Blog | Monday, December 29, 2014

The big dichotomies in improving hospital experience for our patients


A large number of physicians and administrators involved in health care right now are working hard on improving the hospital experience and giving our patients a more pleasant time in hospital. As I've written about previously, I don't believe the solutions are necessarily complex or particularly difficult. They rest with basic common sense and humanity. Like being able to spend more time with patients, spending less time with computer screens, and making hospitals into more healing environments. All this in association with practicing good and thorough medicine.

But there are also some other very significant dichotomies that lie at the heart of what we are doing in hospitals right now. And that's the simple clash between administrative requirements and giving our patients the best possible experience. Here are 3 examples:

1. The aggressive need to reduce length of stay

We all agree that reducing length of stay is in patients' best interests. The less time patients spend in hospital, the less chance they have of picking up an infection or developing another complication caused by their hospitalization. However, at the same time we have to be very careful about giving our patients the impression that our only goal is to “push them out of the door” as soon as they enter our hospital seeking help. Everyday example: an administrator or case manager rushing into the patient room or calling an anxious relative (even before the doctor has had a chance to speak with them about the diagnosis) talking to them about when they may be leaving the hospital.

2. Observation versus inpatient status

This issue is rightly now getting more media attention as it has huge implications for any patients who come into hospital. Without getting into the politics or the theories behind this distinction, what I will say is that on a personal level, I wish this distinction didn't even exist. If people are sick enough to need hospital level care, what difference does it make if they stay in 1 day or 5 days? If our health care system gives the impression of nickel and diming patients, that obviously doesn't promote much good will.

3. Health care information technology

The widespread adoption of IT in hospitals over the last several years is because of Meaningful Use requirements and the rush to comply in order to receive much needed federal incentives. But the technology that is available is suboptimal and often makes life more inefficient for nurses and doctors, who are forced to spend huge chunks of their day glued to their computer screens instead of engaging in direct patient care. A study published last year in the Journal of General Internal Medicine shockingly found that medical interns now spend only 12% of their day in direct patient care and 40% with computers. Anyone surprised if this causes a problem when one of the top complaints from patients is that they don't have enough time with their doctors and nurses?

I don't doubt that a lot of the policies that are being pushed in health care have some very good intentions, but as with a lot of such “push from the top” situations, the full effect on the frontlines is not taken into account. Everyone involved in hospitals, and particularly administrators, need to be aware of how many of the administrative requirements clash on a daily basis with giving our patients a better hospital experience.

If we are serious about this worthy goal, we must seek to recognize and then reconcile the diverging paths. Examples include being as tactful as possible when talking to patients and families about issues such as when they are going to be discharged and their admission status (another example is a printed pamphlet explaining the process and that it's not always the hospital or the physician's decision). On the information technology front, investing in doing everything possible to make IT work for nurses and doctors and getting feedback on what's wrong with the current systems such as poor user interfaces or too many “clicks” to do something.

I'm afraid that no “patient experience officer” or “director of patient experience” is going to solve this. Only some real frontline perspective from doctors, nurses and patients can remedy what our hospitals really need in this area.

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.