Next week, the Institute for Healthcare Improvement will draw nearly 6,000 health leaders to Orlando for its annual forum, once again held right next door to Walt Disney World.
Perusing the program, I see that along with many sessions devoted to "patient-centered care" and "the patient experience," one can take special training field trips to Sea World, Universal Studios, and the Central Florida Zoo.
On these theme park excursions, the program says, quality thought leaders can learn lessons about improving care from the folks who perfect the art of fun, the theme parks' staff.
Hospitals and Shamu? At first, I thought the connection was a stretch.
But it got me thinking.
Lately, it seems my e-mail and journal readings are increasingly speckled with phrases like "patient amenities," "family-centered care," and patient satisfaction," concepts distinct from whether the patient receives the appropriate tests, diagnosis, drugs and medical procedures and, hopefully, is not harmed along the way.
It seems there's a lot more talk about making hospitals work more like hotels and spas, and doctors more like maître d's. Actually, in just two years, some component of Medicare's reimbursement formula will probably be based on Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) satisfaction scores, or so the Affordable Care Act directs. If it's true that improving amenities really does translate to more satisfied and happy patients, hospitals might increase their federal payments.
Now the Orlando connection makes sense.
To underscore the point, a Perspective in the current New England Journal of Medicine carries the headline "The Emerging Importance of Patient Amenities in Hospital Care."
The authors, from the University of Southern California Schaeffer Center for Health Policy and Economics, said their research found that hospitals are spending more on amenity improvements than on improvements in quality of care, "but improved amenities have a greater effect on hospital volume."
Consumers are making choices on where to get care based on those amenities "because they are easier to understand," the authors wrote, than complex, process or outcome measures on HospitalCompare.hhs.gov.
Indeed, just this week I read that 368-bed Sharp Memorial Hospital in San Diego spent $230,000 incorporating a 120-foot long garden atop the emergency room in its two-year old flagship hospital's remodel. Instead of a view of air conditioning and heating units and ugly infrastructure, patients and their families instead see 20,000 plants shape a musical staff and the first few notes of "Ode to Joy," from Beethoven's 9th Symphony. That's not all Sharp has done to improve the patient experience.
I asked Sharp CEO Dan Gross to help me pull these concepts together and he came right to the point. The garden, he says, is just the latest chapter in his organization's efforts to "embrace a new vision" about the way it provides care, a concept it developed after getting lessons from, of all places, Walt Disney World.
"We went to Disney World and the Disney Institute, and there we learned about the concept of onstage and off stage," Gross explained. "And we incorporated that into the design of our buildings and the education of our staff."
"At Disneyland, you never see any of the offstage production in front of you (like air conditioning units)," Gross explains. "And in hospitals, that means that all nursing staff, medication preparation, and conversations take place offstage. And when staff members move between departments, that's offstage too, so we created offstage pathways. Dietary tasks, transporting equipment from radiology to patient rooms, all those are done behind the scenes, and that's all a concept we pulled from Disney."
As patients are wheeled into surgery, no more bright hallway lights blinding them from above; now the lights are installed in recesses along the side.
Gross added that Disney talks about "scripting" its theme park employees. And that translates for healthcare as well, he says. For example, when people need help with directions, healthcare personnel are discouraged from pointing or giving them verbal instructions. Rather, "they should say, 'I have time, I'll walk with you to where you need to go.' The person never gets lost; they feel supported, and they always end up saying, 'Wasn't that nice.' "
Sharp has also fashioned what it calls "the signature moment," a concept in which providers take advantage of points in the care process that the patient might remember, Gross says. For example, after an endoscopic procedure, "the staff place a napkin, glass of juice and some Jell-O on a silver tray and serve it to the patient who has been 'NPO' (nil per os, or nothing through the mouth) for 24 hours." Colonoscopy patients would be ever so grateful, I thought.
At Sharp's Grossmont Hospital a few miles away, "A burly gardener plucks roses from the rose garden on the grounds and puts them in bud vases" to give to the patients.
It all adds up. Since the new building—with its improved staff culture and physical amenities—opened in January 2009, Gross says, Sharp Memorial's Press Ganey scores have skyrocketed, from 49% percentile during the third quarter of 2008, to 61% during the first quarter of 2009 to 98th or 99th percentile in each of the last six quarters.
Gross is aware that many health providers believe "that when patients can rest better and have less environmental stress, they heal better; their call light is on a lot less, they need less frequent pain medication and they get out of hospital faster." In the end, all of this translates to hospital savings.
But that's not the main reason for doing it, he says. "When you create experiences that leave your patient amazed and gratified, they're going to want to continue to receive their healthcare from your organization. There's more gain from increasing patient loyalty than from reducing expenses," he says.
The authors of the New England Journal Perspective noted the chasm between spending to provide amenities in a drive for improved patient experience scores versus spending on improvements that drive clinical quality. But maybe there are a lot more overlaps that we don't yet realize.
The idea that the vacation industry, the folks who make money by making us relax and get happy, might be able to teach health providers how to minimize the stress and pain of a typical hospital stay is an exciting one.