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.

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 237^th. 

“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.