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It’s been said that in New York, it’s not whether you win or lose – it’s how you lay the blame.  Apparently, some Big Apple hospitals have read that book and passed it along to other big-city providers.
That might be a little unfair, because the strongest connection between New York providers and the whining in a recent article about the HCAHPS patient experience survey is the fact that the article was published in the New York Times.  It’s actually a quote from Dr. James Merlino, chief experience officer at the Cleveland Clinic, that’s the clincher:  “Hospitals are going be punished financially by the federal government for things they can’t control.” 
But a whiff of Gotham arrogance still seeped in when New York University physician Katherine Hochman shared this: “People in New York have very high expectations about what it means to be taken care of…When they don’t get their food on time and have to spend eight hours in the emergency department, well, that’s just not their image of what a world-class institution is.”
The implication seems to be that you can step all over patients anywhere else, but only those persnickety New Yorkers will actually hold you accountable when Medicare asks them how things went and starts withholding payment for hospitals that fall short. 
Don’t tell that to Bob Peebles, who helped run hospitals in New York City and Detroit before becoming CEO at Mercy Medical Center-Sioux City.  “I don’t buy it, not for a minute,” said Peebles, whose stint in NYC put him about 10 blocks away from the World Trade Center on the morning of September 11, 2001.  “Patient expectations are the same wherever you go.  But that’s not really the point – the point is, what do you expect from your staff and how well is that being communicated?”

Future HCAHPS respondents...and they could be from anywhere.

“I think the focus needs to be on what staff, physicians and leaders can do to improve the patient experience instead of the ‘throw up your hands’ approach and blaming patients for being more difficult,” said David Brandon, CEO of The Finley Hospital in Dubuque.  “You cannot have an ‘opt-out’ culture if you’re going to succeed in creating an exceptional patient environment.” 

Both Sioux City and Dubuque are in multi-county hospital referral regions (HRRs) that rank in the top 20 nationwide for patient satisfaction.  The HRR around Mason City ranks at the top.  Meanwhile, out of nearly 300 HRRs, Manhattan is dead last and Cleveland is 237th

“Where many CEOs fall down is they see this as a fluff kind of thing,” said Greg Paris, CEO at Monroe County Hospital in Albia, who received IHA’s hospital leadership award in 2007 in part for his work to pull that hospital’s patient satisfaction scores out of the basement.  “What they don’t realize is that satisfaction is directly related to quality outcomes, financial results and employee engagement.”

But, he added, “Smiles and singing don’t drive satisfaction.” 

Paris talks about how using key words reduces patient anxiety, which improves compliance with care plans and leads to better outcomes.  Hourly rounding (“I hear large hospitals gasping,” Paris laughed) reduces patient falls by 50 percent.  Checklists reduce errors.  Discharge calls save lives because one in six patients has an adverse health event after they go home.  Lower employee turnover means fewer mistakes and less harm to patients. 

But shouldn’t getting the highly touted care at Cleveland Clinic or NYU be enough?  The better question – the one really being asked through HCACHPS and Hospital Compare – is why not expect high-quality care and a first-class patient experience?  Anyone who has made use of the Iowa Healthcare Collaborative’s “Iowa Report” will see Iowa hospitals are uniformly committed to both. 

“Yes, we need to have the right facilities and evidence-based strategies in place, but more than anything else it is the never-ending commitment to create a culture that holds service in the highest regard,” said Brandon.  “Without the right culture, the strategies and facilities alone will not allow you to meet the expectations of your patients.” 

And because of the growing amount of publicly available data, hospitals cannot depend on just their word-of-mouth reputations or referrals.  “The next generation will pick their hospital based on outcomes and experience, not just by where their doctor sends them,” noted Paris.


4 Responses to “New York, State of Whine?”
  1. Wayne says:

    I wonder if over-crowding, double-bedded rooms, lack of a primary care infrastructure, patients without social support (homes to go to after discharge), over 100 languages and cultures represented in the population have anything to do with it? Probably not… i’m sure it’s just like that across the country.

  2. Brad F says:

    Please have a look at below. I think it truly is more complicated than your post above.

  3. Greg Paris says:

    The original post above actually hits the mark. There is a direct correlation between tools that drive satisfaction (i.e. key words that improve communication) and clinical outcomes. There is cause and effect between hourly rounding, reduced falls, and the number of elderly who die from falls. There are big hospitals with great patient satisfaction and midwest rural hospitals with terrible results. The truth is we are more alike than we are different. When hospitals and bloggers stop rationalizing and creating reasons why their bad results are invalid or dont matter, they can actually start working on improvement. It’s the right thing to do and the truth is most large hospitals really didn’t care about satisfaction of the people paying the bills until it has started hitting their wallets.


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  1. […] so fast, say several Iowa hospital CEOs. In an Iowa Hospital Association blog post, David Brandon, CEO of the Finley Hospital in Dubuque, Iowa, tells author Scott McIntyre, “I […]

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