With the implementation of value-based purchasing patients are now referred to as customers, bringing about that common belief that the “customer is always right.” Which is ok sometimes, because they are paying, well some of them, for the care they receive. Now with VBP and pay-for-performance, and HCAHPS scores suggesting how much the hospital will receive in compensation, hospitals are training nurses to become, in my opinion more and more like a sales associates working behind the counter of a fast food joint.
“Hello, my name is Klaus and I’ll be your nurse today, I have here medications that can save your life, would you like fries with that?”
Over the past few years I have witnessed nurses enjoy what they do and feel pride in their work, to now become miserable. This is due to the fact, again, in my opinion, that hospitals and other healthcare facilities are approaching the entire thing wrong. HCAHPS are a patient’s perception, an untrained, non-clinical, perception of what the care was like. It does not mean that nurses are not working hard, and they must work harder to improve scores. So how can hospitals carry on their financial aspect of the business, and keep their doors open, without taking away the care and compassion aspect of nursing?
Nurses can view HCAHPS as constructive criticism, one that will allow them to know how patients feel about the care they received, and hospitals should not punish the nursing staff when scores drop, but work together to set goals. Unfortunately the need to raise the scores have added unnecessary stress to the patient’s bedside, I have witnessed a nurse of 30 years get written up by managers because a patient complained that (warning: this is not a joke), “the nurse promised me the world, and didn’t deliver.” (But did you die?)
This proves my point that hospitals are approaching this whole thing wrong. The entire HCAHPS was created because organizations that included physicians and nurses (yes! Nurses were part of it!), were concerned about patient care quality, and how subpar it was. The incentive is to reward hospitals with funds based on the quality of care as perceived by the patients, unfortunately hospitals have taken this concept and attempted to create a hotel-feel, with flat screen TVs and room services, thinking that this will improve patient’s perception of care, though researches shows that improved staffing ratios have much greater impact in patient satisfaction and outcomes.
Now mind you, this is not a generalized remark, there are hospitals providing world-class care, that can afford to have all the other amenities as well such as the TVs and even valet parking, but each hospital must assess their capabilities and work with the staff to select priorities in changes. It is possible to have an old school turn dial TV with semi-functional beds, and small cafeteria, and still have great customer service and provide world-class care, the secret? Invest in your staff!
Happy Nurses makes Happy Patients. This is my personal motto. HCAHPS and patient satisfaction should not be the reason a nurse quits his or her job, I read recently that in a recent survey 50% of nurses have contemplated switching professions, to me this is absurd, we should thrive on and seek high HCAHPS. Decent staffing ratios will provide your nurses ample time to educate your patients on the reasoning behind the treatment choices and make them feel at ease, while allowing time to listen to their concerns. I believe there is nothing that can influence HCAHPS more than connecting with your patient in a personal level, and the power of human touch.
Choosing the right nurses to work with you is also a major part of the spectrum. Hiring nurses who are compassionate about providing excellent care, and giving them the opportunity to shine, will improve the culture of your unit and facility. I had a mentor that used to tell me all the time, “you can teach skills, but you can’t teach compassion and care.” Nurses today are very much aware of HCAHPS and the importance of it, bringing on those nurses ready to accept the challenge in providing great care, while advocating for the patients and implementing evidence-based practices should control the outcomes of the patients and survey scores.
The Dude Nurse
Klaus Campos, BSN-RN