Friday, March 16, 2012

"Hospitals Aren't Hotels"

I've had this this op-ed open for a few days trying to figure out what to make of it. The author's basic claim is that measuring hospital quality with the use of patient satisfaction data is a bad idea, because there isn't necessarily a good match between patient satisfaction and quality care.

I think I can at least partly agree with this thesis; I'd want to say right away that patient satisfaction shouldn't be the only measure of quality used (but I doubt anyone who's consulting quality measures is doing that), and that you can imagine situations where patient satisfaction is high but quality care is low (for example, a short hospitalization has several avoidable errors, but the doctor takes responsibility and apologizes to the patient and her family, and the kind and attentive nursing staff works hard to fix whatever happened, gives the family a copy of the formal report, etc).

But this isn't the claim the author is making. Instead, she says "hospitals aren't hotels" and "In order to heal, we must first hurt." Essentially she seems to be saying that patients aren't capable of ranking their satisfaction with hospitals in terms of hospitals, but instead will insist on ranking them like hotels, or restaurants or something, where if they don't get the outcome they want, or the pillows were flat, or the soup was too salty, they'll only grant one star.

I should stop here to specify that, erm, I didn't look anything up (what the surveys are like, if they've been studied as research tools, etc), and I'm just sort of babbling/thinking. It just seems like a strange and vaguely insulting claim to make about people. Sure, when people are patients, they're often in pain, disoriented, frightened, and maybe sometimes demanding or have unrealistic expectations. But it's not, in fact, like people truly believe that their hospital stay is going to be like a holiday in the tropics, and I really doubt that when people are surveyed about their hospital stay, they're comparing it mentally to their last vacation. They're probably comparing it to their last hospital stay, or their last interaction with their doctor, or dentist, or what a friend told them about a different hospital experience, or something like that.

I know there are a few physician bloggers who write, frankly, hilarious (anonymous) stories about their clueless, rude, or just plain weird patients. I know those patients are out there. But I don't think that describes most or all people. (Coincidentally, I care just as much about their satisfaction, but anyway.) My guess is that most patients are fully capable of realizing that hospitals are probably unpleasant and painful places that can nevertheless vary on other metrics, like how well hospital staff communicate, the responsiveness of the hospital to problems that arise, the clarity of admission/discharge/paperwork, etc.*

The anecdote the writer tells, then (about an old man who at a second hospital confronts the hopeless reality that there are probably no more treatments - the implication being that he would give a low satisfaction score), I don't think, is very telling. The survey doesn't ask "Did you like being told at this hospital that you would die?" If he was told kindly, with time allotted to sit with a doctor and process; if the nurses were told as well so they would act with particular dignity and kindness in his presence; if someone took the time to help him understand why there were no more treatments and offered to consult with his other physicians or wait for him to have a second opinion; if he was allowed or encouraged to have family members present for these conversations; if he was offered a connection with a social worker or a hospice counselor, I have to imagine his satisfaction rating would be high.

* I just cheated and looked up what the survey actually asks about: "communication with doctors, communication with nurses, responsiveness of hospital staff, pain management, communication about medicines, discharge information, cleanliness of the hospital environment, and quietness of the hospital environment." So, yeah.

PS. The author quotes a study - about physician satisfaction, not hospital satisfaction - suggesting that high satisfaction is tied to overuse of care and higher mortality. I didn't look but overuse seems like a separate issue to me.

PPS. I would love to hear your thoughts!

1 comment:

  1. So agree! I was surprised that the story he chose to tell was one where it sounded like the physician in question didn't deliver the news very well...yet it was the news itself that was supposed to have broken the patient satisfaction score. To singlemindedly focus on patient satisfaction and use no other metrics is obviously problematic. But to ignore patient satisfaction is also a mistake!