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My most recent Hospital Impact blog post "The hidden costs of incentivizing patient satisfaction" received a powerful and informative response. Today we continue the conversation with feedback received via the FierceHealthcare - Healthcare Leader Idea Exchange LinkedIn forum.
Tom S., M.D., through the lens of patient satisfaction and process improvement, highlights the folly of incentivizing patient satisfaction, as well as reminds us of the need to identify the root-cause of barriers to our goals:
"Creating a financial incentive for patient satisfaction is like treating hypoglycemia with glucose. It works, but is short-lived and does not address the underlying cause. The goal is to permanently change the culture so that all the staff strive for great service (e.g., turnaround times) and are perceived as empathetic (e.g., address pain, emotional stress, etc). Look for systemic obstacles that prevent success (such as inadequate staffing). Having the right culture results in "performance pride" that always outperforms financial incentives."
Patient experience isn't only about attempting to wow and delight patients and their families.
In a recent phone conversation, a long-distance friend of mine--I'll call her "Debbie"--described her father's hospitalization. She explained that when her father was there, the hospital was overcrowded and had more admitted patients than beds. The result: Her father received his care in the hallway of one of the hospital's inpatient units.
Debbie noticed several aspects of the basic care experience missing in the hallway when compared to a patient room.
Following up from last week, let's resume our list of healthcare reform's unintended consequences for healthcare leaders.
3. Medicare reform
In response to political and economic pressures to expand Medicaid and the growing numbers of Medicare beneficiaries with the boomers, the Centers for Medicare and Medicaid Services and states are working to create meaningful incentives through cost-sharing, means testing and sliding scale payments based upon behavior-related healthcare choices (e.g., not smoking, committing to a regular exercise program).
Healthcare organizations increasingly partner with large employers, third-party payers and patients to create population health and wellness programs that significantly impact both quality outcomes and cost of care. Providing a wide array of nutritional options, exercise facilities and time to utilize them, smoking cessation programs, child care, and addiction rehabilitation programs have been found affect the cost of insurance, particularly for the elderly.
My first introduction to medical futility was as an intern in Chicago in the late 90s. I was working on a medical floor when a code blue was called overhead. I responded to find the nursing staff attending to an elderly male. As I started CPR and called out orders, I inquired as to what his medical conditions were and started looking at this shell of a man.
The nurse reported, "He is a 99-year-old male with diabetes and cardiovascular disease." I realized the man was blind, had above knee amputations to both legs and also had bilateral arm amputations. He was a full code. I am not sure if that was because there was no family to make him DNR (do not resuscitate) or he had chosen to "have everything done."
Futile medical care is the continued provision of care when there is no reasonable hope for recovery or cure of the patient. It is surprisingly quite common. There are many reasons for this.
A wave of renaming activity has been taking place among healthcare organizations throughout the past two years. Our research shows almost 75 hospitals or healthcare systems have changed their names, and the list is still growing.
So what are hospital administrators' reasons for changing their institutions' names--never a simple or inexpensive undertaking--and what are the real consequences--seen and unseen--that accompany these name changes?
Whether these new names are actually going to help their brands during changing times is up in the air and only time will tell. But hospital leadership that believes a name change is necessary to rebrand and reposition their healthcare system for the future may be seriously mistaken.
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