Tuesday, August 25, 2015

How Do You Want Your Mother’s Care to Be?

We are working towards our vision of becoming the healthcare system where everyone, every time, is treated the way we want our own loved ones treated. The most important thing that we want when our loved one is sick is the best possible health outcome. But the second most important thing we want is the best possible care experience. We want our loved ones to be well informed by people who care; we don’t want long waits and delays; and we want the care in a clean, respectful environment.

About a decade ago, the federal government began requiring hospitals to ask their patients a standard set of questions after discharge so that patient satisfaction could be compared across hospitals. This system is called the Hospital Consumer Assessment of Healthcare Providers and Systems or HCAHPS. http://www.gbmc.org/body.cfm?id=2216

The HCAHPS survey asks discharged patients 27 questions about their hospital stay. The survey contains 18 core questions about critical aspects of patients' hospital experiences (communication with nurses and doctors, the responsiveness of hospital staff, the cleanliness and quietness of the hospital environment, pain management, communication about medicines, discharge information, overall rating of hospital, and would they recommend the hospital).

So, the HCAHPS scores are the answer to the question “Are we getting closer to our vision under the aim of better care?” Another way to look at it is “Would you bring your mother to GBMC rather than another hospital because the evidence was that she would be always treated with respect and kindness?”

Some people argue that we should not pay attention to patient satisfaction scores because they are not often correlated with outstanding clinical process and health outcome measures. I think that this is silly. Health outcomes and care experience are two separate dimensions. If for a given hospital they are not both excellent, it just means that the hospital is not effectively working in one or the other or both. It clearly does not mean that being excellent in patient satisfaction causes worse clinical outcomes!

So where do we stand? Well, our overall score has been about average over the course of the last fiscal year. We clearly have work to do because we don’t want our loved ones going to an average hospital. But it is not because our people don’t work hard or don’t care. Our staff works very hard and they do care. When our scores are not excellent it is because our systems need some work. One of our dis-satisfiers is waiting for discharge. Why do patients wait so long after being told that they are ready to go home? It is because we have not designed a system to get the work done expeditiously. The doctors and nurses are working very hard doing other things.

I don’t think that we have done a good enough job enrolling our people in this care improvement work. We have not clearly stated what we are trying to do and given our staff time to discuss it and declare after the discussion that they will be fully engaged in this work. This is our biggest obstacle to improving the care….having the staff not see it as a burden but as a way to not only make the patients happier but to also make their work easier.

We have begun to hold focus groups in our departments and units to foster the enrollment process. The staff is being asked questions like:  “What are the barriers you find when you are trying to provide care to the patient that you would want for your own loved one?”

It doesn’t take long in these discussions before someone raises the question about staffing. It is unreasonable to think that we can do the work well if we are overwhelmed. We must make sure that we have the right number of workers to get the job done. But, we also need to make sure we get rid of wasteful steps to make sure that we are not bringing in more staff to do rework. An example of this is the “missing medication” problem that we have made such great progress on. I am still concerned that nurses are spending too much time looking for medications that they need. If they are spending a lot of time on this, it is not a good idea to bring in another nurse so that we can get all of the nurse work done. It is much better to unburden the nurse of the rework of calling the pharmacy multiple times and then giving the medications late.

Please get involved in improving our care to patients. It isn’t about the HCAHPS score, it’s about giving everyone what you want for your loved ones. Thank you for your hard work and please let me know what you think.

Congratulations to our team at the Sandra and Malcolm Berman Cancer Institute, who under the direction of Dr. Gary Cohen, were among 20 accredited programs nationwide to receive the mid-year 2015 Outstanding Achievement Award (OAA) from the Commission on Cancer (COC) of the American College of Surgeons.

According to the COC, award criteria are based on qualitative and quantitative surveys conducted during the first half of the year and the purpose of the award is to raise the bar on quality cancer care, with a goal of increasing awareness about care choices for cancer patients and their loved ones. In presenting this award, the COC recognizes the outstanding quality of cancer services that the Berman Cancer Institute continues to provide to our patients.

Earlier this summer, our Sandra and Malcolm Berman Cancer Institute and Sandra and Malcolm Berman Comprehensive Breast Care Center along with its affiliated Advanced Radiology Breast Imaging Center were all given a three-year, full accreditation with commendation designation from the American College of Surgeons.

Please thank all of our team involved in the care of cancer patients and congratulate them on these deserved recognitions!


  1. Congratulations to a phenomenal group of people who provide the best care to cancer patients and their families!


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