“Designed by award-winning architects, your accommodations include free wireless, flat-screen TVs, concierge services, a business center, complementary robes, high-thread-count sheets, chef-prepared meals, banking services and an on-site boutique. Emphasis on customer service.”
Sounds like a nice place to stay, right? Someplace that rates maybe five of those little circles on TripAdvisor.
Yes, except it just as easily could be your local hospital. Hospitals around the country are competing with each other based on such amenities — those in Arkansas are no exception — and some are taking cues from the hospitality industry.
“There is an increasing pressure from a business perspective on health care systems and hospitals to be competitive,” said Chad Aduddell, president of St. Vincent Infirmary Medical Center in Little Rock. “And so more and more … hospitals are looking at other industries, other service industries, and trying to replicate some of the things that those hospitality industries have done.”
“Hospitals are not rich. It’s not a particularly well-paying business in general,” said John Romley, an economist and research assistant professor at the Leonard D. Schaeffer Center for Health Police & Economics of the University of Southern California in Los Angeles. “But there are certain patients who are lucrative and attractive to hospitals.”
Chief among these are patients under 65 with good health insurance. “Hospitals are competing for those patients in the ways that they know how,” he said last week. “And it seems that amenities are a way of attracting patients to come to a particular hospital when there’s a need.”
Romley and two fellow researchers, Dana Goldman and Mary Vaiana, wrote about this phenomenon in a 2010 article in the New England Journal of Medicine. “Though amenities have long been relevant to hospitals’ competition, they seem to have increased in importance — perhaps because patients now have more say in selecting hospitals,” the three wrote.
The researchers pointed to patient and physician surveys. Almost a third of general practitioners “said they would honor a patient’s request to be treated at a hospital that provided a superior nonclinical experience but care that was clinically inferior to that of other nearby hospitals. Patients themselves said that the nonclinical experience is twice as important as the clinical reputation in making hospital choices.”
Three factors are driving this emphasis on customer/patient service:
- The above-noted competition for patients
- The continuing effort by health care providers to improve patient outcomes and speed recovery and
- A consumer survey known in the trade as HCAHPS (pronounced “H-caps”), the Hospital Consumer Assessment of Healthcare Providers & Systems Survey.
It is the first standardized, publicly reported survey on patients’ hospital experiences. The survey allows patients’ rating of their care to be compared to other hospitals throughout the United States. Under the Affordable Care Act, the federal government will take survey results into account when calculating Medicare reimbursements.
A few years ago, St. Vincent touted the quality of its “birthing units” in its Center of Excellence for Women & Children. In addition to the neonatal intensive care unit and a gynecological/pediatric surgery unit, the center housed the mother/baby unit, which featured upgraded linens, a complementary terrycloth robe for the new mother and “chef-prepared meals when [patients] want them, just like room service,” according to an article in Arkansas Medical News.
The response was “very positive,” Aduddell said, “but I think you would find that others are doing that too, so it becomes a kind of a minimum expectation. Everybody has to have those things. So now it’s not so much a distinguishing factor if you have it; it’s more a distinguishing factor if you don’t have it.”
“There was a time that having quality staff and quality doctors and some technology was maybe the order of the day,” said Aduddell, who came to St. Vincent a little more than a year ago from a health system in Oklahoma. “But now everybody has those things and so the distinguishing characteristic if most people have similar technology is going to be service. And so you’ve got to deliver that patient experience every time.”
In their article for the New England Journal of Medicine, Romley, Goldman and Vaiana noted that before the 1990s, “hospitals were thought to attract patients by attracting physicians, which they often did by investing in high-tech medical capabilities. This ‘medical arms race’ led many hospitals to offer a costly array of duplicative services.”
The introduction of managed care in the 1990s led to an increased emphasis on cost containment, with insurers, which decided which hospitals to include in their networks, using that leverage to force hospitals to cut prices.
Now, hospitals are competing based on the amenities they offer because patients care about them.
“That doesn’t mean that patients don’t care about quality of care,” Romley said. And it doesn’t mean that discovering that hospital demand is more responsive to amenities than the quality of care reflects patients’ exact preferences, he said. Determining that a hospital is a pleasant place is probably easier for patients than judging it on its quality of care.
“But it does suggest that in the world we live in, patients do value those creature comforts and are able to differentiate hospitals along those lines,” he said.
Helps to Healing
Highlighting outstanding architecture and 26-inch flat-screen TVs, however, isn’t all about attracting paying patients. High-quality, attractive surroundings also affect healing, health care providers say and some studies show.
When the University of Arkansas for Medical Sciences unveiled its new 10-story, 540,000-SF, $200 million hospital in 2009, it noted larger private patient rooms, new operating rooms and a new communications system, but it also touted its large two-story lobby with “pillars of Arkansas limestone, terrazzo floors and a Steinway grand piano.”
All of this, the hospital said in a news release, went toward “creating a pleasant environment that promotes healing and provides ample space for family members to support loved ones during a hospital stay.”
Dr. Roxane Townsend, who heads the UAMS Medical Center, holds that the hospital hasn’t invested in services like improved food choices just to compete with other hospitals. Instead, she said, “We are really focused on our patients’ experience, and we recognize how important well-being is to maintaining or achieving health.”
In opening that new patient tower, “we used architects who understand not just how to build a hospital, but how to build a hospital that helps people heal. They really talk about the healing environment.
“We’re trying to deal with people at all levels so, yeah, we have great technology, we have wonderful staff, we have very talented physicians, but we also understand how important it is for patients to have a good experience, to feel good — as good as they can — about being in a hospital.”
“When we look at the patient experience, we’re not just talking about customer service and the Disney experience,” she added. A satisfying, effective patient experience includes hands-on service along with larger private rooms and ensuring that meals are served hot.
“When we involve patients in their care and they feel like they have more control and ownership in the care plan, they are much more likely to follow recommendations that are made post discharge,” she said.
Said Bo Ryall, executive director of the Arkansas Hospital Association: “Hospitals have recognized that hospitalization can be a very stressful experience, and hospitals have recognized that customer service and hospitality can alleviate the stress for the patient and the family and reduces the stress on hospital staff. It helps to have overall a better patient experience and patient outcome.”
Nancy Foster, vice president for quality and patient safety policy at the American Hospital Association, pointed to research indicating that patients who are comfortable and feel cared for will recover faster, “which, of course, is what we all want.”
The move by hospitals to private rooms, for example, is not just a function of patient comfort. In 2006, the Facilities Guidelines Institute, a nonprofit, and the American Institute of Architects’ Academy of Architecture for Health, published new guidelines calling for single-patient rooms as a standard in any new hospital. Among the reasons was an effort to prevent spread of infections.
In addition, HIPAA guidelines, which include strict privacy rules, were an argument for hospitals to move to single-patient rooms. As Townsend said, it’s impossible chat privately “in a room where patients are separated by a curtain.”
The adoption by hospitals of the HCAHPS Survey has been the third catalyst leading to greater emphasis on amenities for patients and families. Among the criteria the survey lists are perceptions about communication with doctors and nurses, the responsiveness of the hospital staff, the cleanliness of the hospital, an overall rating and whether the patient would recommend the hospital.
The survey has led to attention being paid “to some of the critical aspects of care in ways that we weren’t able to [measure] before,” said Foster, of the American Hospital Association. “Now, we have not only a sense of how well we are doing in each one of our hospitals but also who’s doing it better.”
“How we meet our patients’ expectations has become a vibrant part of the conversation in hospitals,” Foster said. “And now that we can measure how well we’re doing and try different things to see if we can improve, there’s a lot of activity underway.”
With patient satisfaction scores helping determine hospital reimbursements for Medicare, ensuring that the patient experience is positive assumes even greater importance.
“For the first time, Medicare has a reward and a penalty system for patient experience,” said Aduddell, of St. Vincent. “Those results are being reported publicly. That, too, is pushing people to make sure that patient experience is as positive as possible.”
And, of course, the reach of the Internet also has led to increased emphasis on ratings. Hospitals’ HCAHPS scores are readily available at Medicare.gov/HospitalCompare.
“People are on Facebook; they’re on Twitter,” said Aduddell.
“They’re reading and doing searches to find out about you, and they’re looking at comments that people are making. So if the comments that are out there, if the information that they can find when they search for you is positive, that’s obviously going to be positive. And if it’s negative, that too could have an impact. We obviously want to have a positive story out there.”