I am not a fan of surveys, not even a little bit. For example, if I included a survey at the end of these comments to see how you feel about surveys, nobody would believe the results would impact my opinion about the value of surveys. At best it might suggest that at least I appeared to be interested in what others thought.
These are my issues with trying to shape or modify a business strategy based on the information reported in surveys:
- Most of those being surveyed are no longer your patients or customers. Once a patient is discharged their ID badge changes—it changes from patient to prospective patient.
- Prospective patients do not know what changes you have made based on the survey results you obtained because they are not patients any longer.
- The best results hospitals can hope for by using survey results to drive change, other than trying to avoid CMS penalties, is a campaign that says “although you may not have liked us last time, now that we’ve read your survey responses we think you should give us another shot.”
- Hospitals are not static. Healthcare is not static. Surveys results and Press Ganey data are not current. The value of trying to implement change based on data that is seven months old would be like NASA trying to get to Mars—it takes about seven months—by aiming the rocket at where Mars is today. It will not be in the same position in seven months and neither will the hospital.
- If every hospital is trying to change by doing the same things over and over again using old data, it would seem that the only possible outcome is that their position relative to one another will change. If you are ranked in the 51st percentile and I am ranked in the 49th and we both try to change our scores based on survey data, aren’t we equally likely to have scores that are pretty similar to each other.
Imagine that at HIMSS 2014 CMS holds a reception and one representative from every hospital attends. Along with your drink coupon you are given a dart. At the end of the room is a large cork board, and above the board is a banner titled “The Patient Experience Challenge.”
The CMS representative throws the first dart. The position of your dart as compared to the position of the CMS dart determines whether or not you will be penalized. The fifty percent of the hospitals furthest away lose. Now here is where it gets interesting. Everybody retrieves their dart and we run the contest again. If we did that I am guessing two things would happen:
- On almost everybody’s second throw the dart will end up in a different spot from where it was on their first throw
- Most of the people whose throws were close to the CMS dart will still be those closest to the CMS dart, those whose darts were furthest away will still be furthest away, and many of those who were borderline will exchange places.
It seems there is little merit to scoring better than the 49th percentile. I write that because the goal of what is being contested is to avoid the CMS penalty. If we are being candid we know that raising patient experience scores is not the same thing as raising patient experience. The two tasks require different strategies, focus, and different resources.
The hospital that wins the patient experience battle is the hospital that chooses to do what their competitors and peers are not doing.
Pale Rhino Consulting 
Good points, Paul…and I would add: “Whatever the patient survey companies are charging, it’s too much.”
Besides the results lagging too far behind the time they are received by the healthcare institution (try driving your car by only looking in the rear-view mirror), the use of percentile rankings violates the principles of variation.
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Thank you Wayne.
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Paul, You make some interesting points in your blog. One thing to remember is that hospitals are data-driven organizations. In the absence of data, executives and physicians become less interested in improving the patient experience. When satisfaction data is used as a compass (and not a target) and combined with other input, such as that provided by patient and family advisory committees, if can lead the organization to worthwhile improvement projects. I’m reminded of the old adage, “If you don’t measure it, you can’t manage it.” I believe that eventually HCAPS and CGCAPS will take the place of vendor data, thus saving organizations significant expense.
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Thanks Cindy, I appreciate your remarks. Since all of the hospitals are focused on the data-driven aspects of patient experience, namely HCAHPs, and because my clinical expertise is limited to applying a band-aid, I focus on the nonclinical aspects of patient experience. One of the great things about this approach is it relies on patients and prospective patients instead of doctors, nurses, and data.
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