The (Little) Things That Matter To Patients

Outcome measurement is top of mind for all of us in healthcare these days, and there’s been a lot of talk about whether measures drive the right behavior, with some examples of how patient satisfaction measures can create a “Disneyfication” of the healthcare system, which at its worst, results in animatronic nurses reciting scripts and patients demanding the amenities of a 5-star hotel.

Outcome measurement is top of mind for all of us in healthcare these days, and there’s been a lot of talk about whether measures drive the right behavior, with some examples of how patient satisfaction measures can create a “Disneyfication” of the healthcare system, which at its worst, results in animatronic nurses reciting scripts and patients demanding the amenities of a 5-star hotel. When managing towards patient satisfaction in the extreme results in a “patient is always right” mentality and additional or unnecessary procedures are performed on demand we need to question whether “patient satisfaction” or outcomes should be the goal. However, the patient experience with and in a healthcare setting impacts their desire and ability to recover, and therefore can impact outcomes.

Small and not so small things that focus on the patient experience, not in trying to win at patient satisfaction measures, but in really thinking about what will make patients comfortable and cared for to help them heal. At a recent talk at Seattle’s Cambia Grove, a physician who had recently joined Iora Health described their clinics as “places you could actually get better.” Compare how spas are designed to inspire you to health versus your average doctor’s office. A lot of healthcare offices feel like places you could get sick, and they often are.

In their annual report on patient outcomes, Hoag Orthopedics offers patient stories. I was struck by how fondly these patients recalled their hip replacement experiences. There is no way a hip replacement can be pleasant, but Hoag delivers such a high quality of care and for these patients, the hip replacement provided a release from constant pain and function back. As a result, the entire experience was positive.

That got me thinking about my own experiences as a patient and those of my loved ones, and which ones felt that way and which didn’t.

Similar to the Hoag patients, I had a really positive experience when I had an appendectomy, in Russia no less! A few things stand out for me about the quality of the experience:

• The hospital was extremely quiet and in a city of 13 million this was no small feat. Noise in hospitals is often cited as the number one complaint for patients impacting satisfaction scores, and has recently become a top priority for hospital administrators. Compare the noises of a spa to the noises of a hospital and consider which one you’d want to recover in.
  

  Luxury hotel or private hospital, the European Medical Center in Moscow

• As I regained consciousness in the recovery room, hot air was pumped into my bed—general anesthesia lowers the body temperature, but my first sensation on regaining consciousness was of being in a warm cocoon, this continued to my hospital bed which had a duvet on it. This may not seem like much but for someone who is always cold it made a big impression.
• I wasn’t able to eat anything but my roommate said that the food was incredible (and in Russia no less)
• The cost for all this value, including not having a burst appendix or other complications: 2 nights was less than $5000!

Contrast this to my mom’s experience during 6 months in a rehabilitation hospital recovering from a rare auto-immune disease. Blankets were flimsy at best and we supplemented them and the pillows to make her more comfortable—granted this was a long stay and adding comfort and personal items was important. While my mom was in the hospital she started losing her thick and still almost black hair. The physicians looked into whether it was side effects of any of the drugs she was taking. However, when she left the hospital it started to grow back. Her family physician diagnosed the problem: poor nutrition. The food in the hospital was of such poor quality that she lost her hair! Although this hospital had a nutritionist that reviewed patient’s diets, to save money they no longer had food preparation on staff and an institutional caterer brought in food. How did this lack of nutrition impact her recovery? Could she have regained strength and function faster with better food?

Two vastly different experiences with things that may seem tangential to care, but are they really? Think back to when you were a child and were sick. What did you want? Comforting nutritious food, and a cozy blanket. While what was most important in both experiences was treating the original problem: a duvet wouldn’t have helped me much if my appendix had burst or surgery was botched, however, the experience of being warm, comfortable, and cared for definitely helped my recovery. I raved about the experience to a friend who thought I was crazy until she had surgery at the same hospital: she didn’t want to leave either.

The way we are cared for impacts our own recovery, and often our desire for recovery. Patients need to feel confident and cared for and with this, they can take responsibility for their own health.