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Patient Satisfaction and Quality Outcomes: Can We Have Both?

April 9, 2012 9 comments

What are the keys to patient health and satisfaction?

The Hospital Stay Experience

Comedian Mel Brooks as The 2,000 year old man tells us what is was like as a patient in stone age hospitals. “Hospitals ran on the same principles as today – the principles of people walking past you while you’re screaming and not caring. That same wonderful indifference to the sick and the dying. We invented that.”

Mel’s routine came to mind recently while talking with a physician friend who is a senior leader at a regional academic medical center. He said, “We deliver quality health outcomes, what we’re focused on is improving the patient experience.”

Many of us remember our hospital stays as mixed at best. Patient as prisoner, stoic caregivers, bland food, poor communication.  Yet for many years patient satisfaction  scores routinely topped 90%.  Satisfaction surveys were usually filled-out at discharge, before the patient paid the bill. Patients, happy over their improved health, gave high scores on the survey.

Times have changed. Pressures to lower costs and improve outcomes intensify competition among hospitals. More employers offer tiered insurance plans which can cost less per month but charge the patient more to use hospitals with higher than average costs.  Higher priced academic hospitals have to justify those prices to consumers. They want patients delighted with their hospital stay.

What Does “Patient Experience Mean?

The Gallup Management Journal reports hospitals are widely divided about what the “patient experience” means. For about a quarter of hospitals surveyed, it means excellent customer service – the hotel model. About one-third believe it means “patient-centered care”, which is more of a health outcomes model. The rest of the hospital executives in the survey gave answers somewhere between those two models.

The Centers for Medicare and Medicaid (CMS) created a nation-wide standardized patient satisfaction survey which represents the mid-point between the hotel and the outcome models.  It’s called the CAHPS Hospital Survey. It measures how well doctors and nurses communicate with patients, cleanliness, pain management, quietness and discharge procedures on a 10 point scale. Consumers can see how hospitals compare to national averages in quarterly report published by CMS/CAHPS.

Hospitals which embrace patient-centered care don’t think the CAHPS survey goes far enough. They want patients to not only be delighted with the quality of service, but with their health as well. These hospitals work to redefine how care is delivered. It’s not easy. Current models of healthcare delivery often exclude patients and their families from an active role in treatment; they are episodic, not continuous. They focus on a specific problem, not the person as a whole.

With the help of consulting companies like Planetree, many hospitals are moving to the patient-centered care model. This requires them to rethink how they deliver many aspects of care, similar to Business Process Re-engineering (BPR).  As with any fundamental change, hospital culture must change fundamentally. This is the difficult part and may take years to become real.

Happier and/or Healthier?

While there are many case studies which show effective implementations of patient-centered care models, the long-term effect of this change on health care quality and the overall health of the patient is unknown. Many question whether patient-centered care’s focus on delivering only what the patient needs and no more is just a cover for rationing care and lowering costs. If the patient is happier, but is not materially healthier, why go to all the trouble?

As one physician, commenting on an earlier blog in this series said,” The goal has always been to individualize the treatment to the patient but I fear economic pressures may influence this in another direction.”

Right or wrong, this is the road we are on.

How satisfied are you with your hospital’s quality of service? What do you think about patient-centered care? Please comment and share.

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