The Customer is NEVER Right - A Nurse Practitioner's Perspective
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Abolish HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems)

Albert Einstein told the world, “Blind obedience to authority is the greatest enemy of the truth.” That mentioned because despite all the money, time, and effort wasted on “customer experience (formally satisfaction) scores” more money, time, and effort is wasted just to justify wasting that money, time, and effort because no one in healthcare dares to push back.

Healthcare in our nation is in crisis, a silent crisis as so many choose to look away. This silent national crisis is not political although some might disagree. Instead, we only have healthcare’s submissive, altruistic, and accommodating culture to blame. Not only did we follow the herd but we turned over the reins and since outsiders have taken healthcare in the wrong direction with their IDIOTOLOGY [sic] that it is in the patient’s best interest.
A misguided direction, most would say, as overwhelming evidence points out that rating healthcare is NOT good for healthcare or patients. Despite that evidence there are some who insist on making it fit. That is making it fit rather than making it work. Because at this point making it work is beyond attainment.
The latest from that group of enablers a new study, “Association between the Centers for Medicare and Medicaid Services [CMS] hospital star rating and patient outcome” published 10 April 2016 in JAMA Intern Med. (Online).
Somehow, these authors, against their own findings, I must add, that point to a number of reasons as to how the system is flawed, concluded “[t]hese findings should be encouraging for policymakers and consumers; choosing 5-star hospitals does not seem to lead to worse outcomes and in fact may be driving patients to better institutions.”
Are they kidding? Yes, it is very likely that a consumer, rather a patient as the authors chose between the two nouns, would choose a 5-star rated hospital based on the CMS star rating system. But at what cost if your 5-star choice is a rural hospital without an ICU and because of that lack of experience the chosen 5-star hospital has never seen your disease process before your admission? Not my words but the research’s findings. How is that any good for anyone’s healthcare?
It is appalling that despite the overwhelming evidence and the disturbing trail of collateral damage left behind from chasing “customer experience scores” that there are still some who insist on making it fit. When instead the healthcare rating system needs to be abolished. Why do they insist? Simple, contrary to popular belief, “customer experience scores” are NOT about healthcare but solely about customer retention and profits. Not my words either or a suggestion as to some conspiracy theory. But instead ask any healthcare administrator as to who the competition is and they will all share with you that it is those "up the street". Those "up the street" being our treasured colleagues at other institutions trying to help others as well.
To those who disagree that “customer experience scores” are not about healthcare and instead about profits try this simple test. Ask yourselves or any healthcare administrators or pundit to list a single achievement from chasing “customer experience scores”.
The most common reply I have been given is, “That is what they are doing 'up the street' and so will we.” However, on this one, standing in solidarity with colleagues as one unified voice is NOT an achievement but instead blind obedience and an enemy to the truth.
The end point is that the healthcare “customer experience scores” lunacy needs to be abolished. Why? Because since 2005 CMS has been putting out this data of rating healthcare without achievement. And before 2005, it was private consultant companies, like Press Ganey and the likes, all doing the same of rating healthcare without achievement. That being the history many in healthcare are familiar with but that is not the gist of it.
For those who have been watching “patients” morph into “customers and clients” and now into “guest” that dog and pony show goes way back into the 1980s. The 80s being the origin as to when healthcare administrators began to seek a new frontier in healthcare service excellence, and Press Ganey was there then as well. It has been more than 30 years now and in all that time the much sought after so-called healthcare service excellence has yet to be obtained despite all the money, time, and effort invested.
Thus my soul [sic] campaign to abolish the healthcare “customer experience scores” idiocy. Because instead of improving healthcare “customer experience scores” have done nothing for healthcare but foster the culture responsible for the devastating trail of collateral damage left behind for more then 30 years now.
For a moment, lets entertain the idiotology [sic] of seeking a new frontier in healthcare service excellence as healthcare administrators and pundits called it in the 1980s. A frontier that would improve the quality and cost of healthcare they said. Except the quality and cost of healthcare has not improved. Lets take for example preventable medical error deaths, the most infamous quality and cost of healthcare needing improvement and the third highest killer in our nation. If “customer experience scores” were about healthcare one would think preventable medical error deaths would have been reduced significantly at any point in the past 30 years with all the money, time, effort, scripts and signage, valet services, and luxurious lobbies thrown at the problem but not so.
So then not about healthcare as sold to the public. Okay. Well, then, how about improving the experience of being a patient? After all, most seek healthcare during some of the worse moment in our lives and during inconvenient times, for uncertain, unpredictable, and volatile choices in places that are unknown, unpleasant, and unforgiving. Yet, again, despite all the money, time, effort, valet services, luxurious lobbies, scripts and signage, and the all too essential game-changer standard uniforms, just to name a few more, that are thrown at improving the patient’s experience and nothing gained, as the “customer experience scores” needle has not changed either.
If nothing has improved since the 80s with these “customer experience scores” initiatives, why continue to push them? Some will say these initiatives are merely being fine-tuned. How long does it take? It has been more than 30 years and nothing has improved that could be credited to all the money, time, and effort spent on “customer experience scores”. Not to mention, study after study has shown there is NO correlation between rating healthcare and good healthcare, to include this latest attempt. On the contrary, studies have shown the initiatives to improve “customer experience scores” have been harmful to patients with the most satisfied patients not only spending the most on healthcare and prescriptions but they are also the most likely to be admitted and most likely to die. How is that any good for anyone? Yet, despite all that evidence against it the idiotology [sic] of “customer experience scores” continues.
Why? Because these rating systems, whether HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) from CMS or the Press Ganey-likes, are NOT about improving the quality or cost of healthcare but solely about customer, NOT patients, but about customer retention and profits. Not that there is anything wrong with that except that is NOT what is being sold to the public and why a patient picks a 5-star hospital that lacks experience with their disease/illness/injury.
In 2013, the federal government announced a college rating system that would withhold billions of dollars in federal student aid money from low performing colleges. However, in 2015, that college rating system was scrapped after college leaders stood their grounds and pushed back pointing out that the proposed rating system was “misguided”, “clueless”, “wrongheaded”, “oversimplified to the point it actually mislead”, and “prioritized moneymaking”. All of which were predictable in healthcare as well, yet, ignored. And still, despite those concerns have been actualized under HCAHPS they continue to be ignored.
So rather keep trying to make an incomparable idiotology [sic] fit after 30+ years why not abolish it completely? In other words, why not throw in the towel and turn the effort elsewhere, like putting healthcare workers first. I realize it is the ultimate healthcare heresy, to which I risk being excommunicated from healthcare, for me to suggest it is healthcare workers who deserve the credit for the planet’s greatest healthcare system and not the customer or the consumer of that healthcare. However, the current paradigm, patients first, is nothing more than smoke and mirrors. Because if patients were first than preventable medical errors would be where the bulk of the money, time, and effort would be invested rather than on luxurious lobbies and standard uniforms.
Hands down, the best solution to improving the quality and cost of healthcare would be to put healthcare workers first and deflating customer service to no more than a byproduct of an industry genuinely dedicated to helping others. By placing healthcare worker first, NOT in words but with all the money, time, and effort actually invested in them, and everyone and everything else to follow that would be the most efficient and effective system and where the patient would be cared for the best.
To take healthcare back from those who have taken it down the wrong tracks healthcare does NOT need another study trying to make the current failed idiotology [sic] fit. Instead, healthcare needs and would benefit most from a seism paradigm shift that is willing to start by abolishing the 27 questions HCAHPS surveys solicit from patients regarding wait times, pain management, housekeeping, and communication skills as neither affect the quality or cost of healthcare. And instead focus on variables that DIRECTLY affect the quality and cost of healthcare such as outcomes and the safety of healthcare workers and patients. Just my two sense [sic].
Unfortunately, as Mark Twain told us, “It’s easier to fool people than to convince them they have been fooled.”

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