Feinberg tries to make staff understand what patients go through. One hospitalized cancer patient whose pain wasn't well controlled told him how it kept her awake. Finally, the staff got her medication adjusted, and Feinberg asked her to speak to managers to tell them what intractable insomnia was like. She spoke to 400 members of the team "about when the care was great, and how compassionate we were, but at the same time, how we screwed up on her pain. And it will be our goal to make sure her issue doesn't happen to another patient in our care."
"We definitely get more right now than we used to. But we have such a long way to go. And when you have cancer, I don't care if you're a safety-net hospital or the Taj Mahal."
The National Association of Public Hospitals and Health Systems suggests the road for these safety-net hospitals is too steep. Xiaoyi Huang, the assistant vice president of policy for the Washington-based organization, which lobbies on behalf of safety-nets, says the HCAHPS survey "lacks measures of cultural competence, and therefore fails to capture key aspects of healthcare quality" important to minorities. This "flaw" she says, "unfairly disadvantages hospitals" with minority and non-English-language patients.
Other factors that should adjust the scores include "sex, race, ethnicity, income, health literacy, insurance status … disease and functional status," she says.
Such arguments miss the point, because proper focus and attention to each patient is what's important, advises David P. McQuaid, FACHE, president of 969-bed Thomas Jefferson University Hospital in Philadelphia, which gets 20% of its volume from Medicaid and uninsured patients.
"Don't waste your time debating data and targets," he says. "Your focus should be on the best possible outcome, and if you're doing the kinds of things that need to be done in a patient-centered model, your outcomes will follow."
At Jefferson, the trick has been getting providers to see how their certain behaviors—terse or quick answers or rushed visits—may seem insensitive and uncaring when viewed from the perspective of the patient.
So Jefferson created a training and educational video that plays during physician meetings to sensitize providers to the patient's perspective. To get the point across, it begins with patients expressing negative views of their experience.
Says one man, "I remember when my doctor first came in to see me after my procedure. He looked at his watch three times in the two minutes he was there." Says another, "I feel I could have used a little more honest communication, certainly with me, but also with my family."
In 2010, McQuaid instituted a task force within each department to take responsibility for patient experience. There are teams for the ambulatory and emergency departments as well as inpatient areas. When he took over in 2007 as COO, he says, "there was one centralized team, but they obviously weren't effective because the scores weren't good. Now our scores are improving because we've taken this different structural approach."