a patient asked Molly . . . Interview.

patients who reported being most . . . J. Fenton, A. Jerant, K. Bertakis, and P. Franks, “The Cost of Satisfaction: A National Study of Patient Satisfaction, Healthcare Utilization, Expenditures, and Mortality.” Archives of Internal Medicine, March 2012.

results could reflect that doctors . . . Ibid.; see also “Patient Satisfaction Linked to Higher Healthcare Expenses and Mortality,” UC Davis Health System Press Release, February 13, 2012. In an email to the author, Fenton clarified, “Most of our work on satisfaction pertains to outpatients, although some have generalized it to hospital care.”

“Focusing on what patients want . . .” Theresa Brown, “Hospitals Aren’t Hotels,” The New York Times, March 14, 2012.

hospitals that perform worse . . . “definitely recommend the hospital.” This is a conservative tally. I did not include hospitals that scored better than the national average on any one category, even if they had multiple categories in which they scored worse than average, because of the low but still possible likelihood that patients responding to the surveys fell into the “better” categories. I also excluded hospitals that did not have enough data in any one category for Medicare to rank them, in case highly satisfied patients filling out the surveys could have fallen into those categories.

“Patients can be very . . .” Interview.

In 2012, when a white father . . . JoNel Aleccia, “Hospital Granted Dad’s Request: No Black Nurses, Lawsuit Says,” NBCNews.com, February 23, 2013.

Hurley settled. . . $41,250 apiece. Gary Ridley, “Hurley Paid Nearly $200,000 to Settle No-Black-Nurses Lawsuit, Records Show,” MichiganLive.com, March 20, 2013.

more than 61 percent of patients . . . in the bottom half. See Saket Girotra, Peter Cram, and Ioana Popescu, “Patient Satisfaction at America’s Lowest Performing Hospitals,” Circulation: Cardiovascular Quality and Outcomes (May 2012). Some caveats: The 61 percent who would recommend low-performing hospitals is compared to 66 percent of patients at hospitals with high scores, Girotra noted in correspondence with the author. He added, “Although the difference between low and high performing HF hospitals was statistically significant, it was small. . . . Lastly, it is important to remember that the patient satisfaction ratings were provided by a sample of all patients discharged from the hospital and not just heart failure patients.” In addition, Girotra said that on average, patients treated at consistently low-performing heart failure hospitals were less likely to give high marks to those hospitals compared to patients treated at high-performing hospitals.

“is part of an ongoing national effort” Sample Initial Cover Letter for the HCAHPS Survey, March 2013.

valet parking See, for example, Nina Bernstein, “Hospitals Aren’t Waiting for Verdict on Healthcare Law,” The New York Times, June 10, 2012.

live music See, for example, Laura Landro, “The Informed Patient: A Financial Incentive . . .”

custom-order room-service . . . televisions. See, for example, Melissa Burden, “Stakes High for Hospital Service,” Detroit News, March 19, 2012.

“. . . loyalty programs.” Ibid.

spent approximately $50 million . . . executive chef. Todd Sloane, “The University of Patient Satisfaction,” Partners, January–February 2012.

Beaumont Hospital spent half a million . . . score.” Ibid.

scripting nurses’ patient interactions. See, for example, Nina Bernstein, “Hospitals Aren’t Waiting . . .”; Nina Bernstein, “Walkouts by Nurses Loom as Hospitals Seek to Cut Costs,” The New York Times, December 15, 2011; Liz Kowalczyk; Todd Sloane.

use particular phrases . . . See, for example, Jordan Rau, “Test for Hospital Budgets . . .”

Posters hang in break rooms Interviews.

cue cards in their pockets See, for example, Todd Sloane.

wear laminated cards . . . “in your room.’’ Liz Kowalczyk.

at least three times per shift. Ibid.

more than 800 healthcare organizations See, for example, https://www.studergroup.com/what-we-do/institutes/upcoming-institutes/hcahps-summit/hcahps-nashville-tn/post-event-page/.

“coaching” https://www.studergroup.com/what-we-do/coaching/.

A.I.D.E.T. stands for Acknowledge . . . Competency Assessment. Accessed through the Studer Group tools page. Used also in The Nurse Leader Handbook. www.firestarterpublishing.com/NurseLeaderHandbook.

have to undergo “remediation” See, for example, Bridget Ward, “Dumbing Down Disrespects Nurses,” Letter to the Editor, Berkshire Eagle (Pittsfield, MA), June 7, 2011.

“improvement plan.” Competency Assessment.

assessed by “A.I.D.E.T. auditors.” “Tool 9: Aidet Interaction Assessment,” Taking You and Your Organization to the Next Level, Studer Group Tools, 2009.

health systems are now using . . . bonuses. Interviews; See also, for example, “Better Bedside Manners; Customer Service Comes to Healthcare.” Indianapolis Business Journal, March 21, 2011; Franklin Michota, “Adviser’s Viewpoint Patient Satisfaction Is No Simple Thing,” Hospitalist News, April 2012.

auditioned and hired professional actors . . . See, for example, “Hospitals Hire Actors to Improve Patient Satisfaction, Communication,” FierceHealthcare.com, August 30, 2012.

“an open-book test . . .” “Quick-E! Pro Scripting: A Guide for Nurses,” HCPro.com, 2009.

. . . do not approve of these tactics. “Hospitals are not permitted to attempt to influence or encourage patients to respond in a particular way,’’ Ellen B. Griffith, a spokeswoman for the Centers for Medicare and Medicaid Services, emailed Boston Globe’s Liz Kowalczyk.

“hospitals must not use . . .” CAHPS Hospital Survey (HCAHPS) Quality Assurance Guidelines, Version 9.0, March 2014.

“Stepford nurse” Liz Kowalczyk.

ten-page laminated guide . . . “Uh-huh.” “Better Bedside Manners: Customer Service Comes to Healthcare,” Indianapolis Business Journal, March 21, 2011.

“If you haven’t found a way . . .” Rebecca Hendren, “Top 5 Challenges Facing Nursing in 2012,” HealthLeaders Media, November 15, 2011.

Oh, they get it. See, for example, “A Message from ‘Rank and File, RN,’” from Emergiblog.com, November 16, 2011.

“In our staff meetings . . .” Interview.

“good customer service skills . . .” Amy Bozeman, “Wanted: Good Customer Service Skills,” Scrubsmag.com, July 6, 2011.

evaluates staff members on “customer satisfaction.” Todd Sloane.

“Now we are told . . .” Amy Bozeman.

representatives give warm blankets . . . marks to the nurses. Ibid.

at a hospital that switched its “A Message From ‘Rank and File, RN.’”

The University of Toledo Medical Center . . . “true belief.” Todd Sloane.

“patients are more satisfied . . .” Liz Kowalczyk.

UTMC is among the worst performers . . . At the time of this writing, UTMC scored worse than the national average on five categories of Hospital Readmissions, Complications and Deaths Data. See Data.Medicare.gov for current data.

UTMC made headlines . . . See, for example, Susan Donaldson James, “Toledo Hospital Threw Out Donor Kidney, Now Denies Negligence,” ABCNews.com via Good Morning America, August 29, 2013.

study comparing patient satisfaction . . . patient per nurse. Ann Kutney-Lee, et al. “Nursing: A Key to Patient Satisfaction.” Health Affairs, July/August 2009. The study authors caution: “A limitation of the research is the cross-sectional design, which does not inform us about causation.”