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OM in the News: The Dangers in Measuring Hospital Quality

April 23, 2015

nurseOne of our definitions of quality in Chapter 6 is user based: “quality lies in the eyes of the beholder.” The Atlantic’s article (April 17, 2015), titled “The Problem With Satisfied Patients,” states though, that a misguided attempt to improve healthcare has led some hospitals to focus on making people happy, rather than making them well. When healthcare is at its best, hospitals are 4-star hotels, and nurses, personal butlers at the ready—at least, that’s how many hospitals seem to interpret the government mandate by the Department of Health and Human Services. DHHS announced that 30% of hospitals’ Medicare reimbursement would be based on patient satisfaction survey scores. The goal: transparency and accountability, which would improve healthcare.

But a recent study revealed that patients who reported being most satisfied with their doctors actually had higher healthcare and prescription costs and were more likely to be hospitalized than patients who were not as satisfied. Worse, the most satisfied patients were significantly more likely to die in the next 4 years. As one MD said: “Patients can be very satisfied and dead an hour later.”

The concept of “patient experience” has characterized patients as customers and nurses as automatons. Some hospital job postings advertise that they are looking for nurses with “good customer-service skills” as their first qualification. By treating patients like customers, hospitals accept the cultural notion that the customer is always right. But hospitals, too, can offer poor care and still get high patient-satisfaction ratings. A study of poor performing hospitals found that 2/3 of them scored higher than the national average on the key patient question; “YES, they would definitely recommend the hospital.”

Research has shown that hiring more nurses is the true key to patient satisfaction. Higher staffing of nurses has been linked to fewer patient deaths and improved quality of health. Failure-to-rescue rates drop. Patients are less likely to die or to get readmitted to the hospital. Their hospital stay is shorter and their likelihood of being the victim of a fatigue-related error is lower.

Classroom discussion questions:
1. What are the definitions of quality (see Chapter 6) and how do they relate to hospitals?

2. What are the flaws, if any,  in surveying patients to measure hospital quality?

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