Monday, January 11, 2010

Patient Experience at AMCs

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.


  1. Greetings, Mr. Brown:

    I applaud your concern for the urgent need to treat hospital patients with respect and dignity. However, I can't help but notice that the article addresses the implementation of Planetree only on medical units.

    Conditions of inpatient psychiatric units have been in free-fall for years, and if things are bad on medical floors, the situation on psych units is catastrophic. It seems like the 'rules' of patient treatment are completely cast aside in the name of Risk Management (continued)

  2. (continued) A bill effort is under way to add enforcement language to the only law that codifies the basic civil rights of psych patients - HB 1945/SB 743, Co-sponsored by Sen. Pat Jehlen and Rep. Denise Provost. That law is Mass. General Laws, Chapter 123, Section 23, which is violated thousands of times a day, due to no such language existing. Unfortunately, many hospital lobbyists, including the Mass. Hospital Association and the Mass. Association of Behavioral Health Systems, are fighting this bill, which upholds an existing State Law.

    I hope that UMMC hospitals are actively implementing Planetree on psych units. I hope that UMMC can serve as a model for patient rights and dignity, espoused by the law.

  3. Anonymous. Thank you for your comment and for raising this important issue. I do agree that psychiatric illnesses get the short straw and that is a tragic part of our health care system. I do think things are improving, but not nearly at the pace they should be. Perhaps with new payment methods (like global payments), the incetnives will be better aligned to encourage more effective treatment of these illnesses. At UMass Memorial, we do have a very proud history of serving the needs of those with mental and psychiatric illnesses, but I'm sure we too have plenty of room for improvement. I want not aware of the bill you mention, but I will look into it.

  4. I'd like to add that dignifying and compassionate care for people with mental health conditions is not just a good practice but also a part of treatment itself, or should be. In the late 1880's something called Morale Treatment was just that and outcomes were excellent, far better that the couple of percentage points of improvement for anti-depressants being offered as the meat of treatment these days and without any of the horrifying and sometimes permanent or deadly side effects of some psych medications. Given that the vast majority of people with mental health conditions are trauma survivors - who need a soft place to fall, loving, healing and safe environments where their preferences and heeded - it is high time these considerations were integrated as a matter of course. People in recovery, such as myself, are the experts on how to transform the system. Yet we find ourselves all too often on the outside being given lip service on the value of our role and being expected to volunteer. To read more about Morale Treatment see the book Mad in America. It is a civil rights struggle.