We are at a pivotal moment in health care. It’s changing so rapidly even the people leading the change can barely keep up. One of the biggest paradigm shifts over the last decade is the focus on quality over quantity. Improving the health care experience and patient satisfaction are also being talked about in boardrooms across the country (largely due to the link with reimbursements, but still unthinkable a few years ago).
As someone who has worked up and down the East Coast in a variety of different settings—from large academic centers to more rural hospitals—I have found the broad challenges to be the same everywhere you go. Unfortunately it’s also been my experience that hospital leaders often lose the forest for the trees, and are overly focused on unnecessarily complex solutions to simple problems. I’ve treated thousands of hospitalized medical patients over the years, and with my interest in quality improvement and improving the patient experience, I’ve noticed very similar patterns in what our suffering patients report back to us as their best and worst feelings towards the hospital.
While I don’t presume to be putting words into anybody’s mouth, here’s what I suspect a letter would look like from a large majority of patients who are hospitalized in America:
Dear Hospital CEO/Health care leader,
Thank you for asking me about my hospital experience during my recent bout of pneumonia. Overall I found the commitment and dedication of the frontline staff to be highly commendable. Their sincerity and professionalism was without question. However, I would like to point out a few observations (in fact, I will list them to make it easier to read).
1. I spent a lot of time in the Emergency Room waiting for my hospital bed. I know how busy it was and I’m sure everyone was doing their best, but I wanted to mention this. It’s very noisy down there and sometimes felt a little too overwhelming for me (it’s my first time in hospital).
2. There was a lot of confusion when I was admitted about my medication list. The ED and the hospital doctor both had different lists, neither of which was my actual one. I’m sorry I couldn’t remember my exact medication regimen, I’m on several different pills, but is there a better way to get an accurate list, perhaps directly from my primary care doctor or pharmacy? This nearly resulted in a small medication error on my second hospital day.
3. The nurses that saw me on the medical floor were great, but I noticed they were fixated on their computer screens and pushing around their carts more than they were looking at me or other patients! One nurse remarked to me that she agreed completely with my sentiments and proceeded to tell me all about the enormous data entry tasks that nurses now have to do. While I can’t comment on that, my mother was a nurse and my vision of a good nurse was always one who was with their patient at the bedside, talking to them regularly, consoling, and trying their best to make their sick patients feel better. I’m sure things have changed over the years, but I do hope nurses still have time to be nurses.
4. I thought the doctors were very good. Maybe a bit rushed, but again I know how busy they are. One thing though, I was seen by several different doctors in the mornings—the intern, resident, Attending, and then other specialists. All of them asked me the same questions and did the exact same examination. I was confused at first with who was in charge, but got it after a bit (some of the doctors also said opposing things to me, which needed to be clarified).
5. I found it very difficult to sleep at night. On my first night, my roommate kept calling out, and on the second night, there was a lot of commotion outside. Also, when I was already getting better, did the nursing assistant really need to wake me up at 3 a.m. to check my blood pressure? Just a thought. I’m sure I don’t need to tell you, but sleep and a good rest is one of the most important things the human body needs, and it’s especially true when we are sick. It should go without saying that hospitals should be calm, quiet and comfortable places.
6. I had 2 tests done which required me to be NPO. On the morning of each test, nobody could tell me what time the test would be. Have you ever been NPO before? I can tell you, it’s not pleasant. It would be good to have at least some idea how long it will last!
7. A couple of the scans I had, nobody told me beforehand what they were for. A transporter just walked into my room and announced he was taking me downstairs. There were also a couple of occasions where a phlebotomist suddenly showed up during the afternoon to take blood. I’m an educated person, and it would have been good to know the reasons why.
8. My family was extremely concerned about me, and asked on a couple of occasions roughly when the doctor would be around to speak with them. The nurse gave them an 8-hour window! Is this normal?
9. I know it’s a cliché, but the food! I’m not saying we need to have gourmet 5-star food, but I wasn’t a fan. Sorry, but you did ask me what I thought.
10. When I was discharged, the whole process seemed to happen very abruptly. I think we need to be more thorough and go through all the medications and follow-up very carefully. It’d also help if all the appointments were made for me. And while we are on the subject, on my second day in hospital, someone called my family at home and started talking about my “admission status” and when I was going to be leaving. This was before anyone even knew what was wrong with me! More tact please, my family got a bit worked up.
Having given you this list, I still want to tell you that the doctors and nurses did a pretty awesome job. I’m very grateful for that and understand that a hospital is not a hotel. Although you asked me honestly what could improve, that doesn’t mean I didn’t overall receive an excellent service. For that I thank you and your hospital’s dedicated staff.
Medical Patient in America
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care. This post originally appeared at his blog.