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I have been watching with great interest the important dialogue sparked by a recent opinion piece by Theresa Brown in the New York Times. Her commentary suggested hospitals are not hotels and perception of satisfaction is not the best way to gauge the true nature of work hospitals do.
This publicly raised an issue that has been bubbling just beneath the surface since the unveiling of the Hospital Consumer Assessment of Healthcare Providers and Services (HCAHPS) survey and its extension into the value -based purchasing reimbursement equation this year. While I have the utmost respect for Brown as a caregiver and even for some of the concerns she raised, I suggest the need to look at this whole conversation with a very different lens.
It is important to start with the idea of care itself. Through my work in hospitals and from many healthcare leaders I have met I have heard a common mantra: In healthcare there are truly two types of employees, those that provide direct care and those that support the individuals who do.
Each and every role we play in healthcare organizations--be they outpatient or surgery centers, physician practices, walk-in clinics or hospitals--influences the overall experience of patients. Patient experience is defined as the sum of all interactions, shaped by an organization's culture, that influence patient perceptions across the continuum of care. This reinforces that the healthcare experience starts well before a clinical encounter and continues well after. It is based on every interaction a patient and/or their family have on the care journey and is ultimately measured by the very perceptions those individuals have of their experience. That is what is at stake in the HCAHPS conversation, not a colloquial measure of satisfaction as Brown suggests, but a much broader picture of the quality interactions that lead to positive care outcomes.
Considering this, measuring perceptions is not as off the mark as some might suggest. A recent study by Boulding et al. reinforced this point. The study compared two patient-related measures from the HCAHPS survey, grouped as satisfaction (which included would you recommend and overall rating) and discharge instructions (which included having the information you need when leaving and symptoms to look for after leaving), with clinical core measures. The discovery offered significant insights into the power that positive experience has on care.
The measures focused on experience were more predictive than the objective clinical performance measures often used to assess the quality of hospital care, specifically as it related to 30-day readmissions, a core component of quality assessment. The authors acknowledge that while the key drivers of hospital readmission are complex, the findings suggest patients' perspectives on inpatient care and discharge planning provide important insights into hospital performance with respect to quality.
I should be clear that I do not believe HCAHPS scores are the reason healthcare organizations should act, though I acknowledge they have provided a great incentive for focused efforts in the area of experience. As I have written in earlier blogs, patient experience is a much greater strategic commitment than just working to score well on any survey.
I believe this advocates the need to look at the work in healthcare with a much broader vision and with the intention of balancing patient needs and outcomes. Brown suggested providing patients more of what they want may mean they get less of what they need. I propose reframing this thought with a question: Rather than giving patients what they want, should they not be provided the experience they truly deserve?
During a recent On the Road visit to the Banner Health System in Phoenix, an experienced nurse leader and patient advocate explained it was time to shift the thinking in healthcare from that of "our" beds to that of "theirs"--meaning the patients and families we care for and serve every day. If that is the case, it is "their" room, whether private or semi-private, "their" amenities, whatever they might be for the facility, and "their" care.
In fact this changes the mindset of patients being subjects to that of being guests. Patients do not choose to spend nights in healthcare facilities in the same way they would a vacation, but this does not mean we should not or cannot treat them with the same level of service, in conjunction with the dignity and respect they deserve. Hospitals, and other healthcare facilities, are places where care is provided, hope instilled, compassion shown and truths told.
If Brown believes the news shared with our patients, both good and bad, is how they gauge their overall experience, this misses one of the greatest opportunities in healthcare. Providing unparalleled experience, and having measures to certify it is effectively enacted, ensures healthcare facilities and hospitals aren't only hotels. They are much, much more.
Jason A. Wolf, Ph.D., is executive director of The Beryl Institute, the premier thoughtleader on improving the patient experience. He is a recognized expert on organizational effectiveness, service excellence and high performance in healthcare. Follow Jason @jasonawolf and The Beryl Institute @berylinstitute on Twitter.
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