Friday, March 23, 2012

Hospitals Should Learn From Hotels

Theresa Brown, an oncology, nurse wrote an op-ed piece in the New York Times on March 15, 2012 titled Hospitals Aren’t Hotels. In it she questioned the wisdom of using patient satisfaction survey results to determine hospital reimbursement.

A lot of what we do in medicine, and especially in modern hospital care, adheres to this same formulation. We hurt people because it’s the only way we know to make them better. This is the nature of our work, which is why the growing focus on measuring ‘patient satisfaction’ as a way to judge the quality of a hospital’s care is worrisomely off the mark.”

I worry that Brown’s line of thinking will only reinforce hospitals’ and doctors’ smug and arrogant attitude that our industry is special and cannot learn from less important sectors of the economy like hospitality. Bill Joy famously observed, "No matter what business you're in, most of the smart people work for someone else." There should be a corollary that states, "No matter what industry you're in, you can learn a lot from people in other fields."

Don Tapscott and Anthony D. Williams in "Wikinomics" (New York: Penguin, 2008) describe how cutting-edge companies outside of healthcare are benefiting from mass collaboration made possible by disruptive technologies and new digital tools.

Procter & Gamble has made "proudly found elsewhere" a way for the consumer products company to find 50 percent of its new products and service ideas from sources outside the company. Successful P&G products such as Olay Regenerist, Swiffer Dusters, and Crest Spin-Brush were developed by collaborating with scientists and engineers who do not work for P&G.

When HHS tried to implement a “mystery shopper” program to improve the patient experience for Medicare patients, the backlash from physicians was strong; CMS abandoned the program shortly after announcing it. And yet this well accepted retail tool has been reported to lead to better patient flow and improved wait times, extension of office hours, improved telephone etiquette, better physician communication with patients, and more time with patients answering questions about surgery.

Elizabeth Bailey reminds Brown in a letter to the editor that Sir William Osler said,

“’Listen to your patient. He is telling you the diagnosis.’ Sadly, this simple message – to listen to the patient, carefully – is often swept aside in our fragmented, procedure- and data-driven medical system.”

Robert H. Schaffer points out that patients are able to accurately assess many aspects of being hospitalized that can make a difference in clinical outcomes:

“Maybe patients cannot assess the efficacy of many treatments, but they surely can tell whether they have rung the buzzer for a nurse and had to wait 20 minutes for a response; whether they have been wheeled someplace on a gurney and left alone in a hallway for what seemed like hours… whether a bewildering cast of medical characters came and went without explaining who they are and their functions.”

The developers of the Hospital Consumer Assessments of Healthcare Providers and Systems survey that Brown critiqued write that she repeated two common misconceptions about the survey.

“One is that there are necessarily tradeoffs between good patient experiences and good clinical care. The preponderance of the evidence (at least four recent studies) suggests the opposite: hospitals that perform better on the survey tend to do better on clinical measures, have fewer readmissions within 30 days and have lower risk-adjusted mortality.

A second misconception is that the survey is primarily a measure of satisfaction, and that high scores are achieved by catering to patients’ desires for unwarranted treatment. In fact, the survey focuses on important aspects of care such as whether new medications and post-discharge care instructions were explained clearly, which can be measured only by asking the patient. Evidence suggests that patients want clear communication, not unnecessary care.”

For the American health care system to deliver evidence-based, low cost, and high quality medical care will require that all of us change the way we do things. Health care providers like Theresa Brown need to acknowledge that the patient experience is included in the triple aim because it is vitally important. Dr. Day F. Hills defends Brown by writing, “Because patients are seldom the best judges of their medical care, that care cannot be measured accurately by such surveys.” This statement and Brown’s op-ed indicate to me that we have a lot more work to do to change the culture of American medicine. Dr. Day and Nurse Brown just don’t get it. The patient is the only one who can judge their medical care.


  1. Amen! It is concerning when anyone in the medical community resists collaboration with the patient. When it is systemic it becomes diabolical.

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