It’s hard to imagine enjoying a hospital stay, however hospitals are trying to improve the patient experience. Back when I worked for a hospital the executives would bristle when someone joked that the daily room charge in a hospital cost 10 times the daily room charge in a nice hotel. The ratio is probably closer to 30 times now. Despite the massive price increase, hospitals still don’t excel at hospitality.
During Covid-19, patient-experience ratings plunged amid staffing shortages, overcrowding and lockdown rules that barred families from the bedside. Now hospitals are adopting new strategies to help address complaints and service failures that can add up to a bad experience even when treatment is successful.
An executive at Henry Ford Health in Detroit blamed it on high expectations:
“Consumer expectations are being set by industries outside healthcare, and the onus is on us to be better about meeting those expectations and finding where we can go above and beyond,” says Heather Geisler, a former senior vice president of global brands for Hyatt Hotels who joined Detroit-based Henry Ford Health in 2020 as executive vice president and chief marketing and experience officer.
That sounds like meaningless marketing hype. A hospital is not a hotel. Most hospital inpatients don’t want to be repeat customers. Patients don’t even select their hospital. Often, it’s the preference of their admitting physician, whom patients chose for reasons other than hospital affiliation.
In their quest to improve the patient experience hospitals are using questionnaires and analyzing visitor comments looking for patterns. One of the top complaints? The food tastes awful.
Hospital food has long been the butt of many jokes, and it consistently shows up as a bad experience in satisfaction surveys.
To counter those dings, more hospitals are hiring chefs, overhauling menus and steering away from overly processed foods like the standard lumpy mashed potatoes, gravy and mystery meat.
Another patient and family concern is cleanliness. Hospital building cleanliness is associated with perceptions of quality of care. If the rooms don’t appear sterile, how do patients know the medical equipment is germ free?
How patients feel about their environment figures prominently on satisfaction surveys, due in part to heightened concern over sanitary practices during Covid and fears of infectious-disease spread. “There is a fear factor with people’s concern about cleanliness, so when they see a bloodstain on the scrubs of a doctor or nurse taking care of them, it makes them feel unsafe,” says Dr. Thomas H. Lee, chief medical officer at patient-experience survey and analytics firm Press Ganey and an internist and cardiologist at Brigham and Women’s Hospital in Boston.
When I worked in a hospital I recall attending a staff meeting where the nursing managers complained about bedpans in the hallway. They wanted them removed sooner. It left a bad image in the minds of patients’ families.
Probably the most important determinant of patient experience is how they are treated by the staff.
Patient-satisfaction ratings are closely tied to issues such as how people feel they were treated by doctors and nurses. In an analysis of positive and negative insights from 175,334 patient comments collected at a major teaching hospital, Press Ganey found the most common positive theme across all comments was courtesy and respect. “If you don’t feel treated with courtesy and respect, you are never happy with care,” says Lee.
Nurses’ attitude toward patient or family requests effects patient satisfaction tremendously. Concern for privacy is important. Being kept informed with a “plan-of-care-visit” and responses to concerns are also important to the patient experience. Being acknowledged and greeted when a staff member walks into the room goes a long way to making patients feel cared for.
Closely related to courtesy and respect are complaints about communication—whether doctors and nurses explained things in a way patients and families could understand, and explained the reason for new medicines and possible side effects.
A final aspect of patient satisfaction is how patients are prepared for going home. My wife told me a story about when her mother was ready to come home after a hospital stay. They were told the day of discharge and were at the hospital waiting. The hospital could not reach her doctor to officially approve her mother’s discharge. They stood around waiting until my wife finally found a wheelchair, sat her mother in it and rolled her out to the car, without an official discharge. Twenty years later that anecdote is what sticks in our minds.
The root cause of poor hospital satisfaction is that hospitals aren’t competing for patients on the basis of price, quality or competing for patients in any substantial way. Hospitals’ idea of competition is buying physician practices to capture more referral revenue. Hospitals compete with flashy billboards on the freeway showing smiling children. Hospitals build 5-story chrome and glass atriums with overpriced gift shops at the entrance to entice patients with good insurance.
If hospitals want to be more responsive to patients they should start by lowering prices and boosting price transparency. Maybe empower the business office to accurately answer questions about prices and cost-sharing. How about don’t ambush patients with private contractors who arbitrarily charge fees far higher than are covered by a health plan.
I have long said hospital should be The Big Box Health Care Store, but instead hospitals are giant specialty shops that costs a fortune. Hiring former hotel executives to improve the patient experience is unlikely to increase satisfaction until hospitals begin treating patients like customers.