LEAH BINDER: Retirees in South Florida like to eat dinner early. Many line up for “early bird specials” by 4 p.m.
A year ago, a senior-citizen friend of mine was admitted to a hospital there.
“I should have listened to my neighbors and never come to this place,” my friend complained. What disappointed her so much about the hospital? Was it a cleanliness problem, rude staff, or a high infection rate?
No, she liked the hospital overall—and indeed it’s a high performer on standard indicators of quality. The hospital’s fatal flaw: dinner wasn’t served until 7 p.m.
I actually had the opportunity to speak to the chief executive of that hospital, who said he’d heard similar feedback but it wasn’t a big issue on his radar.
This was surprising to me. Shouldn’t customers dominate the executive’s radar?
Health care has virtually no tradition of considering the perspective of patients as mission-critical. That’s because in health care, the payment system creates confusion about who the customer really is: the patient or the payer? Patients often make different demands than health plans or Medicare. Providers meet the needs of both, but the check-writer tends to come first.
Providers also dismiss the perspective of patients because they aren’t experts in clinical medicine, or in the scientific principles of defining and measuring high quality care. The timing of dinner doesn’t appear in medical textbooks as an evidence-based best practice.
Yet serving dinner three hours late isn’t only a convenience issue for patients—though convenience matters when a hospital stay costs more than a suite at the Four Seasons. In fact, it has significant clinical ramifications for highly vulnerable inpatients. Adequate nutrition is important to the outcome of any treatment patients receive at the hospital. So in this case, the failure to put a priority on patient preference was more than a public-relations problem, it was a quality problem and a business problem. Listening to patients would solve it at all levels.
Luckily, times are changing. Nowadays, patients pay more of their bills out of pocket, and the expectations of the Internet generation put increasing pressure on health systems to respond to consumer demands in real time. The gap between payer and patient is closing.
Today, there’s a new buzzword in the industry: “patient-reported outcomes,” and it even comes with its own acronym (PRO). Hospitals are now required to conduct standardized patient surveys following discharge, and their payment from Medicare is partially based on those results.
We are also seeing innovative ways to solicit patient feedback, such as cellphone surveys and social media. Hospitals and health plans are using this data systematically to track consumer comment as a way to gauge overall quality of care. Policy makers and purchasers are increasingly incorporating patient reported outcomes into the criteria for payment and ratings of hospitals and physicians.
Leadership is taking note: The hospital industry invented a new job, the “chief experience officer,” to monitor patient feedback and drive change accordingly. Many hospitals have formed patient and family advisory committees that advise on a wide variety of operational and clinical issues.
Private-sector employers are also getting in on the action. A white paper by the Pacific Business Group on Health made a call for robust integration of patient perspectives into all phases of quality improvement and business purchasing decisions.
Outside of health care, pivoting your priorities to your customer is hardly a breakthrough. But in health care this is the new vanguard.
It’s a welcome departure from the tradition of keeping patients off the radar.
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