When Department of Health and Human Services administrators decided to base 30 percent of hospitals' Medicare reimbursement on patient satisfaction survey scores, they likely figured that transparency and accountability would improve healthcare.

A Health Affairs study comparing patient-satisfaction scores with HCAHPS surveys of almost 100,000 nurses showed that a better nurse work environment was associated with higher scores on every patient-satisfaction survey question.

Adults tell students that it gets better, that the world changes after school, that being 'different' will pay off sometime after graduation. But no one explains to them why.