Patient Satisfaction: Are We Manipulating Numbers?

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Patient satisfaction is a hot topic for healthcare providers. The implementation of using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey as the tool for basing a percentage of Medicare reimbursement has caused much controversy (Centers for Medicare & Medicaid Services, 2015). The HCAHPS survey questions patients about their recent hospital experience and asks about communication with nurses and physicians and the responsiveness of hospital staff. Financial incentives are associated with HCAHPS data. Hospitals impacted by the Inpatient Prospective Payment System (IPPS) must collect and submit HCAHPS data to receive full IPPS annual payment.
Nurses advocate for the patient as the most important factor and strive for the best outcome possible. Despite the best outcome possible, the patient may not be satisfied. What is important for one patient may not hold the same value for another. Satisfaction and perception cannot come before quality and safety. Emotions and perceptions are subjective. What happens when healthcare services and reimbursement are based on fluctuating feelings? In terms of measuring satisfaction, there needs to be discernment between importance, expectations, and satisfaction (Janssen, Ommen, Scheibler, Wirtz, & Pfaff, 2013).
The approach of treating the patient as a consumer may lead to substituting clinical judgment with nursing care influenced by the drive to achieve a high patient satisfaction rating. With a patient, the focus is the healthcare need. With a consumer, the focus is the payment. Although the tasks and surveys for patient satisfaction are important, they should not be the only driving force of nursing care. Nursing includes the virtues of kindness, compassion, empathy, and beneficence, not manipulating patient satisfaction and perception (Geiger, 2012).
What is an appropriate response for a Christian nurse if patient satisfaction ratings are the primary goal? Do nurses and physicians modify their practice to increase patient satisfaction rather than adhere to evidence-based care? Patient satisfaction is a complex concept to measure, due to many variables, such as ill patients who may rely more on their physicians for support relative to other, possibly healthier, patients (Lyu, Wick, Housman, Freischlag, & Makary, 2013). A patient may not be satisfied if he does not get an unnecessary antibiotic or an abused narcotic. Fenton, Jerant, Bertakis, and Franks (2012) reported that one patient satisfier may be linked with prescription drug disbursements. Providers often feel the pressure to practice defensive medicine to satisfy the patient. This type of practice is costly, time-consuming, and enabling. Nurses and ancillary staff also feel the pressure to accommodate unrealistic demands. Nursing focus should be on safe patient care and not be compromised by the pressures of customer service.
The experience of a satisfied and grateful patient is a pleasure and privilege. Many healthcare workers go above and beyond to satisfy their patients. However, when quality and safety are compromised or reimbursement is the goal, this becomes counterproductive. In staying true to the definition of benevolent, a benevolent organization operates for the good of the people served. Although it is desirable to receive monetary bonuses, benevolence may occasionally require forgoing monies to achieve the good of the patient. Hospitals are entitled to full compensation for achieving evidence-based outcomes and measurable quality processes. Patient satisfaction is desired but should not be used to determine payment.
Jesus helped people by giving them what they needed, not necessarily what they wanted. His goal was total health—body, soul, mind, and spirit. Perhaps, his model can help us navigate the muddy waters of patient satisfaction.
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