There’s so much more but together with the other reader comments, you get the picture. Yes, we had consultant after consultant hired. Every few years a new one with a great new idea to improve satisfaction. Last Fall i spent 24 hrs in a hospital, not the one where I had worked. The nurses were kind and I didn’t need much attention from the. At discharge, the nurse seemed like a robot. Reviewing everything she was required to cover by administration. Too bad most of it didn’t apply to me. I felt so badly that nursing has been reduced to that.
18
Of note, in a recent study, "....researchers at Penn State and the University at Buffalo found a link between those who regularly faked or amplified positive emotions, like smiling, or suppressed negative emotions — resisting the urge to roll one's eyes, for example — and heavier drinking after work.."
As an RN with extensive Emergency Dept experience, our team was hounded continuously with Press Ganey training, to take all manner of verbal and physical assault from patients, with a big smile and obsequious responses.
I retired in June, early, at 58, with 36 years of nursing experience. Reference the nursing shortage. Saving lots of money not drinking so much.......
38
Did anyone defending this practice read what the hospital enacted as a solution? A training program to make staff smile more and not use their phones in the hallway.
Study after study has shown the medical team is facing burn out - they cut our support staff, they add more ridiculous EMR charting--charting that is really just to make sure patients are billed down to the Tylenol tablet, it's not about safety - they add class after online training class that we are supposed to complete at work 'when we aren't busy', they cut corners everywhere with cheap supplies the staff waste time trying to problem solve solutions around.
Administration already knows hiring staff would improve patient outcomes - but they'd rather spend money on 'smile training' because in the short term it will cost less.
So please forgive me if I'm slow to answer the call light or brusque when you request a menu, I've got to get those smile training computer modules finished between caring for you, answering phones, chasing down missing supplies, coordinating care between interdisciplinary teams, and trying to keep my other patients alive for the rest of my shift.
73
What you say is true. But there has to be a way to see what patients see and I think secret shoppers are a good tool. But if administrators fail to enact concrete improvements to help staff and patients, you’re right. The tool then is wasted.
9
@NICU nurse
I don't really care why you are slow to answer the call light. I care that you don't seem to care that you are leaving vulnerable patients unattended. And during my multiple hospital stays as a child and teen, usually the nurses were chatting not doing any sort of courses. While they chatted about their lives my roomate cried and cried, waiting for someone to help her to the bathroom because no one would answer the call button. They would let her pee the bed and wait almost an hour to come, get angry with her, and change the sheets. Her parents were too poor to take time off of work so could only visit in the evenings. Eventually my mom essentially took over her care. Once my mom started advocating the nurses started coming in. They only provided care to kids who had parents who knew how to speak up. The rest were left in pain and filth. That's not okay for any reason. One time and one time only my mom left me alone for half an hour. She came back to me fending off a technician who was trying to do a procedure meant for another patient on me. Most parents can't be with their kids 24/7 in hospital. That is a terrifying prospect considering how many nurses act.
2
Surprising how many people are defensive on this topic. What are they defending, that it's better to protect the right to treat people poorly, above all? Mind-boggling that people can even read and are subscribed to this paper. We are hopeless as a nation if Americans, not just Trumpsters and Fox viewers, can't act like adults and act responsibility.
14
Maybe it’s because a nurses job is not to smile and be your buddy but to assess, advocate for you and sometimes save your life. Give me a gruff competent RN any day instead of a nice one who doesn’t know the job.
5
@Sacha
"Give me a gruff competent RN any day instead of a nice one who doesn’t know the job."
Me too
1
@Alexia Thank you for stating the obvious. Courteousness/civility and competence are NOT either-or propositions. Even for those in the "healing" profession.
4
I’m so glad this is happening. I’ve had so many experiences with doctors who were dismissive, smug, who wouldn’t let me finish or wouldn’t really listen to what I’ve as saying, who cut me off to finish my question with something like, “I don’t know if you have cancer” which isn’t AT ALL what I was going to ask and thus struck absolute terror in my heart ... so many terrible, terrible experiences that are painful even just to recount in this comment.
21
Secret shoppers...I guess you need them if you don't take patient complaints/feedback seriously.
19
Why can't we just order good health from Amazon? They sell everything else.
13
@Raven
Cheaper and delivered faster.
5
As a floor nurse and therefore the face of the institution, I am so glad that management is finally forced to open its eyes to what we - the nurses - already know. Management claims to be interested but seldom actually is. There is an endless supply of lip service.
Patient-to-nurse ratios that are too high, not enough assistance or support, and cheap supplies make it very difficult to keep a positive appearance. The unannounced and unexplained tests and procedures that patients are shuffled through are disconcerting for even the healthiest of them.
Institutionalized care in this country is rotten to its core. High time we put the responsibility where it belongs - at the top.
53
Go to any hospital parking lot on Monday morning, then compare it to Sunday morning. Mind you, the patient load stays relatively the same. What does that one simple observation reveal? Hospitals do not have enough direct caregivers, but they do have a ton of non essential, non caregiving employees. Soon robots with perfect empathy will replace direct caregiving, but the parking lot will still be full on Monday morning. Don’t get sick, and have reasonable expectations when you do.
22
Just curious how many of these healthy patients are diagnosed with factitious disorder (what used to be call Munchausen syndrome) where otherwise healthy people feign the symptoms of the illnesses for the sole purpose of getting medical care or malingering where the symptoms are feigned to for some obvious gain such as disability payments.
More than anything, how quickly a psychiatry consult would be obtained would probably be the best indicator of how good the care the hospital provides. If tons of tests are done and the "patient" is discharged without any consideration of the diagnosis of psychiatric disorder, I would consider it to have provided pretty lousy care.
As a physician myself who has also been a hospital patient, I can tell you that the most important thing to me in either role is getting the correct diagnosis. This is infinitely more important than how the nurses greet you.
22
I recently required a major cardiac surgical procedure. Medically, the care I received was superb.
The facility fell short however in a couple of areas.
First, the temperature control in the room was horrible. Upon notifying my caregivers that I was basically a ball of sweat, they lowered the room temperature. After which I was shivering.
I was also encouraged to begin walking once cleared to do so by Physical Therapy.
So I did. The corridors however were so cluttered with equipment for which there was inadequate storage that each time I ventured out of my room I felt like I was navigating an obstacle course.
25
@Leonard Cohen Physical therapists use cones. You had medical equipment. Isn't navigating and balance part of getting back on your feet?
2
@Leonard Cohen. How was their NOISE level? Our family’s recent hospitalizations 93 different facilities in 2 States) have been nightmarish due to staff SCREAMING their social plans and other non -emergency news down the halls and staircases. Hospitals need to bring back QUIET so patients can rest and recover!
4
@Leonard Cohen. How was their NOISE level? Our family’s recent hospitalizations 3 different facilities in 2 States) have been nightmarish due to staff SCREAMING their social plans and other non -emergency news down the halls and staircases. Hospitals need to bring back QUIET so patients can rest and recover!
(That’s 3 facilities, not 93)
1
My first thought is: Why are so many medical professionals so brusque and rude? And then I think they are probably overworked. And that these unrealistic work demands are part of the culture.
Nurses say they prefer to work 3 12-hour shifts per week, so they can have more days off, often for traveling. But is a 12-hour shift best for patients?
Surgery is often scheduled very earlier in the morning. But is that what is best for patients?
And this study, is it really about better care, or is it more about the hospitals status, both in reputation and profits.
18
@Ron Bartlett
It's all about the money. Staffing is cut, patients are sicker (higher acuity), and while being expected to do so much more with less resources, we are forced to smile and skip along happily as we work without breaks, without lunch, without, without.....
Ask any spouse of an ER nurse, what's the first thing we do upon arriving home? Use the bathroom, often for the first time in 12.5 hours.
19
The ultimate is working 6 12-hr days in a row. The employee then has 8 days off without using vacation time. I once asked such a nurse about the quality of her care on the 6th day, she said I really want to work those 6 days in a row. My schedule is what is important.
3
@Ron Bartlett
I prefer early morning surgery because it means I don't have to go hungry so long into the day. I'm not likely to sleep late on the day of surgery anyway.
8
You can’t teach empathy. Or instruct people on how to instantly withhold judgment. It’s sad because this is a place where those skills are most needed. They forget they are working with <> who need help. But time is short, time is money. It is what it is, and in so many cases, it’s not good, it’s almost dangerous and it’s often distracted, inadequate, and unkind.
In a film from the 80s with William Hurt called The Doctor, he was a primadonna surgeon no one really liked (but was good!) and then he got sick and was shocked when he found little empathy especially as he began chemo. He started to work on changing after some <> lessons. Eventually he began training his residents by making them spend a weekend (or week?) as patients in gowns, etc.
Trying to get decent treatment (forget about the horrors of $) can be sickening.
28
Opening this article is like slipping into a moral and ethical black hole, where “customer satisfaction” becomes a thing in a health service to be taken seriously. Does it drive research? Does it enhance practice? Does it help more people receive healthcare? Or do all the McDoctors ensure to offer you (sweep potato) fries with your heart surgery, to keep you happy (price $10,000 per fry. Fries provided by Valeant Pharmaceuticals).
What next, rating them on TripAdvisor? “Elderly relative died, but on the other hand the Nurse looked sad so five stars”. A facile smiley sticking plaster covering the cracks in an otherwise brutal, exploitative and immoral healthcare system. Why people accept this and continue to elect politicians who tell you through their crocodile smile that this system is in your best interests, I don’t know.
19
@Mat
What system are you talking about Mat? -it's not clear, for one thing hospitals and physicians are rated on the internet.
2
@Mat if you read the article you will see that patient satisfaction has a positive impact on at least 2 of the three areas you’re concerned about: it increases a person’s ability to access health care and it improves practice. How many unnecessary doctor visits could be avoided if a doctor actually takes time to listen to a patient? If a patient feels they are not getting the care they need, they go elsewhere, which increases costs for everyone
13
@Mat
One is sure you must have a point... the problem is locating it.
2
Try getting an RN (in an outpatient unit with no aides) to help your elderly relative in the bathroom!
7
RN not required for this, and an expansion of those employed as aides needs to happen to supply these necessary hospital services.
20
@Joan Carroll
Sadly, my friend, the hospital does not get paid to take someone to the bathroom. They get paid when said RN charts minutiae in the EMR; click, click, click...... That's what RNs are doing in healthcare today. We get hounded daily to chart everything, even things we didn't do..... all in the effort to satisfy govt regulators, and to get paid.
14
Why not have surveillance cameras all over the Hospital like they do at 7/11 ? Then we could catch these nurses , doctors , social workers and the rest of the hospital staff at work?
Anyone and everyone who has been in a hospital will tell you that they have been giving the wrong meds, rang the call bell and had to wait at least half an hour for a nasty nurse who told them how busy she was when she got there and so on. That is the minor stuff! It is so much worse.! If you complain the nurse will tell you as one did to me “if you don’t like it you can leave.” I really would have too but I was in an ICU with a blocked artery in my heart and could barely move. Yet I found the strength to say” I would if I could” while I was hooked up to monitors and IV’s. I could go on. Many times I wish I had video tape shot with a hidden cell phone. The compassion is gone in health care and that is a shame- compassion for the sick and the elderly is the hallmark of a great civilization.
32
@old lady cook Amen.
6
@old lady cook
Hospitals are overworking their spread too thin nurses
23
@bj That's still no excuse for utter rudeness!
3
A recent bad accident led to two bouts of hospitalization at a facility known for excellent care. Nurses and aides openly showed dissatisfaction with their jobs and the tension between employees was palpable. A few could not mask the resentment they felt at even having to enter a room to provide care. While there, I learned that many of the workers are not permanently employed by the hospital and must piece together a living by working in multiple places. They face long hours, unpredictable schedules, low pay and few benefits. Hospitals would do well to consider how their treatment of employees factors into the standard of care they hope to deliver.
133
Yup. Poor staff to patient ratios cause much dissatisfaction. You can't squeeze the staff endlessly and have top notch care. Staff resentments of administration and work environment will "leak" through to patient care. Doctors are being squeezed too and terrible EMRs are often a major factor. Endless clicking at a computer does NOT equal patient care. We were always told "if it wasn't documented it wasn't done" but EMRs make documenting paramount regardless of what was actually done.
37
@sealow And yet, with such unhappy stressed nurses and aides, the hospital was "known for excellent care"?
You ask "how their treatment of employees factors into the standard of care they hope to deliver." Evidently these poorly treated employees delivered "excellent care", as the hospital was "known for".
@sealow not surprised, many nurses are actually contract employees and do not work for the hospital but for a contract house. Having been a contractor in the aerospace industry, there is no loyalty to be found from or by the place you are working. They can dump you without cause at anytime without any repercussions, and you can leave at a moment’s notice. The life of a contractor, no benefits, no love for your employers.
4
Comments like "Laidback" below that cynically state this is all about scores and not about satisfaction (scores are one way of measuring satisfaction) are missing the point. I salute folks like Mr. Peterson and others who, clearly despite having other metrics that are profitable for their hospitals, want to go further and improve. What happens when we stop worrying about how a patient feels? I lost my young child to cancer and will tell you: after going to many hospitals across the world, it was those who cared about the "patient experience" that I consider the best providers. Yes, outcomes matter - this is obvious. But assuming you have the best technology, providers and tools, then what? Human beings want to be seen, humanized, understood, loved. And for anyone who doesn't understand - it's not "patient satisfaction" scores that give administrators bonuses - bonuses are based on profits which are driven by two things: 1) procedures and 2) cost. I'm encouraged by this article and by the fact there are still hospital administrators who care about how patients are treated. I'm discouraged by folks who ignorantly dismiss these efforts as being suspect and greedy.
34
@Atis Amar I tried to explain in a long post on strictly medical issues I have talked to hosp people about--which never posted--that my letters are taken seriously by the admins of the Banner system out here in Phoenix--they even set up some conference calls with the kitchen re my thoughts on 24-hr ordering instead of "trays" (Laidback's favorite) and on gown sizes (another one mocked by this poster). I don't separate medical issues from satisfaction issues--if I died or almost did (as has happened) due to iffy treatment, I am not satsfied...see what I mean? I do not feel entitled to be in a resort of whatever I have been accused of here. If I thought a hosp were a resort, I would want many more mai tais.
7
@Atis Amar
So you think that administrator salaries/bonuses etc are unrelated to patient satisfaction scores?!? Really??
You don't think that the whole point of the patient satisfaction movement is to keep the hospital full, to court the patients with the best insurance, and to have your hospital be a "center of excellence" (or some other such nonsense) so that patients travel there from all over? So that profit can be maximized?!?
You really believe that the whole patient satisfaction movement is driven by empathic, well-meaning administrators who care about how the patient feels??
And I am the one who is missing the point?!?!
3
The subtitle of this article is:
"Secret shoppers pretend to be sick to help make hospitals safer for everyone else"
Is the article about making hospitals safer? No. It's about improving "patient satisfaction scores"
Randy Peterson, a healthcare executive type, had a hospital that got high marks on clinical quality metrics. In other words, it provided high quality medical care. But is this what mattered? No. Patient "satisfaction scores" were focused on, and that's what this article is about.
Let's stop pretending that this is about patient safety or clinical quality. It's about improving patient "satisfaction scores", to increase profitability, to increase salary/bonuses for administrator types like Randy Peterson.
And that's the truth. Welcome to healthcare 2019.
51
@Laidback
This is one of the reasons why US hospitals have double the administrative costs of European hospitals, yet no difference in outcomes. Let's concentrate more on patients and less on "consumers."
27
@Laidback
Good point. Nothing in the article about what they would have done if the patient was complaining of pain and asking for opioids.
3
@Steve Evidently shovel'em in. See this comment:
https://nyti.ms/2Z9pH4A#permid=101594976
So much of our healthcare system is broken. I have to believe that most people enter healthcare careers because they want to help people. Unfortunately there are so many things, all instituted with the best of patient care/safety/satisfaction intentions, that get in the way of basic human interconnectedness and empathy. Certainly, it is important to get the patient perspective but what these secret shoppers may not see is the employee and staff struggle to give good care in sometimes Kafkaesque environments and the moral distress that causes for nurses and other clinical staff.
26
@GeriMD
So much about our healthcare system is great
2
You are absolutely correct about hospital environs being kafkaesque but sold as a spa-like experience. I’m a nurse and my profession is the catch-all of the Magnet hospital I work at. (Not that the MDs have it much easier...I see lots of burnout in their ranks too.) The hospital recruit engaged new RNs but everyone burns out by their 2nd and 3rd year. Hospital administration focus is solely on expansion and setting lofty, utopian goals for delivery of care but no support or interest in the execution. What then happens at the bedside is that patients are frustrated and angry with unmet expectations (largely set by expensive, high-tech guides and catalogue-like welcome packet)and staff who are frustrated, demoralized, and exhausted. Yet somehow in all this chaos, healthcare workers manage to deliver good clinical outcomes. Healthcare can’t be solely based on experience and comfort. Accessing your vein may sometimes be messy and painful, to not imagine that such a thing won’t happen and that the person who performs the procedure may be having an off day at a workplace that offers her no support is just not relalistic. And I’m not saying that it’s correct to ignore you, but I am saying that a patient who doesn’t have a realistic understanding of her careproviders will always be disatisfied customer. The system needs to change and patients need to demand & back laws that will force hospital administrations to support their labor force.
29
@Joe RN
Well said, my fellow RN. Well said.
7
Administrators are so far disconnected to actual patient care that they don’t understand the issues. When you have too many patients and too much work to do you don’t have time to socialize with your patient. You don’t have time to get together with the team. You check your phone for messages in the hallway when something comes up. Stable, low acuity patients get upset when a non-critical issue isn’t dealt with like a decompensating, critically ill patient. Don’t forget the crushing documentation requirements of endless box ticking for billing purposes. Frustrating that issues causing lack of empathy aren’t changed, but made worse by making work more difficult to get done.
54
@Alex Stable, low acuity patients get upset when a non-critical issue isn’t dealt with like a decompensating, critically ill patient. That is kind of a broad generalization...Supposedly "low acuity" patients who are seized with explosive diarrhea and who also cannot get up alone also appreciate a quick response...
10
@StarLawrence
Thank you for proving Alex’s point exactly.
11
@StarLawrence
Apparently you missed the part where delay in your care was due to "decompensating, critically ill patient". That means "about to die if not attended to". It's sad and unfortunate, but administration staffs for numbers, not acuity, therefore your diarrhea loses out to the life and death situation. NOT THE STAFF'S FAULT.
11
Doctors look at their phones in the hallways because they are receiving messages about patients from their co-workers throughout the day. Telling them to “keep [their] eyes up” and off their phones indicates a level of obliviousness regarding the demands of a physician’s job that I (respectfully) request to see some proof that Mr. Peterson knows any doctors.
38
A lot of people, of all positions in a hospital, use their phones to alleviate moments of boredom.
6
If done with the right motives, i.e., improving quality of care, this sort of secret shopper seems to be a no-brainer. Where do I apply? As an older woman, I could be very useful. Seniors are often treated as though they are invisible in ERs and other healthcare facilities. I saw this when I accompanied an older but very savvy friend to the ER more than once when she was ill.
17
@Barbara Agree, Barbara. I took care of my mother for 18 yrs (memory)--We were ignored up t 13 hrs in the ER on occasion. An older person, esp, needs someone to run inteference...and even then, they can be ignored...
15
@StarLawrence
I really don't mean to sound uncaring, but if your Mom survived being "ignored" in the Emergency (!) Department for 13 hours, maybe it wasn't an emergency after all?
8
Why are hospital administrators paying people to gaslight their employees? Just so these administrators can turn around and say "got cha!" to the medical and nursing staff when they are caught misbehaving?
Also, why are we asking "why are hospital employees are frequently short-tempered"? We know the answer. Hospitals are under-funded, stressful, emotionally draining environments where the staff works long, long hours; frequently without meal or bathroom breaks. This makes employees cranky.
Hospital administrators should be asking "how can we improve the working conditions for our staff so that they are happier in the work place?” And directing resources towards their suggestions.
63
@Elizabeth B.
"Hospital administrators should be asking "how can we improve the working conditions for our staff so that they are happier in the work place?”
This does not happen in any profit-driven workplace anywhere. Workers are expendable. Money matters.
8
Why don't hospitals just interview real patients about their experiences. A skilled and compassionate interviewer could get the feedback just the same. I have complained and written letters to administration about hospital experiences, both my own and relatives'....they are probably ignored. Sometimes I wished I were getting paid for my feedback, as it does take some time and effort to formulate comments.
Most people probably don't bother. The most obvious blatant issue is shortage of nurses, creating long stretches when patient is alone and staff takes forever to respond to call bell. The overworked nurses on long shifts are very cranky, and seem to spend most of their time entering data into hallway computers on stands. The TV ads for these hospitals tout specialized care in a high tech setting, but the real experience is not compassionate...My experience is that the doctors do a surgery or procedure and then patient is taken to their room and basically ignored except for minimal checks of vital signs.
69
@Janet When I was given 4 times the correct dose of a medication, the administrator of a hospital said it didn't concern him. The supervising physician said his intern said it was my fault. I didn't the error. They did. With some medications, such an error would have killed me.
19
This is comically unethical. Fake patients potentially prevent physicians from providing effective care to other patients on a unit and widen nursing ratios.
This does not touch the fact that patient satisfaction is becoming more important than actual patient care. The system now incentivizes doctors to do what the patient wants instead of what is safe and evidence-based.
42
Seriously???
#1: There is nothing funny about Ethics.
#2: This undercover activity was done at the authorization of hospital administration for the specific purpose of identifying weaknesses in the delivery of an excellent patient experience. Consider it another form of internal audit.
#3: Ever heard of Patient Rights?? If actual patient care does not match optimum patient satisfaction, that provider is NOT communicating appropriately and sufficiently with that respective patient.
As a nurse for more than 50 years, I've seen those communication gaps occur too many times. And as a patient in the Emergency Room in the last 60 days, I found it actually getting worse. So sad . . .
46
@Nurse Barbara
"If actual patient care does not match optimum patient satisfaction, that provider is NOT communicating appropriately and sufficiently with that respective patient. "
What a ridiculous comment. Read the other comments- people complaining about hospital menus and gowns etc. THAT is what they are complaining about, not their medical care. Do menus and gowns have anything to do with "actual patient care"?!?
No.
21
@Russell Johnston
100% agreed with second part of your comment. "Patient satisfaction" has now trumped proper medical care in terms of importance- patients magically know if a doctor is a "good doctor" or not. It's a joke.
14
When I had my gallbladder out in 2003 I wrote a six page letter detailing what was done incorrectly, not done, and what really made me angry. Having worked in a medical laboratory for twenty two years, as both a phlebotomist then as a supervisor to phlebotomists, I feel 100% qualified in pointing out when someone neglects to identify themselves, to wash their hands, to pay strict attention while labeling my specimens, and then doesn't wear INTACT gloves during my blood drawing. I've seen employees touch specimens, taking blood tubes out of a centrifuge without wearing gloves, then come over to me and start to do a 12 lead pre-op ECG. Nope, you're not touching me and I want to talk to you supervisor NOW! Speak up when you see someone do something egregious; your life depends on it! So do the lives of others.
When people ask me why I no longer work in the medical field they get an earful. I would write a book but I don't think everyone would believe some of the events I've seen.
52
I’ve also noticed that doctors and nurses and medical technicians do not wash their hands
3
I usually use the pump in the hallway before entering the rooms. If you think your care provider hasn’t washed their hands, do you speak up and ask?
2
I overheard a guy in ER, easy since there with my father 24+ h behind curtains waiting for a bed--being introduced to a janitor who was to be his Spanish translator, and the MD related med info to him through janitor. Rapidly, patient couldn't get in a word.
After they left, the guy was on his cellphone, speaking English perfectly well, telling a friend "You won't believe what just happened here!"
Northern Virginia c. 2005; I hope they have improved on this, must have. And it seemed the guy did understand Spanish, but still.
8
@Ivy
How is this story relevant at all?!? Is this supposed to be a negative comment about the doctor, as if he somehow should magically know that the guy spoke English??
3
The hospital or physician is supposed to call in a certified translator. The hospitals have agencies on call for that They're not supposed to be using the janitor. And the quality of the interview is supposed to be as good as that with an English speaking person.
8
Really????
So a Secret Shopper is taking up space in a bed when someone is waiting in an ER hallway for a bed who is actually ill?
They get attention from a nurse who could be caring for legitimate patients???
There are other ways to gauge patient satisfaction.
A “ fake “ patient sucking up time and resources is the takes time away from legitimate patients, and from already tight staffing.
33
About time. I had Human Resources peers from other hospitals come to mine, & I went to theirs, ONLY to walk the halls as if visitors to the organization. It allowed hr friends to give specific feedback in how the staff perform around the buildings. We all learned a lot. Glad to see this process. Folks forget in day to day workplaces, how the business looks from the other side.
This is an informative article.
23
@Sarah B. HR Leader
As if an "HR Leader" is in any way qualified to evaluate how healthcare professionals "perform"
22
It's about time that hospitals embrace mystery shopping to assess the patient experience. In spite of the fact that hospitals began measuring patients’ perception of their care in 2008; although there are financial incentives tied to patient experience performance; and the patient experience Star Ratings can have competitive implications, most hospitals are still reluctant to embrace mystery shopping. Perhaps this reluctance is due to the fact that mystery shopping is challenging to execute successfully in a hospital ER, OP facility, and particularly in a hospital inpatient unit. While most experienced mystery shopping companies can conduct inquiry and scheduling calls with relative ease, there aren’t many companies yet that have the background and experience to conduct these more complicated visits successfully. Perhaps, equally importantly, as other commentators have mentioned, the process and benefits of hospital mystery shopping are poorly understood -- or misunderstood. Objections are legion--real & self serving--It’s unethical, takes time away from real patients, patient risks, a waste of time, waste of money, it's spying, etc. We’ve been doing hospital mystery shopping for over 20 years and have heard them all. But it’s time for more hospitals to embrace a tool that provides useful, sometimes otherwise unobtainable information that may uncover the source of puzzling or seemingly intractable experience problems and even uncover unrecognized care issues, as well.
14
And it's time that hospital administrators understand the root causes of the negative behaviors amongst the staff. Industry leaders--in any industry--know that if your staff aren't content and well cared for, patient or customer satisfaction will suffer. Admonitions to smile more and look up amount to a short-term fix. Administrators must address staff care, and really balance the needs of the caregivers--proper staffing, more than 11 minutes to see each patient, adequate breaks, recognition of excellent clinical care--with an organization's desire to expand and increase it's coffers.
9
This is so typical of healthcare in 2019. It's all about patient satisfaction scores. So ridiculous.
18
No, it is all about money.
18
@Laidback
So I suppose Patient Rights are pretty ridiculous also???
And what about compassion? And caring?
If you are a healthcare provider, I recommend you seriously consider exploring the many fields of research.
11
@Nurse Barbara
Compassion and caring are important. As a nurse I am sure that you consider yourself an expert in such things.
They aren't as important as proper medical care
They are extremely subjective and having a patient "rate" their hospital stay based on how compassionate they felt everyone was is ludicrous.
I have no doubt that you belong to the nursing camp who considers themselves the compassionate protector of the patients from the uncaring greedy doctors.
7
What a great idea!
13
Individuals with a mental illness are sometimes not assessed with the same care and diligence as individuals without a mental illness component when seeking help for a physical health issue. On an occasion an ER physician even used hand gestures in a derogatory manner. Could the ‘excuse’ be overworked, uneducated or biased towards ‘those not like them’? Education is needed.
12
Brave souls!
This is incredibly useful -- if hospitals take them seriously.
It's a big help for hospital staff who do care and are faced with recalcitrant administration and antagonistic coworkers, and the simply apathetic.
Having been a tester on a project looking into discrimination in rentals - - I take my hat off to these folks. Allowing yourself to spend unnecessary time in a hospital, including needle sticks, IVS etc -- does present an actual danger of infection.
Absolutely correct that "hospital leaders" review information presented as data - - but never do the walk around - because they really only seek confirmation of their biases. Data is very important - - but easily twisted. ( Those patient surveys are often - as all polls tend to be
worded to elicit a particular response). And for those who stay far removed from hands on work, it is too easy to ignore the human side of what you are allegedly measuring.
14
I'm very glad that this is going on to overall improve all hospital care. It will make nurses/doctors be more careful and make them always want to work together and improve the quality of their work. However, I also would like to know the statistics for if the secret shoppers who were minorities got treated better or worse by the hospital workers. This would show if the people working at the hospital were biased towards specific groups or not. However, overall this was a very interesting topic to write about and am looking forward to next week!
14
I wonder if hosp personnel will start treating all patients like they are ringers. I write an after-action report to the hosp after every hospitalization...Off the top of my head, several things I remember saying are: Lose those giant laminated menus and the need to find the phone and call the kitchen and order food--many times I never bothered and did not have the energy to heal...Or make hospitalists talk to patients instead of staring into computers or even running around corners to avoid family members with questions...Do not turn on overhead lights at night...If you must draw blood at night at your convenience, don't talk and rouse the patient...Answer call buttons in some reasonable time frame...Sweep the floors once in a while. Wash hands--the patient can see if you don't...Don't put in IVs in an arm crook or someplace where they trigger alarms again and again...Have a range of sizes of gowns--not tiny and gigantic. If the patients asks what a medication is--explain--and do not, as in your example, get snippy and say "Doctor knows best." Don't put people in misc wards (dump wards) to warehouse them. There are probably many more...I am glad they have these people going in...but they should not get extra x-rays...esp the beloved CT scan, which is very high in radiation.
67
@StarLawrence
The arm crook! Yes! No!
5
@annieb3 I once had a nurse up on the ward after I was admitted tell me the ER does the arm crook thing, but they do not...Why? Often the patient has to live with the alarms for days from this.
8
@StarLawrence ER nurses are very busy and
a lot of folks get IV insertions, so the quickest and easiest vein is the arm crook. It's in lickety split and on to next patient.
7
These secret shoppers expose themselves to much greater risks than blood draws and IVs. How about hospital-acquired antibiotic resistant infections, such as C. difficile, for starters?
46
@A Reader It's mostly the immune-compromised and
elderly who are at risk for Hospital-acquired infections.
It's usually that population that also may have an operation. It's not very likely that a healthy individual,
there for, at very most, three days would acquire that
sort of infection.
8
@Gloria Utopia
"It's not very likely that a healthy individual,
there for, at very most, three days would acquire that sort of infection."
Did A Reader say that is was likely??
No, he said there is a risk, which there is.
3
It wouldn't happen. How would the "secret shopper" get C. diff if he or she is not on long-term antibiotics--which would actually mean that he or she is a real patient, under real treatment? Also, hospital-acquired infections increase with the length of stay--one reason hospitals are eager to send you home ASAP. IT was my understanding that the secret shopper is not admitted for a prolonged period of time.
1
I think they should only use secret shoppers who are minorities.
As someone who is Black and transgender, I’d say from my own personal experience that the way marginalized people and minorities are treated is especially indicative of a hospital’s culture and sometimes it flies under the radar.
If you’re trying to see what the hospital experience is really like from a patient’s point of view, you should start with the most marginalized patients.
134
5 years ago I was an emergency department nurse working at a hospital that had this firm (etch) do an undercover patient experience. It opened everyone's eyes in leadership to what most of us in the unit already knew. It was the beginning of a series of changes our hospital instituted that made it a much better place for everyone, not just the patients, but employees as well. As a nurse, it was one of the most empowering experiences of my career. We never felt betrayed or as though resources were wasted on a "fake patient." We saw it as validating to what brought most of us to want to work in health care to begin with. We went from not knowing a thing about "patient centered culture" to making it our reason for being. Everyone benefits when a hospital cares about feelings and experiences.
165
@Patricia Dias, NP
You said most of you on the unit knew what was going on. So we need overpriced consultants to communicate that to leadership? Why do they not listen to you if you guys already knew?
30
Because until an official study is conducted, secret or not, it's basically anecdotal information, likely compounded with gossip and hearsay.
39
@hello Ignoring the worker bees is typical in any organization, but “leadership” is more likely to listen to pricey consultants if for no other reason than to justify spending all that money.
43
As a physician and researcher for over 25 years, I can attest to the impact of this type of research. There is great value to qualitative research, which seeks to understand the impact of not just what we do, but how we do it.
If more institutions undertook this type of self-examination, I can promise you, we'd be in a much better place with hospital cultures where folks wanted to work, instead of factories of procedures and profits-wagging-the-dog loss of vision and purpose.
Sometimes it takes an outside party who is solely interested in how the experience FEELS to break us out of our inertia. Just look at some of the cynical comments below and you'll see clearly the problem: The goal is happier patients AND quality medical care. How can we, as health care providers, possibly split this as "either/or" (either you're emotionally taken care of or you're fixed, you can't be both!)?
This split sadly reinforces our over-specialized, myopic focus on simply treating the disease, not the human being having a (more often than not) terrifying experience. This short-sightedness affects the employees too, believe me. If we don't care about how a patient feels, I can promise you, we don't care about the nurse or doctor either.
I see patient secret shopping as an important data point. It forces dialogue that is woefully missing without it. I tip my hat to hospitals innovative and bold enough to want to know and who take the risk to know it.
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@T. Merton MD Phd
Thank you, Thank you, Thank you.
Your beautifully written response is compassionate and caring. It brings us back to the Patient - the reason we are there in the first place!!!
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I have spent my entire career in hospitals and the narrative of this article is spot on. The root cause however is multi-faceted as is the solution. But I can tell you that it starts at the top...For profit hospital systems bring in wet behind the ears MBAs to run their hospitals; execs eliminate support staff requiring professional staff to take on time-consuming chores that move them away from the bedside; facilities are organized by depts rather than functions; CFOs use productivity metrics to evaluate 'performance' rather than patient care outcomes; and MBWA - that old management strategy created to listen to staff members and respond to ideas or problems voiced - has vanished. Unethical...my foot. Just let one doctor walk into a hospital as a 'mystery' patient and watch how quickly s/he will change their mind (read Atul Gawande, On Being Mortal).
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@Stefani Daniels
This is 100% accurate.
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@Laidback So if the patient is a physician, it's a different story from an average old sick person?
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@StarLawrence If you are hospitalized and have constructive observations, I strongly suggest you request your hospital record (you can get it under HIPAA) and then write Patient Relations or the director of the hospital. Those recorded phone calls you get after discharge are not adequate to make useful comments.
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This article has a lot to unpack.
1) Checking on how easy it is to make appointments and evaluating call hold times is one thing, but going to an ER and getting IV's and X-rays? This is most unethical. If a patient is worried about some blood on their arm, there are bigger fish to fry. These people are taking valuable resources in understaffed ER's away from real patients.
2) If there was a complication from the IV or a missed lung mass on the chest X-ray on one of these "secret shoppers", you had better believe the doctor would be held liable for the error. I would bet the "secret shopper" wouldn't say, well don't worry about it. They would be first in line to sue.
3) The secret shopper mentioned is a sociologist? Why not someone with actual medical training? Too many people with no medical knowledge weighing in. We have sacrificed many years for medical training. Patients and medical staff deserve better than evaluations from non-medical administrators and sociologists.
4) There are too many administrators in medicine who are removed from patient care or never even delivered patient care. The are happy to spend $$ on these consultants who are more than happy to collect the money and take it away from patient care resources. I rarely see them on the hospital floors....
5) More satisfied patients in the hospital often have lesser medical outcomes and more unnecessary tests. Is the goal happy patients or quality medical care?
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@MD, MS
Reference for your point #5. Higher patient satisfaction associated with higher mortality. Literally, more satisfied patients are more likely to die.
Fenton JJ et al. The cost of satisfaction: A National Study of Patient Satisfaction, Health Care Utilization, Expenditures, and Mortality. JAMA Int Med. 2012;172(5):405-411
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1108766
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@MD, MS
The point of having Secret Shoppers is for Medical Professionals (like you), understand the perspective and challenges that the patient holds and experiences. It isn't about having a person with medical training evaluate you. Maybe you should try being a patient yourself - get admitted as a "nobody"and see how frustrating and scary it can be.
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@Andrew P : I work for a hospital system, and I and my extended family are patients of the same system. The level of care and solicitation that we receive now, since they know me and mine, is much different than the treatment that I received before I worked here. I was so "unsatisfied" one time, pre-employment, that I checked myself out AMA before said hospital managed to make me even sicker, went to my own doctor, was correctly diagnosed and treated and recovered nicely at home. Actually listening to me instead of following SOP would have prevented that incident, but I didn't want to any more chances at that point.
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I have worked in healthcare for 30+ years and found the use of mystery shopping to be very powerful to move people to take action. When the feedback is from patients or shoppers going through a patient experience, hospital operations can't ignore the need for change. I have used the Baird Group for hospital, physician practice and ambulatory settings with great impact on the patient experience.
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This is a fascinating case report of what troubles current US healthcare.
First, at the top there's a very brief sentence that administrators were concerned that patient satisfaction scores were average when clinical outcomes were better than average. So Americans are not satisfied with good care. Think about what that in itself means.
Second, the solution to unhappy staff grumbling about other departments are being curt with patients was not to improve staff conditions, but enforce a no phone while walking the halls demand and force smiles. Those grumbles are most likely secondary to burnout from conditions forced upon physicians and providers (70% of physicians report burnout). So more requirements are heaped on. Do we really think that's going to improve the already bad staff morale?
Finally, we're now at a point that we're putting actual patients at risk in the name of satisfaction. And I say "satisfaction" because that was the problem at the example facility, not clinical outcomes. Yet, actually sick people waiting in that ER had to wait longer for the physician and nurses and techs to address the secret shopper. There are definitely ethical concerns with the invasive tests for the secret shopper, but what about all of the sick people who never signed up for that?
If we're supposed to be data driven, where is the data that secret shoppers improve mortality more than surveys, especially when we know that higher patient satisfaction is associated with higher mortality
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@Andrew P
"First, at the top there's a very brief sentence that administrators were concerned that patient satisfaction scores were average when clinical outcomes were better than average. So Americans are not satisfied with good care. Think about what that in itself means."
This is the most important point of this entire discussion. People are more concerned about their "satisfaction" than the actual medical care they receive. There is no thanks to the doctors who saved your life- instead its complaining about the lighting or the gowns as if they are in a hotel.
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@Laidback Let me get this straight, Laid. I think satisfaction would include being grateful for not dying...wouldn't you? I did thank the trauma surgeon who recently did save my life--your notes are bristling with wrong assumptions, in my opinion. Somewhere else on here I try to explain medical observations I made in writing...You seem to imply that small things like nourishment to keep up energy and promote healing and incessant noises like IV alarms are just the price the patient pays to be treated--no biggie. Well, if you are feeling punk, scared, uncertain, no one is explaining things, little things loom large.
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@Laidback Man, you are really stuck on my gown comment...In a too-large gown, you are kind of velcroed in place in the bed, stuck...In my case, I have arthritic knees and cannot readily wiggle free...Oh, well...say whatever you want. I will do the same.
"Secret shoppers do expose themselves to some risk, such as blood draws, an IV, maybe even an X-ray. They decline more invasive tests and interventions, though, pleading a scheduling conflict or urgent family matter if the risks become too great."
The ethics of this practice are suspect. Most physicians, including myself, take the first tenet of medicine to be "Do no harm." All medical procedures have potential risks and complications. We order and perform these procedures when the benefits outweigh the risks. An IV is not *just an IV* when the patient develops clots within the adjacent veins. An x-ray is not *just an x-ray* when there is an incidental finding that requires dedicated follow up imaging, notwithstanding the principles of appropriate medical imaging and radiation exposure reduction.
I would be horrified to know that a patient had been harmed by myself or one of my ancillary staff, all for the purpose of consumer satisfaction.
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@SimpleCountryRadiologist You make some valid points here. This is precisely why mystery shopping must be done using a methodology that mitigates risk to both the patient and provider. Some firms move from secret shopping in restaurants & hotels one day to healthcare the next. They have no idea what risks exist. When healthcare organizations opt for mystery shopping it's important to seek a firm with an ethical, safe, methodology that has extensive experience in healthcare. This approach offers deep insight into the patient experience while keeping the shopper and provider safe - Including using real names to preserve the doctor/patient relationship should any pathology be detected and in need of follow up.
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@Kristin Baird For that matter, hosps are full of viruses and bugs--those shoppers are exposing themselves to things like MRSA or worse..
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Everyone who enters the medical system should be a secret shopper. Here in Philly the Rothman Institute gives everyone a feedback form. When I had an injury, I found that Rothman quickly responded to feedback. Things were different on the next visit.
I also got a positive reply from PennMed when I wrote a detailed complaint, acknowledging they needed to address those issues.
In contrast, many people detest the ubiquitous TV sets in doctors’ waiting rooms. They are a major source of stress. Yet doctors routinely defend those television sets and receptionists remain surly.
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@PhillyPerson
My first thought too but in the real world, patients can't afford to complain too loudly out of fear there will be retaliation by the clinicians caring them or their family member. Most of us have the same providers and hospitals that we use and depend on. If you complain, you are often labeled as a demanding patient or family member.
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@PhillyPerson YES! - those awful television sets! Make them go away! While waiting with a friend for her eye surgery at a renowned eye hospital, we could not escape the blaring television. Not a soul was looking at it. I asked the receptionist if it could be turned off - there was closed captioning - and he said absolutely not. Why can't we have waiting rooms that allow for quiet conversation and reading (or phone scrolling for those so inclined), with some classical music at most?
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@KC Having had four big eye surgeries, I cam attest that the eye videos are yucko!
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