Best Patient Cared For
With all this talk about patient satisfaction, it's no secret that nurses HATE this topic. The intention of this post is not to bash the patient satisfaction reimbursement conspiracy- but to alternatively come up with a solution that seems very logical and practical, at least to me.
The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys are currently used to partially evaluate patient’s perceptions of nursing care during their hospital stay. There are also HCAHP survey's for outpatient services and ambulatory surgery centers. Patient satisfaction is a popular topic as the healthcare consumer continues to demand increased focus on patient-centered care and transparency of outcomes. The main objective of the HCAHPS survey is to:
- Allow objective comparisons across hospitals for consumers
- Motivate hospitals to improve quality of care
- Increase transparency of care through public reporting of results
The HCAHPS survey certainly has a place in the evaluation of patient-centered care, however the survey often (incorrectly) uses patient satisfaction and quality of care interchangeably. Some studies found inverse relationships between quality and safety metrics and patient satisfaction. There are also reports of worsening complications rates and mortality with increased patient satisfaction.
My point: The problem with evaluating a patient's satisfaction is that it does not accurately assess how well a patient felt cared for.
This idea dawned on me during one particular patient interaction. I was holding a woman's groin to slowly clot her femoral artery, after a sheath was removed from a cardiac cath. This required me to put all of my weight on her, similar to the body mechanics of giving chest compressions. My patient, visibly uncomfortable, yelled out and said "GET THE F*** OFF OF ME!"
In that moment, I knew that if I let up pressure, she would bleed profusely. I leaned over her face, looked her square in the eyes and said sternly "You will thank me one day." Then, I saw her facial expression soften, and she looked back at me and said "You know... you're right."
Now, if she was asked how satisfied she was with her overall hospital experience, the first thing she might say would be along the lines of "Awful! I was in so much pain!" However, if the survey asked her how well she felt cared for... she would most likely give a positive response.
See what I mean? Caring principles are the core of nursing practice, and are strongly supported by evidence-based research. If the HCAHPS Survey has any intention of adequately assessing the nursing care provided, it should be changed to "How well did you feel cared for?"
Revising the survey could help improve the patient’s experience, as well improve nurse-sensitive outcomes, while allowing nurses to maintain the autonomy and integrity of the nursing profession.
Now it's your turn! Do you think the HCAHPS survey should be changed to assess how a patient felt cared for?