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For other articles and previous issues click here. October 4, 2004 Patients
Are a Virtue Besides providing quality care, smart and innovative healthcare systems are creating a friendly environment where a tasty batch of just-out-of-the-oven chocolate chip cookies works wonders. The quality of patient care is an issue throughout the United States at nearly every hospital and healthcare facility. But what about incorporating patient-friendly characteristics while maintaining a comfortable profit margin? According to many healthcare administrators, there is a way to do both. One of the leaders in providing a “patient-first” experience is Windber Medical Center in Windber, Pa., a small town of less than 5,000 residents in the coal-mining region of west central Pennsylvania. Back in the mid-1990s, Windber Medical Center seemed to be headed for a slow death, but things have turned around under Nick Jacobs, who was named president and CEO in 1997. With the support of several administrators, Jacobs—whose background includes teaching music, art, and tourism—instituted a philosophical change at the hospital that includes massage, music and aromatherapy, pajama bottoms and bathrobes, fresh-baked bread and cookies, double beds in the OB area so husbands and wives can share a bed, and yoga. Much of the credit goes to Planetree (www.planetree.org), a nonprofit organization that outlines a plan for hospitals to treat patients like pampered guests without damaging the bottom line. In essence, the organization—which now includes more than 100 healthcare facilities—espouses the philosophy of “creating patient-centered care in healing environments.” Jacobs says changing Windber’s clinical philosophy wasn’t easy and admits he was almost fired in 1999 because the thinking was so radical. But since 1997, Windber has seen its revenue increase by more than 300%, enjoyed exponential increases in the emergency department and other departments, and was recently named one of the top 15 care hospitals in the country by Modern Maturity Magazine. “I could never figure out why you can spend a thousand dollars a night to stay in the Ritz-Carlton and there will be people falling over themselves servicing you, and you can spend more than a thousand dollars a night in a hospital and you are lucky if someone changes your bedpan,” Jacobs says. His thinking was particularly affected by watching his father die from lung cancer at 58 in a large healthcare facility where no one would bathe him and Jacobs and his family members slept in hardback chairs. “It was a cruel experience,” he recalls. “Now what we attempt to do is to demystify healthcare.” Janelle Barlow, PhD, owner of TMI USA, a Las Vegas-based marketing and consulting firm, says most of the issues that have been cited on her healthcare clients’ patient satisfaction surveys have little to do with the clinical end. “Billing is always an issue because in some cases billing departments come across like aggressive debt collectors,” says Barlow, coauthor of Branded Customer Service: The New Competitive Edge. “So many mistakes are made on billing it seems that virtually every stay requires some clarification for the patient.” Barlow said in some cases, patients feel like they are “buying hubcaps” when it comes to the billing issues and the way their bills are handled. In addition, insurance limitations that “kick” patients out of the hospital earlier are a major concern with patients even though they have little to do with the hospital or healthcare facility. Another concern is having a physician handle too many patients simultaneously, resulting in patient care that is perceived to be lower than average. So what are the solutions to these problems? Barlow admits she doesn’t have the magic potion, but she has worked with her hospital clients on ways to make the patient feel more cared for as soon as they enter the hospital. “By the end of the stay, a patient wants to feel as if they have received a great deal of attention,” she says. “They want to feel special and confident that everything that could have been done for their well-being was.” This patients-first attitude could include small perks such as giving a patient a short, personalized tour of a wing or department or installing small refrigerators in patient rooms. South Nassau Communities Hospital (SNCH) in Oceanside, N.Y., has tailored an in-house training program at a minimal cost to identify the top 10 service behaviors they want staffers to practice. Vice President for Performance Improvement Ruth Ragusa says the decision was made to do this in-house rather than outsource the work because it costs less and the message means more to staffers when it comes from internal coworkers. The training program, which is taught to multidisciplinary groups of 20, requires participants to sign a “service pledge.” A total of eight training sessions comprise the program, and the hospital has prestated targets and goals each year that must be addressed. “At our sessions, we practice role playing and use real-life experiences to help improve our service,” says Ragusa. “For the program to work, though, it needs leadership involvement from the get-go and it requires constant communication, both verbal and written.” SNCH Assistant Vice President for Human Resources Paul Giordano says staffers are encouraged to treat a patient or visitor as they would want to be treated. “We want them to be both proactive and reactive as to what our customers require,” he says. Ned Barnett, APR, the owner of Barnett Marketing Communications in Las Vegas, has been working with healthcare clients for many years. He says a hospital’s customer service is dictated by finances, both costs and reimbursements. One idea is to encourage physicians to practice more experience-based medicine, such as using statistical analysis to determine best practices based on outcomes rather than on “how it’s been done in the past.” In essence, physicians can adapt these practices to everything from care to referrals. “When patients have a choice, they will always choose the hospital that seems more consumer-friendly because they have little ability to discern technical capabilities,” he notes. “[Whether or not it is accurate], patients will intuitively relate caring as manifested by consumer-friendly attitudes and practices with quality.” Barnett says maintaining a handsome bottom line is possible while being more patient- or consumer-friendly. In fact, it’s vital. He suggests hospitals hire an ombudsman to conduct research among patients and prospective patients to help determine what is important in terms of service. “This can be important for staff training and motivation so a hospital will deliver on what patients want and need,” he says. Quint Studer, a former hospital president and 20-year healthcare veteran, is founder and CEO of Studer Group, headquartered in Gulf Breeze, Fla. Studer says it is not a surprise that the country’s best hospitals are adopting patient-centered healthcare models. What is surprising is the depth of the strides that have already been made. Studer believes patient-driven hospitals are becoming the rule rather than the exception. “There has definitely been a paradigm shift,” says Studer, author of Hardwiring Excellence: Purpose, Worthwhile Work, Making a Difference. “Hospital administrators and management teams are well-aware that empowered consumers are shaping the goods and services they buy across every spectrum of business. And they are acting on this knowledge with heartening speed. The most successful hospitals are those that listen to what customers want and give it to them. It’s that simple.” Studer has identified some of the characteristics of the nation’s top-performing hospitals. They include the following: • They strive to create a caring, friendly environment. Employees at successful hospitals understand that patients might feel vulnerable or uncomfortable in what seems like an alien environment. • They employ “key words at key times.” Patients typically feel in the dark about what’s happening to them at various times during their stay. Great hospitals take steps to keep patients enlightened about every aspect of their care, even those that may seem insignificant. • They regularly communicate credentials. In healthcare, experience is everything. However, too often an experienced doctor wrongly assumes that patients know his or her background. Referrals are so common that many patients really have no idea how experienced a physician might be. That’s why great hospitals coach care providers to volunteer their credentials. • They communicate the plan for patient care. Healthcare professionals tend to be naturals at clinical procedure but may not be as good at keeping patients informed. Often, they may wrongly assume patients already know what’s going on. Great hospitals insist that employees keep patients in the loop during each and every interaction. • They communicate well with family members. Great hospitals make sure that doctors are focused on the needs of the patient as much as possible. They look for ways to maximize their communication with family members. Studer says other examples include scheduling convenient visiting hours, reducing wait time without making patients feel rushed, diligently managing patient care, and devising clear and understandable billing procedures. “Patients are generally not ‘regulars,’ so it’s understandable that they don’t know what to expect from a hospital,” Studer says. “But when they identify the issues ahead of time—and when they feel empowered to ask questions—it raises the expectation level. And higher expectations lead to policy changes, which lead to higher standards of care.” Denise Strong has visited numerous hospitals in the Detroit metropolitan area in the last several years as a community volunteer and with both her parents, who have required overnight stays. Strong has noticed more emphasis on caring in some of the hospitals and a more comforting atmosphere in new facilities but says that in most places the nursing and care staff is overworked and stressed. “You see some surgical rooms and cancer centers with lighter, more cheerful colors, single-patient rooms, and, in general, less sterile environments,” she says. “But it still comes down to the people who provide the care, and all too often they just aren’t around enough.” Providence Health System, a nonprofit healthcare organization with participating doctors’ offices and clinics in California, Alaska, Washington, and Oregon, found it necessary to deal with a specific challenge as a way to improve patient care. With a growing list of physicians at healthcare centers throughout the West Coast, it needed to find a better way to get patient history information to its physicians in real time. For years, Providence Health System received high marks for making healthcare information available to consumers through its Web site. But then physicians needed this same service for their clinical needs. In 2003, the health system built a Web portal bolstered by data warehouse services that aggregate information on individual patients. The portal makes the medical histories documented in Providence-enrolled doctors’ offices and clinics available to doctors treating patients who have entered its acute and long-term care facilities. As a result, when a doctor from a convalescent facility needs to know a patient’s medication or treatment history, he or she can go to the portal and within three seconds receive a report detailing everything Providence knows about that particular patient. Called the Health Integrated Delivery Network, the system is expected to improve patient care and let doctors work more efficiently. In 2004-05, Providence plans to add a new service using a technology that will allow doctors to send secure messages on health issues or test results to patients. Mike Reagin, director of research and development for Providence Health System, says the system understands that improving patient care not only includes dealing directly with the patient but also making the job of its physicians less cumbersome. As a result, the staff should provide better patient care in a more timely manner while reducing physician caseloads. Strong says reducing physician and nurse caseloads would be a critical step toward providing more patient-friendly care. “There has to be some ideas out there that would work—shorter shifts, more volunteer help—something,” she says. “I’m sure it’s difficult with the rising costs of healthcare, but patients rightly feel they should be getting something more than medicine for their money.” That seems to be the case at Windber, where patients are visited by “The Golden Girls,” a pair of friendly golden retrievers, and other pets. Patients are also allowed access to their own medical records, and a Spiritual SWAT Team has been formed consisting of more than 120 spiritual counselors who are available at a moment’s notice. Beyond the bottom line, Jacobs says Windber has seen its infection level fall below 1% while compiling one of the state’s lowest average lengths of stay and mortality rates. “We’ve learned that doing everything from making cookies to having pets roam the hall doesn’t lead to more germs like conventional thinking would suggest,” he says. “Patients actually heal faster in this environment.” And for those administrators who are concerned about finances, Jacobs has one last piece of advice. “True affordability is not the issue—the philosophy you use is,” he says. “At the end of the day, it’s a wonderful experience touching patients’ lives in such a profound way.” — Mike Scott is a freelance writer who has contributed to more than 70 magazines, newspapers, and Web sites on numerous topics—from business to healthcare to technology. He lives in Waterford, Mich. |
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