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Articles by Donald E. L. Johnson

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Hospital experiences depend on many things

By Donald E. L. Johnson

Health Care Strategic Management, Dec. 2001, Vol. 19, No. 12

Copyright 2001 by The Business Word Inc.

What is your hospital’s experience rating? Is it the same as your quality score?

And how do the two scores correlate? These are relatively new questions for hospitals, but they actually address familiar issues such as guest and employee relations in new clothing.

Experience consulting a fad?

Kathy Johnson’s Health Forum Journal, which usually is on the cutting edge of management fads and trends, has picked up on the “experience” question, running articles in its last two issues.

And Gary Adamson, chief experience officer of Starizon, an health care experience consulting firm in Greenwood Village, Colo., is building a conference center in Keystone, Colo., where he plans to offer retreats for health care executives.

So, a couple of savvy marketers think the experiences that consumers and employees have in hospitals and medical offices affect those institutions’ market shares, value, costs and, ultimately, profitability.

In an irritating way, the experience of reading about improving the health care experience makes sense.

The whole concept is irritating because it seems to state the obvious, repeat history and take executives’ eyes off the cost containment and quality improvement balls. It’s about guest relations, quality Back in the early 1980s, Kristi Peterson built a business training hospital personnel in guest relations, which hospitals copied from the airline and hospitality industries. Over 10 to 15 years she and a few competitors made a huge impact on the cultures of many hospitals and medical practices.

And my family, friends and I have experienced those mostly impressive guest relations in recent weeks in five hospitals, several physicians’ and dentists’ offices, with home care agencies and in durable medical equipment stores.

To me, hospitals and dental offices are a lot friendlier than airlines, these days.

Security experience wanting However, anyone can walk onto a patient floor and into an emergency department as easily as if they were visiting a Home Depot or Wal-Mart.

That lack of security in hospitals is an unsettling experience for many visitors these days. Unlike their visitors, patients don’t worry about security very much. They’re too concerned about when they’ll be seen in the ER, visited by their families and doctors and allowed or made to go home.

The thing is that visitors outnumber patients, physicians and employees, and, forced to hurry up and wait, they sit around patient rooms, family lounges, waiting rooms and hospital cafeterias talking about their experiences.

For most people who have encounters with hospitals, the experience is positive unless there is evidence that someone isn’t paying attention or that there has been a major screwup.

Experiences change in different parts of hospital Admittedly, the same patient and family member can have different experiences in different parts of an institution.

Waiting from 9 p.m. to 1 a.m. in a busy ER with an elderly patient showing stroke symptoms can be disconcerting and boring, to say the least. Why is that ER doc so pompous with family and patient? Why does it take four requests to recover the patient’s glasses from the CT scanner room? Why does it take so long to see an obviously seriously ill old patient and then to get the CT results? Why are the nurses so rough in transferring the patient to a gurney from the CT scan table?

And then the experience can change. CT results are reported. A senior resident is called. Early morning surgery is performed. Things move fast. The patient immediately improves. Miracles. Dread turns into hope.

The ICU is bright and modern with a huge nursing station that allows nurses to sit outside patients’ rooms, ready to respond to requests and problems. The nurses are friendly, and a senior resident takes time to explain what’s going on.

Patient changes change hospital experiences But things deteriorate. A second operation is required. Why does another senior resident, not the attending, do the operation? What a routine experience. The patient improves a bit and is moved to the rehab floor. The patient gets restless. A family member has to remind a nurse that a sign on wall says two people must help this patient. The family has to suggest precautions against a fall. Why didn’t nurses see that? They’re the ones with all the experience with head trauma cases. The family has the experience of making a contribution.

Back tracking a bit, consider this experience with physicians. The patient presents with deteriorating communications abilities and paralysis. Looks like stroke. Primary care physician refers. Specialist refers. Specialists do tests. Schedule MRI. Patient goes home. Hospital refers to outside home health service. Home health people from a competing hospital are more responsive. They visit and assess. Very nice. They recommend calling 911 if condition worsens. It does. Ambulance crew responds in minutes and talks stubborn patient into going to the hospital. A good experience for the family. ER doc orders CT scan. It uncovers head trauma problem.

Hospitals can’t control the physician ‘experience’ Now, here is a probably fairly routine experience that no hospital manager can control. The PCP and specialists didn’t order immediate CT scans, and patient didn’t get the scans until one and two weeks after seeing the PCP and specialists, respectively.

That is a frustrating experience for the family and the patient. What were those doctors thinking? Similarly, a friend with a rare lung cancer has been waiting since June for diagnosis, not to mention treatment. Her CT scans were sent to three nationally prominent referral centers. She decided to go to one cancer center and got an appointment with a specialist. Then he calls and cancels. He tells her that she’ll have to spend a couple of weeks in his city, waiting for tests, and for him to make a trip or two out of town. Turns out he has scheduled a trip after making the original appointment. His vacation, consulting client or some conference is more urgent than a patient’s health and life.

What kind of experience is this for the patient, her family and many friends? For me? I was the first to recommend the famous cancer center. For her local oncologist who found and made the referral to the lung cancer specialist and for her PCP? It’s probably too routine.

And, then, to cap the experience, her oncologist’s assistant tells the patient that her cancer has changed and she needs chemo right away. Then the local oncologist tells the patient that the radiologist who wrote the report is sloppy and she doesn’t agree with the report.

Some experience. Some quality! Routine?

What’s a hospital manager to do? And what’s a hospital manager or even a practice manager to do? A cancer center executive doesn’t know what a specialist communicates to a patient the medical center has won through the hospital’s sophisticated marketing and promotion. But the experience is real and has a tremendous impact on an institution’s reputation. What makes a good experience? Depends on the condition of a patient and the personalities of lots of folks, including families, patients, physicians and allied professionals.

What’s impressed me in my recent encounters as patient and family is that virtually everyone I’ve encountered has taken the time to be friendly, helpful and informative. Everyone is very professional, regardless of whether they’re in an HCA, Methodist, Adventist or Catholic institution, large and small in Denver and Peoria, Ill.  Yes, there were a few bad calls by our physicians, but, then, medicine is an art, not a science.


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