Hospitals Should Learn from Hotels

Posted March 23, 2012

By Kent Bottles, MD

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.

–Kent Bottles, MD, is a member of the Wing of Zock external advisory board.

0 thoughts on “Hospitals Should Learn from Hotels

  1. Agreed! Evidence increasingly shows that comfort heals, as well. If we’re serious about helping patients to recover from illness and injury, caregivers simply must consider patient satisfaction and do all possible to mitigate stress and anxiety of patients receiving care.

  2. Indeed, hospitals are not hotels. Sick people don’t check into hotels to be relieved of their pain and their fear or to be treated for their illness. They go to hospitals to be relieved of their suffering which is a multi-faceted condition – physical, emotional, spiritual. I know that some procedures hurt, but I’m not going to hold that against the health care professionals that perform the procedure. What I will judge them on, however, is how they responded to my pain. Was it anticipated (and even prevented), acknowledged and treated? Was I shown care and compassion? Was I treated with respect? The health care system, hospitals included, does not exist in isolation – it is woven into the fabric of communities. Its job is not to perpetuate itself – it’s to care for the human beings it serves. Illness doesn’t just happen to a body. It happens to a person and to everyone touched by that person. I recently went to the hospital lab to have blood drawn. The phlebotomist was working alone, having a very busy day, and I had to wait quite a while. She apologized so sincerely for keeping me waiting that I immediately forgave her. Her response to my experience confirmed what I already know about my community’s hospital. It has a culture that cares about the people it serves. This is evidenced by things as relatively simple as an apology. My point is that humans are not fragmented beings. We experience life on many levels. Our lives are interwoven with the lives of many others. And we all exist in in systems that interact and affect each other. Health care that is delivered in such a fragmented fashion so as to not recognize anything beyond fixing one body part is not what we need or desire. If my hospital doesn’t understand this, I’m going to look for another one. Hospitals should not be held to hotel standards. The standards should be much, much higher.

  3. I’m a nurse tired of patients demanding lattes, thinking that it’s ok to call me “the help”. I’m tired of independent patients laying in nests of 20-25 pillows asking why my doing CPR on a dying patient is more important than getting their cell phone one inch closer to them.

    As some nurse blogged:
    “No, it’s not the people who don’t need to be there that get to me. It’s the lack of understanding that we see people according to acuity, not first come first serve, and that if you’re waiting, it’s because someone else CAN’T wait.

    It’s that we are witness to horrific pain, tragedy, and grief, and have to just stuff it down and keep going. Trying to dredge up an empathetic presence for someone who is NOT ill, who is being impatient, after just having been witness to something awful is really, really hard sometimes.

    But, I still do it. I stuff it all down and treat everyone as nicely as I can muster, then go home and have a really good cry.”

    1. As a professional registered nurse, I wouldn’t like being called ‘the help’ either. But allow me to offer you another perspective. The most valuable thing I learned in graduate school is that every behavior serves a purpose. Whether they are aware of the real intent or not, people don’t do things without a reason. Patients I cared for when I did hospital nursing were out of their element, away from home, missing their family or their pets, scared, not in control, in pain, worried about finances or keeping their jobs…..
      The medical model fixes problems, and in too many parts of the health care system, that means body parts that are broken or organs that aren’t working. Nurses are trained to care for people who are living with a broken body part or organ. That means we look at the whole person. In addition to a physical assessment, we do a psychosocial and even a spiritual assessment. We know how all aspects of a person work together and how the care just isn’t as good when the problem is treated in isolation.
      This is true on a larger level as well. Hospitals with a medical model culture treat diseases and other health care problems. That gets noticed by the patients – the customers. Hospitals that treat people as human beings care that the experience of each individual they serve is as good as it can be….effective, efficient, respectful…relief from suffering. Patient satisfaction is a good measure of that.
      I encourage you to be a change agent in your hospital. Serve on a committee that crafts policies that support person-centered care. Start a volunteer program that can ‘wait on’ people whose needs don’t necessarily need to be attended by a health care professional. Advocate for the support you need to do your job well.
      Google ‘nurses are the most trusted profession’ and you’ll see link after link of online articles about how much respect and trust Americans have had for nurses for more than a decade. Know that you are a valued health care professional and take a seat at the table where change happens in your hospital.