Patient satisfaction and improving the hospital experience are all the rage these days in hospital administration circles. Hardly talked about a decade ago, the issue has become the mainstay of many a discussion held in health care boardrooms right now.
Of course, this is due in no small part to the matter of HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) surveys and the fact that much needed federal reimbursements are tied to these ratings (and that's not necessarily a bad thing). The problem however for many hospitals and health care organizations is that the term “patient satisfaction” has become something of a bumper sticker, and we lose the forest for the trees when we try to discover the barriers to achieving better results.
Whenever you ask patients and families what they really want, the answers will actually be very simple and straightforward—like improving communication and making hospitals into more healing and compassionate environments. While hospital administrations lose sight of these very obvious areas for focus, the tendency is to spend massive amounts of time and money on solutions that aren't what patients are asking for, such as giving them glitzy “iPad computer surveys” or making doctors and nurses wear “Have a Nice Day” badges (Yes, that really happens). Speaking as someone who has worked in several different hospitals in very diverse parts of the country, I'd like to give one classic example of an everyday mistake that we make that stares us in the face, but we don't do anything about.
Let's think laterally for a moment. Supposing you are a customer in any other arena, how would you feel if the organization you are dealing with gave you the impression that you weren't welcome and wanted to push you out of the door as soon as possible? Yet this is what happens in the world of hospital medicine all the time.
The background is as follows: hospitals are under tremendous financial pressure to discharge patients as soon as possible and be sure that only patients who are “truly ill” are actually admitted to hospital. This is part of the reasoning behind the unpopular “inpatient” versus “observation” distinction that has swept through the system over the last decade. As hospitals obviously have to respond to avoid financial implications, this pressure is unfortunately passed onto patients, as we give them the impression that we want them to be discharged almost as soon as they enter the hospital emergency room! And while it is obviously in our patients' best interests to recover quickly and not spend an excessive amount of time in the hospital, everyone involved in health care must also avoid coming across as worrying more about the length of stay than the patient's actual illness!
A classic everyday scenario, that has played out in every hospital I've ever worked in, goes something like this: Case managers, who have to quickly determine a patient's admission status and likely length of stay, scrutinize the case as soon as they get into work in the morning. They immediately start making inquiries and will often speak to the patient or call an elderly patient's anxious relative to go over the discharge arrangements. This discussion frequently happens before the doctor has even had a chance to see the patient! So, the relative, who naturally has a number of questions about their loved one's health (and may be in a completely different part of the country), hears first from the case manager, who inadvertently gives them the impression that all the hospital wants to do is push them out the door as soon as possible!
Although the case managers themselves are under huge pressure to do this, the problem is that if we ever give our patients and families the feeling that our number one goal has nothing to do with their medical illness—what sort of hospital experience does that promote? We need to exercise supreme tact and discretion with how we deal with these issues, and be sure that we don't steamroll an already worried person with bureaucratic technicalities. It may be a necessary thing to do, but we can do it better and more compassionately. Every hospital doctor will know the experience of having to pick up the pieces afterwards when they speak to an upset patient or relative, who has just spoken to a non-clinician about their discharge arrangements. We need to first and foremost show empathy and concern. If our patients and families start off their hospitalization on such a sour note, what hope is there for an optimal experience?
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.