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Friday, October 11, 2013

Ranking Hospitals: Customer Service vs. Patient Care

By Heather Millar

woman in hospital

A couple of years ago, just as I was finishing my radiation treatments, my daughter fell out of a bunk bed during an active dream and knocked herself unconscious. She lay on the floor, staring straight ahead. She was unresponsive for a couple minutes. I can honestly say those were probably the worst moments of my life. I thought my girl was dead, and immediately started wailing.

Thank God for a college pal, a doctor, who was with us.  She immediately went into ER doc mode, calmly made sure my daughter was still alive, kept her immobile once she woke, tried to get me to stop screeching and called for the ambulance.

The ambulance took our family to a lovely little regional hospital – so quiet, such nice nurses, a kind and understanding ER specialist, no wait for the CAT scan to make sure my daughter’s brain wasn’t hemorrhaging. We were in and out of the ER –procedures, tests and all – in a couple hours. Lightning speed, if prior ER experiences are any measure.

The following Monday, I saw my radiation oncologist and told her the story.

“You were lucky,” she said. “That’s a terrible hospital. We have a summer house nearby. I cut my hand during a home improvement project and went there. I suggested that they should disinfect my hand before stitching it up, but they didn’t. I’m a doctor, but they didn’t listen to me. My hand got very infected; my colleagues here [at a big academic hospital] had to undo the damage. My hand was a mess for more than a month.”

A study about to be released by Thomas Jefferson University in Philadelphia, may explain this anecdote: It concludes that patient satisfaction might not be the best measure of hospital quality.

Patient satisfaction is one of many measures that are used in a statistical method, PRIDIT, used to gauge hospital quality and set reimbursement rates.  Dr. Robert Lieberthal, assistant professor in the School of Population Health at the university, refined this method, taking into account patient experience, but heavily weighting actual patient outcomes to score hospitals.

According to Dr. Lieberthal, if you have a complicated condition, like cancer or heart disease, you’re more likely to have a better outcome in a big, busy hospital. The more patients and beds a hospital has, the reasoning goes, the more experience the medical staff acquires. More experience leads to better medicine.

Yet big academic or urban health centers are also more likely to be noisy and chaotic and to serve yucky food. In a busy hospital, your nurse might not respond right away because a patient down the hall is having an emergency. In a busy hospital, nurses are more likely to wake you in the middle of the night for meds or shots, because that’s when they can get to it. In a busy hospital, you’re more likely to have to have a roommate who moans all night or keeps the TV too loud.

None of that is fun for patients. As Dr. Lieberthal says, “Based on this study, the hospitals that have the best survival outcomes are not doing the best job of satisfying patients.”

In other words, you may be miserable in a big, busy hospital, but you may also be more likely to survive there. In this consumerist, “customer is king” society, none of us want to hear that. But it’s something to remember the next time you’re picking a hospital.

What do you think?

Posted by: Heather Millar at 11:15 am

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