Why aren't teaching hospitals providing a better overall experience for their patients? That is a question I explore in an Op Ed today in the Boston Globe. You can find it here. The one great thing about writing Op Ed pieces is that it forces you to distill your thoughts to their true essence, since 700 words is not a lot of space. The one great thing about blogs is that it allows you to expand upon your Op Eds! So here are a few additional points.
First, a few more words about Clinton Hospital. Their performance really is remarkable, even for a small hospital. Of the 10 patient satisfaction measures reported on (the results of the survey questions I mention in the piece), Clinton is in the top 10 percentile in the nation on 8 of them. I have not found a hospital anywhere that performs that well. There may not be one. What is their secret? Not a magic formula. Clinton President and CEO Sheila Daly tells me it's all about culture. "Our staff does not know any other way. Putting the patient first is just how it has always been here."
Second, there has been much discussion of late about the relationship between cost and quality. But not much about cost and experience. A few weeks ago, the New York Times did an interesting story on end-of-life care. It highlighted UCLA - one of the most prominent academic medical centers in the country. UCLA has been receiving the kind of attention lately it can do without. According to Medicare data, it is one of the most expensive hospitals in the country. For the last six months of life, spending at UCLA is double the rate of the Mayo Clinic ($50,000 versus $25,000), with no better quality outcomes. White House Budget Director Peter Orzag says this of the disparity: “One of them costs twice as much as the other, and I can tell you that we have no idea what we’re getting in exchange for the extra $25,000 a year at U.C.L.A. Medical.”
U.C.L.A. Chief Executive David T. Feinberg says what "we're getting" is a full court press to save lives. “If you come into this hospital, we’re not going to let you die,” he said in the story. But one thing we're not getting for all that extra spending is a better patient experience. Of the 10 publicly reported patient experience measures, Clinton beats U.C.L.A. on 9 of them (and the 10th was a tie). The U.C.L.A. scores are worse than the national average on 6 of the 10 measures (on 2 of the remaining 4, they are tied with the average). In fairness, like many AMCs, they do beat the average on two important measures (overall rating and likelihood of recommending the hospital). My point here is not to trash U.C.L.A -- it is a great hospital. It is simply to demonstrate how far all AMCs still have to go in improving the patient experience.