The ultimate goal of patient-centered care is to heal the patient. But the Affordable Care Act has begun linking hospital reimbursements partly to patients’ satisfaction — how they feel about their experience.
In a Gallup Business Journal article, Jennifer Robison says the health care industry is concerned about the right “patient experience” and is striving to find innovative ways to provide it. But she notes that there’s a continued debate as to what it actually is.
Hospitals in Georgia are deeply involved in trying to improve each patient’s experience of care, sometimes seeking to take it to an entirely new level. For example, at Gainesville’s Northeast Georgia Medical Center’s imaging department, the traditional flimsy gown has been replaced with a warmed robe.
“All of our facilities have the patient’s best interest in mind,” says Debbie Duke, director of imaging services for the Northeast Georgia system. “That hasn’t changed.” But Duke says she had long had a vision of “what could be for women” compared to what was being done.
Women are often nervous, she says, especially when additional imaging studies are required. She was determined that if she had the chance to work with an interior designer, she would make imaging a more pleasant experience for everyone — and women in particular.
Finally she got that chance.
“For children,” she says, “there’s a kitten scanner” in the imaging area.
“This scanner is not only used for children,” Duke explains, “but it speaks in 17 different languages so our non-English-speaking patients can better understand the kind of test they are about to have.”
“Really, it’s the little things that can make a difference in how the patient remembers being treated,” said Duke. “We thought a spa-like atmosphere with warm robes would redefine how women felt before a mammogram.”
“We also applied some of these ideas in our CT or MRI exam rooms, too,” she said. “There are relaxing images, such as clouds on the ceiling.”
At Northeast Georgia’s Braselton imaging facility, hospital officials want to provide a relaxing “ambient experience,” Duke says. She describes how patients will be able to choose what scenery will be projected on the walls, such as mountains, the ocean, or even children’s cartoons, as well as colors in the room to help decrease anxiety.
Kind treatment works wonders
The new patient satisfaction movement includes a survey called HCAHPS (pronounced “H-caps” ), the abbreviation for Hospital Consumer Assessment of Healthcare Providers and Systems. Simply put, it collects data and measures patients’ perception of their experiences while hospitalized. It’s the first nationwide, standardized, publicly reported survey of patients’ perspectives of hospital care.
The survey asks discharged patients about their recent hospital stay. The questions include such subjects as communication with nurses and doctors, the responsiveness of hospital staff, the cleanliness and quietness of the hospital environment, pain management, communication about medicines, discharge information, overall rating of the hospital, and whether they would recommend the hospital.
Under the health reform law, Medicare is using these surveys to help determine bonus payments for hospitals.
Hospital administrators view HCAHPS as a way not only to improve care for their patients, but to improve their own bottom line, since scores are linked to specific reimbursements and patient loyalty. Both keep hospitals in business.
Hospitals are focusing on services that help patients have a pleasant stay, not just those that help them get well. For instance, if hospital staffers appear to ignore a patient’s call light, it can make a big difference on how the patient feels, even if the individual’s surgery was successful.
“A speedy response to a call button or a quiet room at night does not mean you’ve received the best quality health care,” says Dr. Carolyn M. Clancy, director of the Agency for Healthcare Research and Quality (AHRQ), “but both are important to patients.”
Behavioral changes start at the top, with administrators and physicians. Medical personnel are being asked to do something that goes slightly beyond clinical care.
Atlanta physicians Barry Silverman and Saul Adler, in a soon-to-be-published book, say some physicians are prime candidates for training in proper communication.
Silverman and Adler say the typical patient’s impression of a physician’s capabilities is not based on the doctor’s actual medical expertise (which few patients have the training to evaluate) but on the doctor’s bedside manner. The quality of care that patients feel they receive “comes from the . . . doctor’s concern for you as a patient and a human being.” In other words, physicians need to be nice to people.
Nurses, too, are making behavioral changes. Many say they now spend more time in their patients’ rooms, where they are focused on communication, education and empathy. Patients remember that.
In addition, all staffers coming into a patient’s room are strongly encouraged to wear a smile, whether they carry a stethoscope or a mop.
A ‘culture of safety’
Mayo Clinic Health System in Waycross is focused on “placing the patient in the center of their care,” says Holli Sweat, chief nursing officer at the South Georgia facility. “The words we promote [as guidelines] are ‘safe,’ ‘effective’ and ‘compassionate.’ ”
“As part of our culture of safety,” Sweat says, “we initiated a bedside medication verification system.”
The patient experience adjustments that have been made in Waycross are purposeful.
For example, a recent $6.5 million, three-story expansion was designed for patients to be more comfortable than ever — using evidence-based designs, technology that allows bedside charting, state-of-the-art bedside monitoring, and plenty of natural light. The rooms, designed with comfortable sleepers for family members, include three zones: for the patient, family members, and staff.
“We take the patient experience very seriously,” says Loy Howard, president and CEO of Tanner Health System in Carrollton. To help patients with unexpected hospital waits, Howard says, “a 1,100-gallon freshwater aquarium and turtle habitat welcomes clients to the emergency room at our Carrollton facility.”
In addition, local musicians frequently offer free performances for patients and the public on the first floor of the hospital. The calming effect of music seems to be therapeutic for patients and encourages relaxation for visitors.
Today’s emphasis on patient-centered care has gone far beyond “do no harm.” Healing is still the central concern, but how patients feel about the healing process makes a difference, especially when it’s tied to a facility’s reimbursement. Patients generally rely on their own memory when completing their HCAHPS surveys, so it’s good to have them leave the hospital in a satisfied frame of mind.
Physicians, nurses and other health care providers have always had patients’ lives and well-being at heart. That’s why they chose the medical profession. But they didn’t always pay attention to how each patient felt while receiving care.
They do now.
Judi Kanne, a registered nurse and freelance writer, combines her nursing and journalism backgrounds to write about public health. She lives in Atlanta.