In late 2015, Petra Wilson, managing director of Health Connect Partners, a consultancy in Brussels, had a cardiac monitor fitted so her doctor could keep a closer eye on her heart.
One day, she got a phone call from her cardiologist about some slightly worrying data, and was asked to come in and discuss it. Lying on an examination bed, she was told she had not been looking after herself.
“I was quite indignant,” said Wilson, recounting the story at the ‘OECD Policy Forum on the Future of Health,’ held in Paris last week. “I’d done my best; before bed I’d try reading, drinking tea and exercising. But the doctor said, the data doesn’t lie, you obviously haven’t followed our advice.”
“Well, if the data doesn’t lie, I asked him if I could have access to it, so I could test it myself. But no, I was told the data my body generated was locked in the hospital for security reasons.”
The encounter left her feeling that the healthcare system can often be unwelcoming – even insensitive. “I was very disappointed and felt disempowered and disengaged from the system,” Wilson said.
For Samir Sinha, director of geriatrics at Mount Sinai and the University Health Network, this experience reflects the fact that, “the expectations of our patients have changed and our systems haven’t.”
Michael Porter, professor at Harvard Business School and author of ‘Redefining Healthcare’, a seminal work on the theme of patient-centred care, agreed. To correct this imbalance, patient satisfaction needs to become an explicit goal for hospitals. “Rating services is so embedded in our lives and we don’t even notice it. But it’s not normal in healthcare,” he said.
Hospitality role model
One route to improvement would be if hospitals borrowed some hotel-inspired features, services and staff training, said Don Berwick, president emeritus and senior fellow with the Institute for Healthcare Improvement. “We need to change the question and the lens by which we judge ourselves. It’s not what’s the matter with you, it’s what matters to you?”
“When I stay at a hotel I get an email asking me whether there was anything staff could have done differently to make my stay a little bit better. Healthcare could be more like this. It would help lead us away from the old doctors on pedestals, patients on their knees attitude,” Berwick said.
Metrics of patient experience and satisfaction are increasingly being measured and publicly reported, driving healthcare managers to pay more attention to how services are organised and delivered.
This focus on performance is trickling into most hospitals and the pressure is likely to grow, with health ministers throwing their weight behind a new international patient outcomes league table last week.
Higher patient experience ratings can make a significant impact on a hospital balance sheet, according to Porter, who has done studies that indicate organising care around patients can cut costs by 20 to 30 per cent.
“We’ve tried controlling high cost areas, we’ve added very important safety issues, electronic records and care coordinators, but we haven’t changed the trajectory of healthcare,” Porter said. “But what we’ve learned is the most powerful lever of all is improving the outcomes that the patients achieve. That gets you fundamental efficiency and is better than a hospital squeezing suppliers or firing some people.”
Doctor knows best
Berwick said his late father, a doctor in Cincinnati, would have baulked at patient satisfaction questionnaires. “You’d hear him on the phone, arguing with patients, often times shouting something like, I’m the doctor, you’ll get penicillin when I choose.”
Today people’s needs and expectations are quite different and Toyin Ajayi, chief medical office at the Commonwealth Care Alliance, a US non-profit focused on the “high-need” two per cent of the population, said her medical staff pay attention to all parts of the mind and body.
Doctors are empowered to look beyond their narrow purview, “To probe deeper to find out whether, for example, the reason a patient is not taking their diabetes pills is because they are so lonely in the evenings that they don’t even think about medication,” Ajayi said. “We’re mandated to help patients in any way we can.”