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April 26, 2011

Hospital execs largely clueless about patient experience

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Just caught the results of a study looking at patient experience in hospitals, and I’ve got to say, it doesn’t reflect well on hospital executives.

The study, by The Beryl Institute, concluded that execs rank patient experience as one of their top three priorities, coming in higher even than cost reduction.

Sure, that sounds nice. But as Beryl notes, these same execs have little idea of how to improve. In fact, 73 percent of the 790 execs surveyed don’t have a formal definition of a good patient experience — though they do consider noise reduction, discharge process/instructions and patient rounding to be key issues.

Honestly, I doubt they’d care this much if HCAHPS measurements weren’t just around the corner, poised to shave down reimbursement levels if hospitals don’t get on board.

Come on now, hospital leaders.  Just walk through a few units of your hospitals and try to imagine yourself staying there.  Do you think your patients feel comfortable, especially when they’re in shared rooms with little privacy and seldom informed about clinical decision making?  Do they feel like a cog in a big machine?  I dare you to work a shift with one of your nurses and see what patients feel day-to-day.

Improving patient experience is a nice goal, definitely, but you can’t do better than make vague stabs at the problems which affect your business, don’t even bother.

 

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November 21, 2010

Would you feel safe in this ugly lobby?

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A patient having his blood pressure taken by a...

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Folks, I’ll never forget that night.  Led gently by my worried husband, who was a bit concerned about my ability to keep breathing, I walked into the lobby of a mid-sized, plain-vanilla 100-odd bed community hospital in my neighborhood.

I already knew, from phone calls to my PCP, that I probably had pneumonia. And I knew that while I probably didn’t need an admission, I definitely needed a hand.  My temp was 104, my cough was in the Black Plague range  and I could barely walk.

So, then medical reality collided with nice, warm, compassionate medical theory.  The details aren’t important — basically, since the ED staff had nowhere appropriate to put me while I waited, and demanded I wear a mask I simply could not tolerate  — I ended up sitting on the floor inside the glass box between the outside and inside doors to the facility.  At least the cold from the winter night kept my temp down a bit.

I’m sorry, but I absolutely cannot fathom why even a not-so-rich community hospital can’t do more to make very, very uncomfortable and scared people feel safe when they enter an ED door.

Why are hospitals spending SO much energy advertising their abbreviated ED wait times?  Customer service, right? Well, guys, I can assure you that it makes more sense to start with EDs that aren’t a nightmare to visit. Get people through quickly? Sure. But for the time they’re in the lobby, much less in case, make that time welcoming and safe.

Yes, I realize not every hospital will spend enough to put Pottery Barn-style couches and deluxe coffee and tea service out there, but what bothers me is that comfort doesn’t seem to be anyone’s aspiration when patients arrive.

The nursing staff in the emergency departments I’ve visited are largely abrupt and impatient, refusing to make the slightest human connection with patients.  The lobbies themselves stack uncomfortable institutional chairs and horrible lighting on top of one another in a graceless manner which rivals sitting in the New York City subway at 2AM.  And if you want food or drink you often have to go on a hunting expedition you’re in no position to conduct.

My take? This is not acceptable. No. Not for a second.  I don’t want to hear any excuses about it.

If your hospital can’t afford high-toned decor, maybe get a volunteer to serve as a concierge to help make people comfortable. Rent a goddamned cot or two for patients who aren’t dying but feel like they want to.  Provide some hot liquids, for Christ’s sake — it’s not going tap out the budget for a mid-sized community hospital.  Remind your front-desk nurses that people are in pain, and base part of their pay on the reports you get from patients.

You know, evidence is piling up that patient satisfaction correlates pretty strongly with profit.  If compassion and common sense aren’t enough to convince the hold outs that it’s time for them to make their front door inviting, I guess nothing will.

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November 19, 2010

Meaningful Use: What is it good for? A lot of smoke and mirrors

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EHR Adoption Framework_AD

Image by andyde via Flickr

Meaningful Use?  Whoa! Good God y’all! What is it good for?  Very, very little. Sing it again…

OK, maybe it’s the greatest idea in the history of health IT, or maybe it’s a good idea gone terribly, terribly wrong (my theory), but it it’s not going to move hospitals along any faster than they are already toward smart, sophisticated IT use that saves lives.  There are efforts out there that do stand a chance of improving IT use (take your pick from dozens, which I’ll get to in another post), but has anyone provided clinical, social science or other data suggesting that going to MU first was the best way to spend all of this time and money?

After my months-long absence from the blog that I love (<grin>) I’m freshly charged up with looks to me like another major distraction from improving quality.

Here’s my logic: check me  out here and see if you agree. The harder the government comes down on hospitals, the more dust will get swept under the rug.  And when that “dust” is inefficient processes that stand a chance of killing people,we’re not talking any kind of joke here.

Want an idea of why I’m so skeptical?  Here’s a few (why not a  couple of bonuses):

*  Just got off the phone this week with a children’s hospital CEO, who’s found that 20 percent or less of his colleagues are ready for meaningful use.   And check out an Information Week article below, which reports that just 40 percent of hospitals  meet 5 MU criteria. Wow.

*  Why has it suddenly become a priority, in recent years, to automate processes at the bedside before the processes themselves have been perfected?  When Your Editor attended a conference this week on healthcare IT topics, the bedside came up a lot, but not much talk on whether we’ll be running into a GIGO problem.

* Medical groups and hospitals are under great pressure to form Accountable Care Organizations, a new entity for which there are some precedents (decades of capitation) but no clear-cut model.  With doctors and hospitals struggling to create the most basic levels of partnerships, is now a good time to pressure them to form their work habits around their IT investments? Yeah, yeah, they’re suppposed to fund and find EMRs and HIEs that meet their needs but really, how often will that happen?

If you’re a big MU fan, well, I’m sorry if I offended you.  But I’d much rather you flame the heck out of me here so we can have a nice dialogue on the subject. This is important stuff, people.

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August 15, 2010

Tweet roundup: Data loss at Thomas Jefferson, med records found in dump

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Happy weekend!  Here’s a group of tweets from the past few days that might be worth a second look.  If you have tweets you’d like to see in our roundup please feel free to share them.

Cheers,

Anne Z.

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Tweets for the week of 8/8/10

> @idtexpert #Medical #IdentityTheft Alert: Huge loss of patient data at Thomas Jefferson #University #Hospital in #Philadelphia ; http://bit.ly/dsTWhd

> @drchrono patient med records found in a Boston dump! sounds like yet another good reason to get an EMR: http://bit.ly/bOEPCP #emr

> @hcapr Regional Med Ctr of San Jose Uses Pocket-Sized Handout to Improve Quality Scores: http://tinyurl.com/2cp7ph2 #HCA #hospital #cms #healthcare (Hey, I’m intrigued; how about  you?)

> @ShigeoKinoshita RT @ingagenetworks: 3 ways to increase engagement and revitalize your healthcare system http://bit.ly/98Fe7s #hcsm #health20

> @AndrewPWilson: CDC Gateway to Health Communication & Social Marketing Practice http://bit.ly/b4udxS #gov20 #health20

> @HealthYRc Lone bedbug sends Kings County Hospital ER into fumigation lockdown – #New #York #Daily #News#Hospitals#Health > http://bit.ly/bSFMlS

> @HealthYRc It’s easy to buy babies at govt hospitals – #Times #of #India#Hospitals#Health > http://bit.ly/ddRmdH (ED: Sounds outrageous but check out the story)

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