Patient satisfaction: Hospitals are not like car dealerships

Recently, I attended what may have been my last quarterly medical staff meeting at my local hospital — ever. (I am retiring from medicine in ten weeks.) I certainly wasn’t there for the food, although the fare was much better than the daily servings in the doctors’ lounge. Part of the night’s agenda was a rousing talk by the hospital’s new chief medical officer (CMO). A retired surgeon, the CMO is supposedly a liaison between the medical staff and the hospital administration, although with a hospital salary he has more allegiance to the hospital then his former peers.

His topic was patient satisfaction  and an argument that the new Holy Grail for a successful hospital was 100% patient satisfaction. He used comparisons of car dealers who ask you to rate their services on surveys as “always.” (Not “usually,” “sometimes,” or “never.”) Ignoring for a moment the fact that I find these disingenuous requests self-serving and annoying, even for a car dealer, I was struck by the analogy. So now the goal is to be perfect on new federal government questionnaires.

In case you missed that last part, patient surveys are mandated by Uncle Sam.  As if ACA, ACOs and medical homes weren’t enough, now part of patient care quality has been reduced to reviews like TripAdvisor or Angie’s List.

HCAHPS (pronounced H-CAPS) stands for Hospital Consumer Assessment of Healthcare Providers and Systems. It is the first national, standardized, publicly reported, survey of patients’ perspectives of hospital care. While many hospitals have collected information on patient satisfaction for their own internal use, until HCAHPS there was no national standard for collecting and publicly reporting information about patient hospital experiences of care that allowed valid comparisons to be made across hospitals locally, regionally, and nationally.

This all sounds good in theory. But what questions are they asking? There are 27 questions sent to random and recently discharged patients. They include communication with nurses and doctors, responsiveness of hospital staff, cleanliness and quietness of the hospital, pain management, overall hospital rating, and whether or not they would recommend the hospital to others.

The whole premise seems a bit flawed and skewed. After all, unlike a car dealership or hotel, one often doesn’t electively choose the hospital. Many admissions are emergencies, or mandated by insurance companies or where a patient’s doctor or surgeon has admitting privileges. From the hospital’s perspective however, this matters little since the same yardstick will eventually compare them all to each other.

Back to Dr. CMO.  He said, “Studies have found that patient’s perceive you have spent more time at the bedside if you are sitting rather than standing.”

“But,” I said, “there are no chairs in the room.”

“We know that, and are working to fix that issue,” he said. “We want all of our patients to answer ‘always’ to all of the questions.”

But many are out of our control. How can I ever effectively manage the pain of a drug addict? How can I control the quietness of the hospital if nurses are laughing, code blue, red, grays blare overhead, and alarms are going off constantly? I realize that a large part of medicine is the service industry, but how about some really important questions?

Here’s what I would like to ask the patients:

  • Did the condition for which you entered the hospital improve or go away?
  • Was the hospital bill clear and accurate and easy to understand?
  • Did a doctor explain procedures to you fully and in enough detail?
  • Was the food hot and edible?

It is essential that patient’s basic needs are met inasmuch as is possible, during the hospital stay. However, I would imagine that all of us, if inpatients, would gladly trade the waterfall in the lobby, or quiet time between 2 to 4pm, for clear nursing and physician communications, and quick response to a call bell.  Increasingly tethered to a computer, much of this becomes quite difficult. I do believe that the addition of computer workstations in the patient’s rooms does help this interaction.

HCAHPS is now mandated by ACA as part of the measures to determine hospital value-based incentive payments. Now I understand why suddenly they are so interested in these survey results. The new equation is better survey results equals more money from the government, at least now for the hospital, and maybe down the road, the doctor.

So as I ride off into the sunset of my career in private practice, I wonder how much more will be heaped upon the shoulders of physicians. After June, I won’t have to worry about HCAHPS,  ACOs, meaningful use, or ICD-10. I will be fishing.

No one will be asking the fish if I am standing or sitting.

David Mokotoff is a cardiologist who blogs at Cardio Author Doc.  He is the author of The Moose’s Children: A Memoir of Betrayal, Death, and Survival.

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