Posts Tagged patient satisfaction

Do Hospital Amenities Impact Quality Care?

Acccrystalchandelierording to a study at Johns Hopkins (2/1/15) improving hospital amenities improve patient satisfaction with the facility but otherwise do not improve satisfaction with care.  This is important for two reasons:

  1. Patients really can tell the difference — a crystal chandelier hanging in the hospital room does not make nursing care better!
  2. Patient satisfaction measurement is a powerful tool to assess medical care — if the patient’s expectations are met, it is likely good care is delivered.

The tremendous building boom for hospitals is strange given this bit of science  — are CEOs trying to improve quality by remodeling?   Now it seems clear CEOs should focus money and energy on improving hospital quality until the level of quality is very high then if there is money to spare consider improving the physical amenities.

Increasing the distance a nurse must walk to see patients results in decreasing nursing visits.  This seems simple enough, but the current trend in hospital remodeling is to eliminate rooms with multiple patients.  The trend reduces RN visits, increases the need for nursing assistants, increases hospital cost and may increase falls for elderly patients.

The hospital that looks like a nice hotel seems to be the desire of hospital CEOs.  This may be fine for obstetrics but may be wrong for geriatrics.   A multi-bed ward with 4 patients allows one nurse to check on 4 patients quickly.  4 times the number of nursing visits makes it much easier to prevent falls.  When nurses still wore those pointy white hats they had this figured out.

Progress marches on.  American health care quality is as low as many 3rd world countries but at least we have nice surroundings in which to suffer the complications.

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Patient Satisfaction (the CMS view)

The chart above is extracted from CMS data.  All US hospitals are now required to collect data on patient satisfaction.  This data is used by Medicare to adjust hospital payments upward for good satisfaction scores or downward for poor satisfaction scores.  This new payment adjustment certainly has the attention of hospitals since the adjustment amounts to a significant amount of money.

If one looks at the actual questions they really are pointed toward the quality of communication.   The questions are not about whether the treatment was satisfactory but whether there was good communication between the patient and the doctors, nurses and other staff.  The focus on communication tends to get around the criticism that sick people are never satisfied because they have some disease.   Even a sick patient can be quite satisfied (or not) with the communication received during a hospitalization.

The above table is the summary for the entire US.  The data is subject to a selection bias because the patient selects the hospital with some intent to select a good one.  But given that bias the results are not all that great — about 20% of patients did not feel they always had good communication with nurses and doctors.

Satisfaction is not the same thing as quality health care.  You might have been given the wrong medication or had unnecessary surgery but you went away happy (and ignorant of the problems).  Doing the right thing and getting a good outcome is what hospitals need to focus on.  Patient satisfaction is a small step in the right direction.

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