Thursday, October 22, 2015
To improve patient and family satisfaction, start with this 1 simple thing
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.
Contact ACP Internist
Send comments to ACP Internist staff at firstname.lastname@example.org.
- An open letter to the BMJ regarding us dietary gui...
- Table rounds prior to bedside rounds
- Is the white coat needed for identification?
- Medicare audits, or how I spent part of Labor Day ...
- Guide for the perplexed
- Marketing medicine and the treatment of high blood...
- Will you trade me a CLABSI for a pneumothorax?
- Is your hospital crooked?
- In defense of aging
- Doctors, death and dignity: the semantics of 'suic...
Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.
And Thus, It Begins
Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.
Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.
Controversies in Hospital
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Iowa City, IA, with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).
db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.
Suneel Dhand, MD, ACP Member
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.
Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.
Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.
Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.
William Hersh, MD, FACP, Professor and Chair, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, posts his thoughts on various topics related to biomedical and health informatics.
David Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care.
Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.
Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites for influential health commentary.
Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.
Elaine Schattner, MD, FACP, shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology, and as a patient who's had breast cancer.
Mired in MedEd
Alexander M. Djuricich, MD, FACP, is the Associate Dean for Continuing Medical Education (CME), and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis, where he blogs about medical education.
Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).
David M. Sack, MD, FACP, practices general gastroenterology at a small community hospital in Connecticut. His blog is a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.
Reflections of a Grady
Kimberly Manning, MD, FACP, reflects on the personal side of being a doctor in a community hospital in Atlanta.
The Blog of Paul Sufka
Paul Sufka, MD, ACP Member, is a board certified rheumatologist in St. Paul, Minn. He was a chief resident in internal medicine with the University of Minnesota and then completed his fellowship training in rheumatology in June 2011 at the University of Minnesota Department of Rheumatology. His interests include the use of technology in medicine.
Technology in (Medical)
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in education, social media and networking, practice management and evidence-based medicine tools, personal information and knowledge management.
Peter A. Lipson,
Peter A. Lipson, MD, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. The blog, which has been around in various forms since 2007, offers musings on the intersection of science, medicine, and culture.
Why is American Health Care So Expensive?
Janice Boughton, MD, FACP, practiced internal medicine for 20 years before adopting a career in hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling.
World's Best Site
Daniel Ginsberg, MD, FACP, is an internal medicine physician who has avidly applied computers to medicine since 1986, when he first wrote medically oriented computer programs. He is in practice in Tacoma, Washington.
Other blogs of note:
American Journal of
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.
Michael Benjamin, MD, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.
The Public Library of Science's open access materials include a blog.
One of the most popular anonymous blogs written by an emergency room physician.