Readers of the New York Times recently were challenged to look at a series of photographs and pick out which were taken at hospitals and which at luxury hotels.
There was a shot of a thick grilled fillet of salmon artfully surrounded by roasted vegetables; a marble fountain in a spacious spa; a lounge with a glowing fireplace in a flagstone wall. In fact, these were examples of what patients and visitors can enjoy at, respectively, Henry Ford West Bloomfield (Mich.) Hospital, St. Dominic Hospital in Jackson, Miss., and Capital Health Medical Center–Hopewell in Pennington, N.J.
Do these lavish amenities count heavily when patients choose a hospital? Do they drive higher patient experience ratings, garner more glowing recommendations and, as intended, boost occupancy?
The developers of the Hospital Consumer Assessment of Healthcare Providers and Systems questionnaire apparently didn't think so. Or at least, aside from cleanliness of the room, they made no allowance for the contribution of creature comforts to the inpatient experience. But that, suggests University of Southern California economist John Romley, may have been a significant oversight. In a recent analysis of the metropolitan Los Angeles-Orange County-Riverside markets, Romley and colleague Dana Goldman concluded that the quality of the accommodations and amenities at a hospital actually have three times as big an impact on patient demand as the facility's clinical excellence.
Not every hospital has $100 million at its disposal — as Century City Doctors Hospital did in 2004 — to promise patients "five-star personalized service" featuring a concierge, bedside Internet, on-demand movies and gourmet cuisine prepared and served by a celebrity chef. (The Los Angeles hospital declared bankruptcy in 2008.) But any hospital has the resources for a facility improvement campaign like the "Room-a-Day" program launched earlier this year by Citrus Valley Health Partners in Covina, Calif.
Almost every day, explains Patrick Kegin, Citrus Valley's chief patient experience officer, at least one of the 370 rooms — most of them doubles — in the system's three hospitals is taken out of service. A team bustles in and searches for anything that may have fallen into disrepair — a torn curtain, a missing hook, a twisted slat on a blind, a dusty picture frame. They make sure everything is shipshape again, then they strip and re-wax the floor from corner to corner. "It's not reconstruction, it's a cosmetic face-lift," Kegin acknowledges. "It's tidying up, sanitizing and fixing all the little things that have been let go for years."
About 150 rooms have undergone a blitz like this in eight months, reports Kegin, and upticks in patient experience surveys have been registered in tandem. Meanwhile, with help from a donor, the system has completely renovated the 10 rooms in its hospice "with accent lighting and beautiful art; it looks like a four-star hotel," he says. "And it's not like we dropped a whole lot of money on it." Renewed attention also has been paid to the landscaping and maintenance of the campus grounds.
Kegin wishes Citrus Valley were surrounded by rosebushes like those at Sharp Grossmont Hospital in La Mesa, Calif., where the groundskeepers came up with a remarkable initiative to brighten the patient experience. Every Thursday throughout the blooming season the five men of the landscaping crew snip a few roses, put them in vases donated and collected by the hospital's volunteers, attach an explanatory message with an inspirational aphorism and then personally walk from room to room delivering the flowers to patients designated by unit nurses to be in need of cheering up.
For the groundskeepers, the program, dubbed "This Bud's for You," is as satisfying as it is to the patients. It's an opportunity to feel themselves part of the flow of hospital life and patient care, says Andy Grossman, their former supervisor. The hospital's engineers were jealous, and now they bring "Cheer Bouquets" of balloons and teddy bears to hand out to patients whose rooms they're called to when a thermostat needs adjusting or a light bulb burns out.
Encouraging and empowering everyone in the organization to participate in improving the patient experience can take surprising turns. The main courses on patient menus at Flagstaff (Ariz.) Medical Center run more to French toast, pepperoni pizza and cheeseburgers than eggs Benedict and coq au vin, but among other enhancements the food service staff now garnish the breakfast plates with fresh fruit, the dinner plates with fresh herbs and the lunch plates with edible orchids.
Flagstaff's nutrition assistants write their names on patients' whiteboards when they come to take orders, always ask if there's anything else they can do for the patient and make sure it gets done or alert a nurse. They also check that the bedside equipment is arranged for the patient's convenience. To make sure meals are presented appetizingly, to sample reactions and to solicit suggestions, the nutrition services director and the manager themselves deliver trays several times a week.
"Leading by example, engendering a paradigm of compassion and caring" are extremely important for a hospital's leaders, Kagin says. "When I go out into the corridor, I always make sure I have my name tag on and I interact with everyone I see. No one goes by me without my saying something to them." He has many heartwarming anecdotes to tell as a result.
Both Citrus Valley and Grossmont are among a long list of client hospitals that subscribe to the "First Touch" principles propounded by Sage Consulting. Unit by unit, says Kegin, all 3,200 employees are being trained to be comfortable with the techniques of attentive listening, suspension of preconceptions and appropriate touch (from a hug or a handshake to a stroke of a bedridden patient's foot). "By the end of the sixth quarter, we will have the entire organization educated on these fundamental ways to build connections and accelerate the energy exchange between people," he says.
The whole hospital wins or loses when value-based purchasing is keyed to HCAHPS scores, notes Cathy Lee Frederick, assistant vice president of service excellence at McLeod Regional Medical Center in Florence, S.C. But two years ago, she recalls, "our shared goal of patient satisfaction seemed not to be shareable. It all seemed to belong to nursing. Everyone else would be riding on the wave of nursing."
To get other departments to pull their weight and row in unison, McLeod now pegs all yearly management bonuses to achievement of patient experience targets, not simply to individual departmental goals. This year, leaders will get no bonus at all if a single patient experience measurement is subpar.
"Goal alignment is a piece of cake if it's limited to the clinical area," Frederick says. "But the absence of a cohesive team is like cancer. The challenge is to get people who're not necessarily comfortable at the bedside to take on a role on the team and be beneficial and bring value.
For more on how the patient experience is measured and why it matters, read our cover story "The Patient Experience."
David Ollier Weber is a principal of the Kila Springs Group in Placerville, Calif., and a regular contributor to H&HN Daily.