Sanford Health Gets it Backwards

By Mathew Keller, RN JD
Regulatory and Policy Nursing Specialist

Mathew Keller, RN JD
Regulatory and Policy Nursing Specialist

Limousine service, upgraded television setsnurse-to-patient “scripts,” gourmet food service, nurse uniform requirements. Hospitals all over the U.S. are offering more “customer-centric” patient care in order to increase patient satisfaction scores, which are becoming more and more important to raise and maintain Medicare reimbursement amounts.

These efforts, however, often have unintended consequences.

In the first place, customer-centric interventions rarely (if ever) improve the quality of care patients receive. Rather, they merely improve patients’ perceptions of care.

That’s why Sanford-Bemidji has it all wrong in their current push to link nurse pay to patient satisfaction scores. A patient’s perception of their care has more to do with a good customer-service model than a good healthcare model, but Sanford continues to insist that nurse pay be linked to patient satisfaction scores.

Perhaps the biggest issue with this approach is that nurses have little control over the factors that research shows improve patient satisfaction scores the most. Quality of food service, wait times, physician attentiveness, even staff uniform colors are all factors in patient satisfaction scores—none of which nurses have control over.

The research also shows that short staffing, a constant issue at Sanford-Bemidji, is a significant factor in patient satisfaction scores. Short staffing is inherently unsafe and puts patients at risk.

Instead, focusing on safe nurse staffing actually improves the quality of care patients receive, not just their perception of it. The literature shows that improving nurse staffing while controlling for variables (including physicians, LPNs, and nursing assistants) significantly cuts the risk of mortality, lowers the incidence of medication errors and other adverse events, cuts patient readmission ratesreduces nursing-sensitive negative outcomes, and even saves hospitals and insurance companies money—and that’s just the tip of the iceberg.

If Sanford administrators actually care about the quality of care in their facility, perhaps they should consider linking nurse manager compensation to safe staffing. This would be much more effective in improving quality of care than short-sighted attempts to link bedside nurse compensation to patient satisfaction scores.


  1. These practices may work in Disneyland, but not in health care, Nurses must fight for evidenced based care to govern their practice. And, they must organize to have a voice at the table. Just do it!

    Doris Carroll
    Vice President
    Illinois Nurses Association

  2. We are simply insulted by this offer. When asked, the management could not cite any data that supports their request to link any incentive pay to survey results having any impact on patient satisfaction scores, they simply replied they thought it was a good idea. If all their good ideas had worked in the past, there would be better patient satisfaction scores, instead they have made no progress in years!

  3. Bahahahaha! Let’s try this proposal on management first and base their pay on perceived leadership skills, department raises and scheduling.

  4. How about administration and management get paid by nurse satisfaction !! And with all the money we save from decreasing their inflated wages we could put staff in patient care areas !!! What a novel idea, healthcare dollars actually going to patient care….that’s a brilliant idea if I do say so myself !!!

  5. Healthcare in general gets it wrong, yes, but Sanford in particular gets it wrong. As a former Sanford employee and now in my current job I have free uncensored access to all types of people in all types of job levels at all types of places, including other former Sanford employees that are now practicing/working elsewhere, patients, you name it. Sanford is going to have a hard time staffing that new hospital if they don’t change their business model soon.

  6. I have never understood the inflated pay that administrative staff are paid. Nurses are the bottom line or maybe should be considered the top line for every one of those people who come into the clinic or hospital for care. Nurses don’t like what they do they LOVE what they do!!!! Their pay cannot be incentives that they have very little control over. I agree with other comments about paying administrative staff on leadership skills etc. Good luck.

  7. That hospital needs to make some huge changes, I can’t imagine a hospital in Minnesota having worse patient satisfaction rates. Some upper management changes are an absolutely necessity!

  8. Three years ago my husband had a very close call with the flu that went into pneumonia. I will be forever grateful to the nurse in Bemidji who made the call to transfer him to Fargo. The one nurse that was amazing in Fargo was Sarah Solberg. She was so comforting to me at a very scary time and so professional, just very good at her job and I will never forget her. I can’t tell you what color their scrubs were or if their performance was based on their pay…I would have to say I doubt it. Being a good person and doing well at your job is a choice that comes from inside.

  9. I’m not affiliated in the medical field, but NATIONWIDE we have a medical problem with administrators trying to shove things down our throats. 95% of the patients are there trying to get well so they came go HOME!!! The administrators, excess employees ( trying to justify their jobs ), and rich patients wanting these excessive tidbits ( for ego purposes ) should get some COMMON SENSE back in their governing!! Satisfied nurses, early discharges, and less “amenities” is what we need. Most patients could give a (darn) about frills!!!!

  10. Hey all out there,
    the pts should be doing their satisfaction scores based on “If their nurse knows what to do when their heart goes into atrial fibrillation with RVR” rather than if they got a good back rub or they got their pain med as quick as they wanted it.
    Ive been a nurse over 30 years and its simply appalling what is being demanded of us….Like we work in a restaurant or something and we are being graded on the food value. nothing will change until people are educated and the government is banking money on peoples perception of care as opposed to what it actually is or should be.
    also there is a huge lack of accountability in America and especially in the health care field; pts essentially expect Doctors and Hospitals and nurses to be accountable but definately not them. pts need to be more accountable and that will not change until there is more motive to do so. A financial incentive for pts is way over due.
    another issue is that; people who make health care policy dont take care of pts so they dont know all thats involved. They strictly go by the “Numbers” and that happens in staffing all the time. Administration follows numbers and they dont staff by acuity. The acuity is getting worse all the time, its not getting better.

  11. If surveys were a reliable tool, we would have a different president, different congress, and if our survey comments were really read by hospital administrators, they would improve staffing and working conditions. We simply must understand that surveys are a tool to give us an idea about how things are going in a particular area, they are not a science. Sanford does not have the research backing their proposal, and the surveys Sanford wants to use are a complex tool that even management admitted they could not cite data or accurately articulate how this would work. Just another tactic to blame nurses for low patient satisfaction scores. Surveys do not improve patient scores, and tying nurse incentive pay to them will surely fail.
    Ashley, RN, Bemidji Bargaining Unit

  12. Wow. Bedside nursing is already in a state of decline, and this will surely not help. Basing pay on satisfaction surveys, whether or not some of the factors are even remotely controllable, is a horribly stupid idea. This will surely lead more nurses to jump ship, which will further short staffing, which will lead to even worse patient care. By the end, will the administrators even get paid if they have to divert ALL patients to hospitals that guarantee their nurses a pay check?? Obviously the job requirements of the administrators need to change – they should have to have bedside experience on their resume. On an additional note, I don’t know when healthcare became “customer service”, but it’s a poor movement. Patients are patients. They require care from people that required a lot of education. How about we let those educated people make some of the best decisions for care? How about at the end of a patient’s hospital stay the only survey question asked is, “Are you alive?”

  13. I am not in the medical world, but have a lot of experience with customer service.
    This is ridiculous what they are considering. To paraphrase a quote from Richard Branson, it is not best that the customer comes first, but the employee (nurse). If the employee is happy, then they will perform at their best, which will translate into great customer service to accompany great nursing care. Not to mention that patients and their families are often going through a rather difficult experience and may often not be in the proper frame of mind to be filling out a survey and won’t always like the proper treatment, which is in the best interest for their care. Better care also will come from nurses being happy with being properly compensated for their profession.

  14. agree with all of the comments. I never learned anything of value from a “new ” BSN. Any complaints from patients were due to lack of staff r/t acuity. Loved the job, the patient care, even most of the docs, but destoyed my health trying to care for morbidly obese and deathly ill patients with poor staffing!!

  15. I agree nurses have little to no control over all these factors but rather than pointing out the flaws of 1 non-union hospital (I’m sure you are working on that MNA) you should focus your attention on the overall government’s genius idea of linking payments to hospitals on customer satisfaction not patient outcomes and care provided. This is bureaucracy at its best.

  16. For 11 years on Bemidji’s second floor, I have watched suicide attempts wait more than a week without placement or treatment of any kind. We simply hold them until they can be placed in a mental health facility on court commitment or their hold expires and they leave against medical advice. I just recently got my BSN, and requested to investigate the possibility of doing cognitive therapy with these patients. I am also an educator in the Adult Rehabilitative Mental Health Services as a second job. There is a billing code for Transition to Community where ARMHS workers come into the hospital and help patients come back home. I was informed that I would not be supported in this endeavor, that they wanted to go a different direction.

    It hurts too much to continue in the capacity as a medsurg nurse, and believe there is a better way and be denied the opportunity to try.

    I am leaving my unit.

  17. I am interested in where this information originated from. I currently work for a Sanford facility outside of the Bemidji region but am concerned and apprehensive about my future as a nurse at Sanford Health. This is only adding to existing uncertainties in my mind. I emailed administration questioning this topic but it, of course, it was denied. Very little elaboration was offered. If this information is true it will negatively affect the nursing morale in our facilities. I do not not plan on staying with Sanford Health if this is what the future holds for the (already controversial) nursing pay scale.

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