Apparently, patient satisfaction is really bothering me this week…
As some of you know, I work for the VA Healthcare System. I love my job, mostly because my patients are awesome. I actually went to work for the VA because I wanted to take care of veterans. I am a veteran. It is just as rewarding as I thought it would be. I am happy to take care of these guys (and increasingly, gals) every single day.
You know what is different about the VA?
No real agency financial penalty for bad patient satisfaction scores.
So, the government is able to steal reimbursement from hospitals based on patient satisfaction scores, but the executives involved in VA care get productivity bonuses that are not based on patient satisfaction? The VA conducts patient satisfaction surveys occasionally, and we get a sample size of like three hundred veterans. Why aren’t we sending out surveys to everyone when they are discharged? Why aren’t we making calls to survey all inpatients, or for that matter, all outpatients?
Because we don’t have to. End of. This blog from VA brags about its high scores, but it is the same less-than-300 sample size I told you about.
This is an issue. If the federal government is making YOUR hospital financially responsible for patient satisfaction scores, why aren’t the executives at VA penalized for poor performance with a reduction in performance bonuses?
I make it a point to ask all of my patients how their hospital stay is going. I have had one patient complain in 2 years. They mostly love getting their health care at VA. Non-VA Care like Veteran’s Choice is not as popular as you would think. Many of my patients turn it down. It isn’t home.
But still, the federal government is not equally surveying the patient population. In Fiscal Year 2011, there were 550,000 inpatient admissions VA wide. Five MILLION unique patients were treated. And in 2012, 300 vets were surveyed. If I were making the VA budget, I would consider bonuses based on satisfaction, and watch the few terrible, entrenched VA employees I see treating patients rudely every day finally get fired.
Now, a story.
This DID NOT HAPPEN WHILE I WAS A VA EMPLOYEE. I am the family member of a veteran who was treated in the VA Healthcare system. He is now deceased. This is HIS story:
John was always complaining about the ‘damn VA’. However, he did not utilize many of its services correctly, and whether this was because of poor education by the VA’s employees, or extreme bullheadedness by John himself, we will never know. (I am guessing the latter) After he was correctly enrolled and in the system, it went very smoothly. They treated him well, he loved his doctors, and more importantly, he was treated holistically. Mind, Body, and Soul. Conventional medicine with modern completeness. Seriously. I was impressed.
John was a long-time VA patient. When he was diagnosed with cancer for the second time, and it was inoperable, he was offered every treatment option available. The oncologist was so upset that John didn’t come to see him when the symptoms started eight months before. This was his second round of cancer with John. After a few chemo treatments, John decided it was not for him. He was offered a pleurodesis to manage his malignant pleural effusions, which were seriously interfering with his activity. Hospice was consulted early. He was made a DNR.
Naturally, poor John had the one in a million allergic reaction to the talc. After the procedure, someone forgot to put his telemetry monitor back on… or he took it off to go outside and smoke. (more likely) When he came back and went to bed, he had respiratory distress and A Fib RVR. His nurse found him down, and he was transferred to the ICU. During the chaos in the unit, his chest tube Atrium container was kicked over. So, naturally there was blood in all of the chambers. (this becomes important later)
The next night, I was sitting in the doorway of his ICU room reading a book when he suddenly LEAPT out of bed, over the side rail, mumbling that he had to pee. To say that he was a fall risk at this point would be a gross understatement. He was weaving and bobbing like a ship in a hurricane. I jumped up and held on to him, and grabbed the urinal on the bedside table for him to use, and called for help. He was grudgingly allowing me to hold the urinal when his nurse appeared and shouted at me that I shouldn’t have gotten him out of bed.
I stated calmly that the side rail was still up and that he had leapt over it to stand to urinate, and that I did not attempt to ambulate him. She then told me that I had kicked over the chest tube and interfered with her calculation of his drainage. And then she said, “He is not going to get better if you try to do things he isn’t supposed to do!” About a terminal patient.
Of course, the chest tube had been kicked over the previous night and she had obviously never looked at his drainage. She shouted at me and shook her finger in my face. And I told her to get the hell out of his room. Because she had been playing on her phone in a chair, and didn’t notice when he jumped out of bed until I yelled for help. He was very upset, hypoxic, and confused, and didn’t understand why this woman was yelling and being mean.
Needless to say, there was a scene that I don’t care to hash through again here. I told the VA Police officer and Nursing Supervisor that I would have him transferred to another facility immediately if that woman came anywhere near him again. I didn’t want him to see anything ugly this close to the end. They assured me that our wishes would be followed.
We took him home to die a few days later. Hospice was provided. A bath aide, social work, home oxygen, medications increased on demand, etc. It was amazing. I wrote the VA a pretty great letter about his care after he died. It was four years ago, yesterday.
Wait….I forgot to complain about his care in the ICU!
No, I didn’t. His care was great at the VA. I am a healthcare professional, and I knew that nurse was not the rule. She was the unfortunate exception. I guarantee you that if I had been a layperson you would not have heard this story of great VA care. I would simply have complained about that unit nurse.
Why are we allowing lay people to rate the value of their treatment based on their perception of their care instead of the reality? Like I just rated John’s.
While a layperson may have seen nothing but the awful attitude of the ONE staff person we had an issue with, I can see the wonderful care given by the literally hundreds of staff members we interacted with at the VA. Because I am a medical professional. And I can rate these things with an eye toward truth rather than how I was made to feel.
Patient satisfaction based reimbursement has to go. And so do performance bonuses at the VA in my not-humble-at-all-opinion.
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