HM@15 - Is Hospital Medicine a Good Bet for Improving Patient Satisfaction?

The Hospitalist. 2011 October;2011(10):

October 1, 2011 | The Hospitalist

Among pediatric patients, a 2005 review found that “none of the four studies that evaluated patient satisfaction found statistically significant differences in satisfaction with inpatient care. However, two of the three evaluations that did assess parents’ satisfaction with care provided to their children found that parents were more satisfied with some aspects of care provided by hospitalists.”⁸

I think it’s really important to say, “I know you don’t know me, but here’s the upside.” And my experience is that patients easily understand that tradeoff and are very positive.

—William Southern, MD, chief, division of hospital medicine, Montefiore Medical Center, Bronx, N.Y.

Similar findings were popping up around the country: Replacing an internal medicine residency program with a physician assistant/hospitalist model at Brooklyn, N.Y.’s Coney Island Hospital did not adversely impact patient satisfaction, while it significantly improved mortality.⁹ Brigham & Women’s Hospital in Boston likewise reported no change in patient satisfaction in a study comparing a physician assistant/hospitalist service with traditional house staff services.¹⁰

The shift toward a more proactive position on patient satisfaction is exemplified within a 2008 white paper, “Hospitalists Meeting the Challenge of Patient Satisfaction,” written by a group of 19 private-practice HM experts known as The Phoenix Group.3 The paper acknowledged the flaws and limitations of existing survey methodologies, including Medicare’s Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores. Even so, the authors urged practice groups to adopt a team-oriented approach to communicate to hospital administrations “the belief that hospitalists are in the best position to improve survey scores overall for the facility.”

Carle Foundation Hospital in Urbana, Ill., is now publicly advertising its HM service’s contribution to high patient satisfaction scores on its website, and underscoring the hospitalists’ consistency, accessibility, and communication skills. “The hospital is never without a hospitalist, and our nurses know that they can rely on them,” says Lynn Barnes, vice president of hospital operations. “They’re available, they’re within a few minutes away, and patients’ needs get met very efficiently and rapidly.”

As a result, she says, their presence can lead to higher scores in patients’ perceptions of communication.

Hospitalists also have been central to several safety initiatives at Carle. Napoleon Knight, MD, medical director of hospital medicine and associate vice president for quality, says the HM team has helped address undiagnosed sleep apnea and implement rapid responses, such as “Code Speed.” Caregivers or family members can use the code to immediately call for help if they detect a downturn in a patient’s condition.

The ongoing initiatives, Dr. Knight and Barnes say, are helping the hospital improve how patients and their loved ones perceive care as Carle adapts to a rapidly shifting healthcare landscape. “With all of the changes that seem to be coming from the external environment weekly, we want to work collaboratively to make sure we’re connected and aligned and communicating in an ongoing fashion so we can react to all of these changes,” Dr. Knight says.

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Whats My Name Again

A particularly frustrating aspect of patient satisfaction surveys can be the difficulty in getting patients to remember the hospitalists who cared for them. With numerous studies suggesting that a lack of recognition can be a huge stumbling block for accurate and fair surveys, hospitalists are employing a range of memory aids.²

Doctors and nurses are writing their names on dry-erase boards, where they can post test results or scheduled exams, and invite patients and their families to ask questions. Other hospitals are handing out pocket cards or using bedside printouts that explain the types of doctors the patient may encounter, with pictures of the team members.

Newer survey-based tools, such as the Communication Assessment Tool and Press Ganey’s Hospitalist Insight, also include photos of individual hospitalists to help improve the validity and accuracy of the data. “If you get a survey with a picture on it, that’s going to go a long way toward helping you recall that experience, and so that’s where we went,” Press Ganey researcher Brad Fulton, PhD, says.

At the University of Colorado Denver’s Acute Care for the Elderly (ACE) Service, hospitalists were first educated about the importance of introducing themselves and making sure patients understood who was in charge of their care and who was on their team. “And then we moved from that to actually providing for our patients a handout that includes the names and pictures of the members of their team, individualized for that month, so they would know who was coming in and where they fit into their care,” says ACE director Ethan Cumbler, MD, FACP.

The double-sided page also established expectations of care: when the patients should expect to see their doctor, and what they should expect in communication between their doctor and PCP. The handout explicitly requested that patients bring up questions and invited family members to be part of the discussion on rounds.

“That’s getting beyond the individual provider behavior and into more of a programmatic intervention,” Dr. Cumbler says. “But the goal is the same: to make patients understand what’s going on with them here in the hospital and to help the hospital experience be a more comprehensible, less frightening, and more patient-centered experience.”