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Presidential Voting and Press Ganey Part 2

If you haven’t read the first part of this two-part series, which was published before the primary results were known, please go here to review it.

The final results in the New Hampshire Republican presidential primaries have been published and I’m confused.

Based upon the sample from Dixville Notch, each candidate should have received one portion of the votes, but when a larger sample size was taken, the candidates all received different portions of the vote. None of the final results were even close to the predicted results from Dixville Notch.

Jon Huntsman’s scores were off by 31%
Ron Paul’s scores were off by more than 100%!
Rick Perry’s scores were pretty close, but he still got votes even though the survey said that he wasn’t supposed to get any votes at all.
Rick Santorum should be happy. The initial survey said that he would get 0.000% of the vote. He ended up with 9.4% of the vote. What a massive error that was!

Candidate Dixville Notch Predicted Percent Vote Actual Percent Vote Difference
Newt Gingrich 1/9 = 11.1% of vote 9.4% of vote – 18%
Jon Huntsman 2/9 = 22.2% of vote 16.9% of vote – 31.3%
Ron Paul 1/9 = 11.1% of vote 22.9% of vote + 106%
Rick Perry 0/9 = 0% of vote 0.7% of vote + “a lot” %
Mitt Romney 2/9 = 22.2% of vote 39.3% of vote + 77%
Rick Santorum 0/9 = 0% of vote 9.4% of vote + “even more” %

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Now you can see from the sample of an actual Press Ganey report in the previous post, a difference in a “mean score” of less than 1% can make the “percentile rank” change by 5 points or more. What happens when the mean score changes by 100% or more? Disaster.

So it seems that the scores from small sample sizes in Press Ganey surveys are pretty much like random number generators.

Kind of like administrators praising and demeaning staff based upon how many blue Chevrolets drive past the hospital between 3PM and 4:30PM on Tuesday afternoon. If there are 5 Chevys, you’re the best. If there are 0 Chevys, you’re fired.

If administrators and hospital boards can’t see the problems with basic statistics, how are they supposed to run hospitals effectively?

Make sure to leave a copy of this post on your administrator’s desk or under your administrator’s door.

We need to bring some accountability to those who manage our profession.

9 comments

  1. Not to detract from the thrust your post, but the 3 votes for Obama were in the democratic primary. State-wide he got 80% of votes in that primary – which is less than the 100% he got in Dixville Notch.

  2. “If administrators and hospital boards can’t see the problems with basic statistics, how are they supposed to run hospitals effectively?”

    They don’t run hospitals effectively. They tend to be idiots. That’s the problem: idiots are in charge.

  3. Linda Williams, RN, MBA

    The author obviously has way too much time on his hands and what appears to be an axe to grind here. We have used Press Ganey for years and are a top performing hospital whether looking at PG scores or CMS HCAHPS scores. They wouldn’t be the largest satisfaction vendor with 50% of U.S. hospitals if they weren’t doing things the right way!

    • Oh, Nurse Williams, thank you, thank you, for your cogent and pertinent responses.

      Come on, Press Ganey. Your corporate offices have visited these articles over 100 times in the past two days and the best you can do is send some minion to launch ad hominem attacks against me?

      As for Nurse Williams …

      First, alleging that I have too much time on my hands and that I have an “axe to grind” are personal attacks. They don’t respond to the issues raised and really have no place in the discussion. Kind of like me saying that you obviously carry a clipboard at work, have wasted your nursing degree, have no clue about the practical aspects of clinical medicine, and couldn’t start an IV to save your life. Not very productive, is it? Let’s stick to the issues raised, shall we?

      Next, your hospital’s performance – if it really is “top performing” as you say – really has nothing at all to do with the inaccuracy inherent in low sample sizes. Trying to associate the two is called a “straw man argument.” Similar to me saying “I am a widely published author of authoritative medical texts, therefore Nurse Williams is wrong.” If you want to engage in arguments, you have to avoid logical fallacies.

      Then is the emphatic assertion that Press Ganey must be “doing things the right way!” because of your allegations that they have the highest market share. That is called a non-sequitur. And again, it doesn’t respond to the issue that low sample sizes are inaccurate, misleading, and adversely influence the practice of medicine.

      If you’d like to discuss why you believe that low sample sizes are accurate despite the demonstration that they are not as shown in the New Hampshire primaries, go ahead. Otherwise, scurry along and go back to analyzing your hospital’s great satisfaction scores and telling yourself what a good job you’re doing.

    • So Press Gainey has a large market. A lot of people bought Pet Rocks, Enron and Obama’s “hope and change” too. And of all these fads, one became the largest energy company (that didn’t produce energy) and another became the president.

      So, while at the top of the heap satisfaction scores, have you asked your staff how satisfied they are with your leadership? Have you asked your physicians if Press Gainey alters the way they practice medicine? At least you would get a better statistical sample and more accurate indication of your leadership than you would get from Press Gainey.

      Have you ever asked how many people have been harmed by Press Gainey? How many physicians felt pressured to give antibiotics when not needed (causing allergic reactions or C. Diff diarrhea), or escalating doses of pain medication when not needed( causing addiction, OD and deaths), because they just “didn’t want to deal with another complaint”?

      Of course Press Gainey scores don’t affect medical decisions, right? They just are feedback to hospital administration to help alter physician/nursing behavior in making medical decisions…

  4. These types of comments are highly unproductive and inaccurate: “If administrators and hospital boards can’t see the problems with basic statistics, how are they supposed to run hospitals effectively?” + “They don’t run hospitals effectively. They tend to be idiots. That’s the problem: idiots are in charge.”

    I suggest that, before berating Press Ganey and by extension all other firms in its similar segment of healthcare performance improvement, you consider the context of your own work environment — the emergency department. Surely it has been reflected by your administrators the difficulty of obtaining a high response rate from those that typically frequent the ED — namely, those without insurance coverage (much less the means or ability to fill out and return a survey), or those in a high pressure situation that may end quite poorly (to name but a few classes of ED patients).

    While a low sample size is, as you point out, unfortunately not oriented toward achieiving statistically meaningful analytical results, to reflect this back upon Press Ganey specifically as a sign of ineptitude in business practices is blatantly unfair. Scientists, former health providers, and health policy and management experts form the core of Press Ganey’s operations. As well, these are the same kinds of individuals who likely manage your own organization, who are tasked with working in a highly volatile, regulated environment where change is constant. To broadly accuse them of being “idiots” is baseless and achieves nothing.

    • I disagree that the comments are unproductive and inaccurate.
      Why should anyone believe that people who don’t understand simple high school statistics are competent to manage a health care organization in which people’s lives are at stake every day?

      What is it about a work environment that validates low sample sizes? Easy work environments generate valid predictions with low sample sizes while those in “high pressure” work environments do not? Your whole second paragraph is a non-sequitur.

      Your third paragraph did make me laugh, though. You admit that “scientists, former health providers, and health policy and management experts” who run the organization are not only returning statistically insignificant analytical results to the hospital clients, but they analyze the results and pass the analysis of these inadequate statistical samples as if they have some meaning.
      You then use the logical fallacy of an appeal to authority to try to create an argument that because they are “experts”, they must be correct.
      I didn’t accuse Press Ganey personnel of being “idiots.” I accuse them of using their “expertise” to make statistically insignificant information appear significant so that they can collect hundreds of millions of dollars each year from the hospital administrators who rely on those “expert” credentials and who do not use due diligence in interpreting the results of the data that is presented to them. In the process, both Press Ganey and the administrators denigrate the medical profession and cause harm to patients.

      So your whole comment is based largely on unsubstantiated criticism of facts, contains no facts to rebut the facts I have presented, and relies upon logical fallacies to attempt to make your point.

      Nice try, though, counsel.

      • “I accuse them of using their “expertise” to make statistically insignificant information appear significant so that they can collect hundreds of millions of dollars each year from the hospital administrators who rely on those “expert” credentials and who do not use due diligence in interpreting the results of the data that is presented to them.”

        I think you just summed up most of your malpractice positions based on insurer statistics! Nice work.

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