But in more urban settings, healthcare leaders say good scores are a tougher challenge because their patients are more disgruntled—that is, culturally less likely to say they’re pleased. They say their hospitals are bigger and busier, and their patients are sicker, and that Medicare’s formula does not adequately adjust for that.
Lauren Johnston, RN, MPA, CNAA-BC, FACHE, senior assistant vice
president for patient-centered care for New York City Health and Hospitals Corporation’s 11 acute care facilities, agrees that her patients are tougher to please. For now, she says, the amount at stake will not be as large because the number of Medicaid patients her facilities serve is far greater than their Medicare population.
“Although CMS is starting with Medicare patients, when it adds Medicaid patients to the payments for patient experience scores, the impact is potentially devastating,” Johnston says. “So we’re going to fix this. And we’re
The scores for overall ratings of the system are better than most of the private hospitals in the city, she says.
NYCHHC has 250,000 discharges a year and 1 million ED visits. “We’re huge, in the most diverse city in the nation. When you walk into our hospitals, there are signs in 14–15 languages,” Johnston says. “Everybody has to deal with multiple cultures; they have to be specific in how they respond to each patient. And we’ve learned that what works in one place may not work in another.”
So NYCHHC is just working harder, trying lots of strategies. It has launched a charm school “for a few of its hospitals, a three-day course that teaches staff a cornerstone of behavior: respect. “You have to graduate from the school to work at those facilities,” she says.
Another NYCHHC strategy tries to improve staff accountability. “We have a board up on the nurse’s unit with every single staff member’s picture, name, and title right on the picture. So there’s no hiding who you are. You can’t be disrespectful and think no one will know you, because a patient can go up to that board and say, ‘It was that person right there,’” Johnston says.