By Rose O. Sherman, EdD, RN, NEA-BC, FAAN
A CNO colleague recently shared that health systems tolerate terrible behavior from patients and families because they are worried about their HCAHPS scores. She noted, “We are being held hostage because these scores impact our reimbursement. It seems crazy because the demand for healthcare far exceeds our ability to supply it. Patients and families come in expecting a Ritz-Carlton experience; we cannot deliver that. The bending to patient demands is coming at the expense of the staff experience, and frankly, that keeps me awake at night.”
Patients and families are angry about a lack of access to care, fragmentation of communication, and an overall lack of perceived coordination in healthcare, impacting patient experience scores. These frustrations are being taken out on the nursing and hospital staff. Consider the following comments from charge nurses about their recent experiences with patients and families:
We had a code happen on our unit. The patient in the room next door had his call light on. I went in after the code was over and tried to explain what happened (which I am sure he could hear the commotion). Instead of being sympathetic, he complained about how long it took me to answer the light and noted that it was not his problem that another patient had an emergency.
I feel like patients and families treat us like hired help. An increasing number of patients now order food on DoorDash and expect us to go downstairs and pick it up when it is delivered. Some patients are on diet restrictions but don’t care, so they have food delivered. This would have never happened in the past, but it is pretty standard now.
Patients and families now explicitly request that their assigned staff not have foreign accents – no immigrants, they tell us.
Patients and families threaten to go out on social media and complain if they don’t get what they want. We are so short-staffed that it is hard to meet their expectations.
Some OB patients come in with “their delivery wish list and plan” – they expect nurses to be their personal Doulas.
For many months, nurse leaders have been asking me why we are not more honest with the public about what is happening in our healthcare delivery system. One colleague recently compared what is happening with HCAHPS scores to what occurred in healthcare with the introduction of the pain scale. “For decades, we told clinicians that the goal was for patients not to have any pain and that they could not get addicted to narcotics if they had pain. The unintended consequences of our actions were a legacy of drug addiction that continues today. I see the unintended consequence of HCAHPS eroding the healthcare staff experience, ultimately leading to serious future access issues and massive staffing shortages.”
The challenge today is that the healthcare environment has significantly changed since COVID. The demand for healthcare continues to increase as the population ages. In a consumer-driven industry, healthcare organizations must compete to gain new patients and maintain loyalty. The script is flipping: many health systems struggle to manage high volumes, and many physician practices don’t accept new patients. Meeting the current healthcare demand has become almost impossible.
For the past two decades, the patient experience has been the focus of everything we do. However, healthcare has changed, and so have the resources available to deliver it. Patient experience metrics impact reimbursement, yet achieving excellent scores in the face of many challenges has become more challenging, and the staff experience is suffering. When circumstances change, so too should how we look at public policies such as HCAHPS.
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