This is not a chicken or the egg situation - this company was started on selling survey services, setting them up, and then providing quality data. The company has exploded since clients have to participate in CAHPS and has completely lost sight of supporting it's people and it's clients. Press Ganey's bread and butter now is the people selling and setting up CAHPS for clients, which is good, but the people doing the work are not valued, supported at all, and Press Ganey hesitates to develop them for fear of them leaving. They really believe that more responsibility is a reward rather than raises or promotions. This is also a very political environment. If you don't have a tough skin, you will be eaten alive.