Would you go so far as letting patients/families decide if patients want to be the early birds for tests? For elective cases where the time of day or patient digestive state doesn't matter, should patients be able to schedule their wake up call/procedure? I always enjoy debating "hospital should/shouldn't operate like a 4 star hotel" with colleagues.

First 'Hospitals are not star hotels'. You are not here on a vacation to relax and go by your own time schedules. I totally agree with patient-centered healthcare. But, one has to remember that hospital is an organization with several different departments simultaneously and there is a need to stick to strict timelines and schedules to make this system work efficiently. You can't just say "Please wake me at 11 am sothat you can run some tests on me." Each of the employees (Physicians, nurses, nurse-aids etc) have several other patients and tasks to take care of. Again, I believe in patient-centric health care but there is not just a fine line but a thick solid line between being a patient at a hospital and being a customer at a 5-star hotel in Hawaii.

That would be nice. Would you advocate that some hospitals continue to treat patients like lab rats? That they should be the "Liver in 204 who is going sour" with no back to their hospital gown? That you should let them languish on an OR table with an open surgery while you go to work out for an extra half hour or so rather than read the "margins?" That their loved ones should be banned from being with them or seeing them? That they should be shoved in a corner without explaination for hours? That they should be allowed to be collapsed on the bathroom floor vomiting blood without anyone knowing or checking?
Sound like a 5 Star hotel to YOU? That's all I was saying, and I don't want to debate because, thank God, I am the president and I don't have to debate, Just DO IT. Treat people with diginty, love and respect.

I work in a nursing facility, not on the floor but in the office. I can tell you first hand that even though alot is spoken about patient rights , you dont see enough rights acted on.. It is their right what time they wake up, but with the shortage of time, nursing staff and healthcare reimbursment, it has made the healthcare feel like it is on a time table, Get up, eat, shower, nap, up, eat, bed, and it starts all over again. I have been checking into a way to keep my mother at home as long as I can, I have checked into responselink medical alarms and I think this is the way for us to go at this point. I want my mother to have her rights, and I want her to be able to exercise those rights in the privacy of her own home until it is no longer feesible..

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As a marketer I tell people that the best marketing is word of mouth and word of mouth starts with the patient experience. Stop your ad campaigns and focus on service and your marketing will take care of itself. No one seems to want to make that connection.

Anthony Cirillo, FACHE, ABC

There was a great article in the Sunday New York Times (click above) on this very issue. You'll find that a little flexibility from "strict timelines and schedules" will be a valuable long-term investment in any health care institution. Like it or not, this is the way care will be delivered in the future. Those hospitals that do not adapt will simply be out of the game.

I've spent my professional career helping hospitals and health care organizations to better listen (and respond) to the needs of patients/families. We've made a lot of progress in the past 20 years; but we have a long way to go.

I agree with Anthony Cirillo's comments; word of mouth is very important for many health care decisions. It will be interesting to see if the publication of data (scheduled for March 2008) about patient experiences (and permitting comparisons between hospitals) will result in more targeted execution of service improvement

I actually work in a critical care unit where we are so centered on patients/families' wants and needs that I am ready to tear my hair out. I can't pass my medications or chart my assessments or crosscheck my orders or round with the physicians (all responsibilities of mine to actally DO) because I am constantly doing things like special order meals, coordinate transportation of belongings, giving directions, holding elevators, updating a million family members, fetching things, fluffing and tucking and generally "serving" my patients and their families. There are simply not enough hours in the day to do my job for which I require a license as well as be a servant. I've been an RN for 18 years and am leaving the bedside because I see the service end as being the destiny of nursing - taking us back to when nurses were harlots who tried to redeem themselves by taking care of the sick.

I've been an RN for 18 years and am leaving the bedside . . .

Sounds like a wise choice on your part.

It reminds me of the teachers who hated kids, and burned out.

Better to go where you are happy, and let the care givers who love giving care take over.

This seems to be the defining issue for healthcare improvement. We know quality is uneven across the country. Those places that make patients part of the care treatment team and where the care is patient centered on the whole patient and not just the patient’s disease seem to be where the islands of excellence are happening.

Nick, it's not that I don't love taking care of patients. I do and have always loved doing that. It simply has not been kept as a priority for nurses in my institution. The issue is that the move toward 5 star hotel service is not being backed up by service personnel to make this dream a functional reality. During my entire career, nursing has been viewed as the great cross-trained workforce. When a new regulation or process is introduced, the functional reality of this development lands, to a large degree, on the shoulders of nurses. Taking care of my patients just isn't as important as servicing them in the eyes of my management. If we had other employees to do all the service work, I could return to doing what I do best, provide exceptional clinical nursing care to my patients. And how long have you been an RN?

Hang in there Lisa. I am also a career RN and I read and understand your frustration. Nobody is saying that patients and families don't deserve everything we can try to give them. The question is who is expected to deliver on a hospital's promise of superior service. In 2002, a list of 28 "never events", such as med errors and wrongful surgeries was devised to outline events that should never happen in hospitals. Of these 28 "never events", only 13 of them would involve a practice of a physician, but all 28 involve nursing practices. Now that Medicare and private insurers have decided not to reimburse for death/disabilities associated with "never events", hospitals may want to ensure that nurses can and are actually providing safe licensed care instead of looking up a pizza delivery number for a family, for example. BTW, a friend of mine in another state had an unfortunate incident last year. A large family of 10 showed up to visit one of his patients. In his other patient's room, family was visiting their ventilated loved one. The patient's restraints had been untied while the family was at bedside. The 10 member family was aghast that there weren't enough chairs in the room so everyone could visit comfortably together and made the RN run and gather 8 more chairs for them. In the meantime, the ventilator patient's family couldn't find the RN to report that they were leaving and left the patient unrestrained. In the RNs absence, the patient pulled out his breathing tube. New airway could not be re-established and the patient died. Now that RNs, who have a direct role in "never events", actually have an impact on a hospitals reimbursements through their practice, decisions will have to be made about how far to stretch the demands placed upon the licensed workforce.

Well, one of the ways that we have handled this difficult challenge is by creating a force of volunteers and paid professionals that include: aroma, pet, humor, music and massage therapists,as well as volunteers that do hand massage, provide additional attention. We cross train housekeepers who interact with patient and family and finally, we include family members on the care teams. With only a small hospital, we now have almost as many volunteers as we had employees ten years ago. We also encourage ministers, priests, rabbis and eucharistic ministers to interact with the patients.

I am a nursing home consultant and found this article to be quite interesting. Customer service in most nursing homes reminds me of customer service from the cable company -- they can get away with treating you like dirt because they know you don't have a choice. I do believe that unlike the cable company, most nursing home employees would like to see more person-centered care. But it's difficult when it's never been done before (nursing homes are about as anti-innovative as you can get). The state QIOs have come up with wonderful tools for person centered care but nobody seems to use them. Interestingly enough, Ralf Habermann and John Schnele at the geriatrics department at Vanderbilt did a study a year or two ago and discovered that most nursing home residents could actually care less about how their daily routines were structured and care was provided. I am also reminded of a favorite nurses excuse that hasn't been mentioned yet: "If we didn't tell them what to do they would lay in bed all day". It certainly makes you think.

I don't understand all this antagonism toward the healthcare system, in this case, hospitals. As a physician who spends all of his time in the hospital taking care of patients and teaching residents, as well as currently having three relatives in the hospital where I work at this very moment, I think I have an interesting perspective.

Obviously, we would like to move toward patient-centered care. There is a big push for this, but I think alot of people don't understand that Insurance companies, as well as the CEO's top admin officials (the same admin guys who preach about patient-centered care) are relentless in their efforts to decrease length of stay.

No, a hospital is not a hotel. This is something I would like to tell every patient, but I don't. No patient (except mothers-to-be and my drug-addicted patients) is happy in the hospital. The food is not good, entertainment is lacking, and the nurse is NOT a waitress or belhop (sp?).

Why do patients get blood draws at 2-4am? Why do patients have to go by the hospital schedule and not their own? Think about it. Each day, Several hundred patients get blood draws, dozens get surgery, dozens get procedures, HUNDREDS get radiologic imaging, all have to be fed three times a day. The only way to get all of this stuff done is to start early. Otherwise, when will we get time to talk to patients and families.

By the way, I LOVE TO TALK WITH PATIENTS AND FAMILIES. It is the most rewarding part of my job. At the same time, there are some patients and families who I cannot stand and, YES, I do make an effort not to talk with them. Who are they? No particular socioeconomic, ethnic, age or sex.

If you're reading this, I presume you are at work on your computer, or you're at home in the house you pay for by going to work. MANY MANY MANY MANY hospital patients are not like you and me. I'm not talking about purely mentally ill ones either. I'm talking about the drug addicts who know how to manipulate the system (it is not hard to do). For example, I currently have a 24 y/o female patient with leukemia (ALL). She has failed chemo and is awaiting a stem cell transplant. She is a wonderful human being. I only spent about 5 minutes talking to her today though. Why? I'll tell you why. Because I spent several hours today working a with a known drug addict (who has been to prison multiple times), discussing why I can't support his habit and why he has to stop faking his illness. (He admitted to it). I was very kind to him, but then he threatened me. Today is the first time in my life someone has actually threatened to "get even" with me. I seriously doubt he meant it, but the psychiatrist on the case really made a big deal out of it. Just remember this the next time you're in a hospital sitting in a semi-private room next to a crack addict with HIV who passes her disease around while making money for drugs. She will take about 95% of my time in the room and you will get the other 5%. Oh, and remember, you're basically paying for your stay as well as hers.

On average, I see about 18 patients per day. Most hospital doctors see this many in our country. I think 12 is the ideal number though. I'm not complaining though. I love my job. There's no other career I'd rather have.

If you are ever a patient in the hospital, ask questions whenever you like. Don't be afraid. At the same time, don't be suspicious. The doctors and nurses, as well as the ancillary staff really are there to help and we think we are putting you first. Also, it would be a very good thing to follow the doctors/nurses instructions. We do this stuff all day every day the system is fairly streamlined. Again, ASK QUESTIONS.

Drug and addiction can be devastating to family members and individuals.Drug addiction treatment can include medications, behavioral therapy (such as cognitive therapy, psychotherapy, counseling, etc. ). A Research Based Guide released from the National Institute on Drug Abuse (NIDA) said that treatment must be specific to each individual and assessed and modified continually to match the person’s changing needs.

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