I have already had two posts(1) about the Press-Ganey(2). But that isn't enough. Any physician reading this likely has the same visceral hatred that bubbles up whenever these two (one w/hyphen?) words are brought up.

Again, for those who are not familiar with the term, Press-Ganey, it is a survey that administrators of hospitals use as gospel for who is the best hospital and is all about customer satisfaction.

But there are flaws in this Press-Ganey. What are the flaws? Oh, too many to list here (let me count the ways...). I'll just hit the highlights:
  1. First is that Press-Ganey has a complete monopoly. They are accountable to no one, despite their less-than-scientific method of procuring data. If I practiced medicine in the same "Evidenced Based" manner that the Press-Ganey does, I'd lose my license.
  2. While the (from now on abbreviation PG will be used) PG is supposed to take a random sample of patients a physician sees, it is biased in the sense that the surveys are voluntary and only motivated and healthy-enough to fill out a survey in the first place.
  3. Plus, take the ER for example. My "random" sample is based on patients who are discharged from the hospital only. No admitted patients fill these out. As an "Emergency" physician, the admitted patients represent the true emergencies. I'm not saying all discharged patients aren't supposed to be there, but I'd call them easily addressed "Urgencies."
  4. Worse, the odds are that the more often a patient shows up to the ER, the more likely they are to eventually get a survey. Do I need to spell out what kinds of patients show up to the ER frequently?
  5. I am graded by the patients that I had to spend the least amount of time with since I focus my attention on the true Emergencies first and foremost.
  6. And while the PG should have the same standards for every hospital - since they compare every hospital and form a grade for each hospital/provider, they don't. Each hospital interprets the selection of patients differently - I know bc in my career I've already worked at five different hospitals. One hospital excluded patients with "drug seeking behavior," whereas my current hospital does not.
  7. The grades are on a curve. In other words, hypothetically, if you think that on a five point scale 5 is excellent and 3 is average, and all doctors surveyed had an average of four, that would mean all docs are above average. But all docs don't get a PG score of above average. They can't since it is done on a curve. You could give above average care and get a score in the bottom 25% (an "F" if you were in school). WHAT??? Yes. That is true. And that is exactly what happens. Good doctors are getting penalized even when the satifaction scores are above average.
So why am I venting, again, about the PG? Here is my recent foray into PG madness:

I started a new job in January, and from the get-go had great PG scores. Of course, the sampling was low, so nothing was statistically significant. Once I got one unhappy patient, it killed my score. So 4 excellent scores and 1 bad one = Very bad PG score. But despite that, my scores were still in the top 80%. And stayed that way until June.

All of a sudden, in June my scores dropped to 1%. I naturally assumed I must have gotten a bunch of really bad reviews. Bad luck? Bad day for me? I didn't know. We have a binder that has the recent PG reviews for the department, and looking in there, all the reviews were 5's. The highest. I didn't get it.

The inevitable happened. My administrator saw my scores and insisted I be rehabilitated. My medical director had a "talk" with me. But to his credit, he promised to pull these surveys so that I could find out what was said so I might know what to improve. And he assigned someone to the four hour, painstaking task, of searching for all of the surveys and matching it up with the charts. And you know what they found (drumroll.......)?

These charts didn't belong to me! They were the PA's patient, or another physician (obvious when the pt is criticizing the tall male MD when I am a petite female doc). In fact my scores were almost exclusively 5's. Putting me at the top of the scale, not the bottom. Yet I still get that scarlet letter score pasted up all over the ED that makes me look like a mean uncaring doctor.

My director apologized to me, but it is not his fault. It is the fault of the administrators who are so desperate to have some standard with which to grade themselves, they choose not to use scientific rigor to evaluate that very imperfect standard that they use. And we doctors are the ones who suffer.