I was recently approached by a nurse friend working on the patient experience team at her hospital. She was upset about our posts at Integral leaders in Health. How could we characterize the current situation, where corporate hospital, payor, doctor and university well-being competes with patient well-being as a Medical Care Crisis? She told me how her hospital devotes enormous resources to make sure that patients have a positive experience. As a former hospital president and practicing vascular surgeon, did I forget how hard the patient experience team worked?
She makes a good point. The hospital-patient experience team, indeed, does a great job within the boundaries of their responsibility as the hospital.
But remember, our current crisis isn’t a hospital problem. It is a balance problem. The four components (doctors, hospitals, payors and universities/innovators) are out of balance and patient well-being is no longer the priority. No matter how hard we try to address the situation from the perspective of a single component, we will not be able to change our situation.
For instance, what is the role of the patient experience team during a stalled hospital/insurance company rate reimbursement negotiation where hundreds of patients are told they may have to find a new doctor; or when the hospital terminates a doctor’s employment and care is delayed as patients scramble to find new doctors? What are they supposed to do when administrators start making clinical decisions? Decisions like closing ORs and rescheduling patient procedures weeks later (often with no input from the clinician)?
The hospital patient experience team has no influence over mandated referral of patients to facilities owned by the doctors where profit motive has a higher priority than quality. They have nothing to do with unaffordable drugs being prescribed to patients. They have little to offer patients when their burned-out doctor retires early and there are no doctors accepting new patients. They are powerless to deal with mandated referrals of patients to an employed doctor’s facility for testing/ procedures even when there is a less expensive and more efficient option desired by the patient. The patient experience team has no authority over the universities to teach patient well-being as part of their curricula.
These are the patient dissatisfiers that fuel the Medical Care Crisis— dissatisfiers well beyond my experienced nurse’s control.
That’s not to say that hospital patient experience teams have no role in addressing the Medical Care Crisis. I believe they do. Consider the following:
In our research, which included interviews with dozens of patients, we found that the greatest opportunity for improvement was in the area of communication. Perhaps, the patient experience team should champion this cause – the re-engineering of communication? Specifically, we repeatedly heard how patient families would sit at the inpatient bedside of a relative and never see the same doctor more than once. Often the therapeutic plan would change with each rounding doctor. Were the doctors not talking to each other? Sometimes, the relative would miss the doctor altogether (during lunch perhaps). The plan was always obfuscated in those cases. “There is no quarterback in-charge” was a frequent lament.
Similarly, we frequently heard that as an outpatient, when tests/procedures were performed, there may be days, even weeks, before a result was conveyed to the anxious, worried patient.
Sometimes, the result was texted electronically to the patient, even when the news was bad (like cancer). Both examples of poor inpatient and outpatient communication seem like easy fodder for an ambitious patient experience team to address? No?
The problem (and thus, the opportunity) with communication in medicine rests with the fact that patient communication is always an added task to someone’s full-time duties. Nurses are expected to oversee medicines on 35 patients in a care unit. and communicate with every family member when approached. Surgeons are expected to perform five operations a day. and communicate with every family member when they arrive. Doctors are expected to see 30 outpatients in the office, and call test/ biopsy results to every patient in a timely manner. Communication in healthcare is always an add-on to someone’s already busy day. And the result is often bad medical care.
Name one other enterprise the size of healthcare that does not have a dedicated team with a senior leader whose sole responsibility is communication and public relations – should medicine be different? For example, why would a hospital not assign a health professional to every in-patient unit, where their sole responsibility is to round with each doctor, nurse and therapist that comes in contact with a patient, and then communicate the plan to the patient and their family?
Asked differently, why shouldn’t the hospitals hire “clinical quarterbacks?”
Why wouldn’t a similar type “clinical quarterback” be hired to champion outpatient communication as well? In a balanced healthcare environment where patient well-being is the priority, such “clinical quarterbacks” would be the responsibility of the hospital.
And with that, would not the patient experience team be the ideal group to oversee such an elegant process, a process that truly addresses the Medical Care Crisis?
Integral Leaders in Health stands ready to work with any hospital patient experience team to help make this “integral idea” a reality. That includes my nurse friend and her patient experience team.