67% of patients rate their hospitals highly; hospitals under staffed, under paid, mismanaged

Most patients feel they got good care while they were hospitalized, but a sizeable minority were discharged unhappy with their care, and comments posted in response to Robert Pear’s report on a government survey of patient satisfaction shows how years of cost containment errors by politicians and employers have undermined the quality of care in America’s hospitals.

The key findings were:

Nationwide, in the average hospital, 67 percent of patients said they would definitely recommend the institution where they had been treated to friends and relatives. Sixty-three percent gave their hospitals a score of 9 or 10 on a scale of 0 to 10.

At the average hospital, more than 25 percent of patients said nurses had not always communicated well with them.

The new data, part of a survey of patient experiences and perceptions of hospital care, is posted at a government Web site, http://www.hospitalcompare.hhs.gov.

Every employer, insurance company executive, politician, nursing executive, physician and hospital executive should read the report and the comments on the New York Times web site.  The comments are here. They show that:

1. Hospital executives are not doing their jobs. They aren’t training and retraining their personnel, and they’re not hiring good people and getting rid of the incompetent.

2. Physicians refuse to discipline and call out their incompetent peers.

3. Consumers and employers who demand that health insurance premiums not grow so fast and say that they want “more affordable” health insurance have forced health insurers to demand bigger and bigger discounts from providers.  As a result, after cutting their administrative costs to the bone, most hospitals have cut their budgets for nursing, nurse training, quality assurance and all other levels of staffing for patient care.

4. Like consumers and employers, politicians don’t want to pay as much as they should for health care delivered to beneficiaries of the Medicare and Medicaid programs. Their budget cutting also has forced hospitals to cut their budgets and understaff.

5. Going to a hospital is a scary and life-threatening experience. Patients should think many times about having elective procedures done in hospitals unless they can afford to hire private duty nurses attend to them and advocate for them around the clock while they are in hospitals.

6. Politicians and employers can get away with under-funding health care providers because consumers are more aware of and outspoken about how much they spend on health insurance and pay in taxes than they are about how well they are served by under staffed and over worked nurses and physicians.

I guess we’ve been lucky as patients. In recent years, I’ve had several encounters with five hospitals around the country that were treating me or family members. I came away from those hospitals impressed with the quality of care and staff every time. As akid, I was operated on by a surgeon who had no business doing pediatric surgery and I suffered the consequences. But I survived and have lived a long, healthy life thanks to the nurses and physiicans who cared for me and to the developers of the drugs and medical equipment that were used to extend my life. Most important, I’ve always had health insurance.

Yet, one family’s generally good experiences are no better samples than the mostly negative comments on the NY Times web sites. It is very hard to measure health care quality, outcomes and a patient’s health status. Our bodies are just too unique and complex, and the people who treat us are equally complex and unique. Medicine is both an art and a science, and no one is a perfect artist. Medical science, of course, is evolving and certainly is not all we’d like it to be.

What the government survey shows is that the smart people who are heatlh care workers are as good as the systems and tools they are given. The prospective payment system used by Medicare to set prices it pays providers has distorted the health care market and cause a deterioration of the quality of care.  And the study shows once again that employers who negotiate the lowest possible premiums they can get from insurers are dishonest brokers and should be taken out of the health care market, which they have distorted as much as Medicare and Medicaid have.

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