I am a skeptic of the physician evaluation component of HCAHPS. I suspect patients respond to hospital amenities, and better food, bigger TVs, and swankier lobbies have a halo effect—affecting how they assess not just the structural aspects of their care, but how they perceive their caregivers.
You probably share my bias. On an individual level, we can explain stellar assessments easily, because we all have a natural inclination to attribute good report cards to whatever brilliant skills we bring to the bedside. However, if we receive an appraisal mom would not want to pin to the refrigerator door, we activate our deflector shields and point towards the patient’s leaky sink, broken bed, and roommate with the earsplitting screams.
When our crosstown rivals reinforce those impressions by citing say, increased foot traffic post an upgrade (“build it and they will come“), we might be lulled into thinking designer labels win the day. Substitute some slippage in communication and care craft for a five star experience, and all will be well.
For those reasons, I vaulted into a recently released study entitled, Changes in patient satisfaction related to hospital renovation: Experience with a new clinical building. Johns Hopkins built a new hospital wing and they surveyed how the enhanced digs transformed their patient satisfaction measures. Here’s what the patients got:
Patients admitted to the new clinical building experienced several patient-centered design features. These features included easy access to healing gardens with a water feature, soaring lobbies, a collection of more than 500 works of art, well-decorated and light-filled patient rooms with sleeping accommodations for family members, sound-absorbing features in patient care corridors ranging from acoustical ceiling tiles to a quiet nurse-call system, and an interactive television network with Internet, movies, and games.
In essence, the buildings changed, but the caregiver teams didn’t. As a result, the investigators were able to compare pre and post HCAHPS and Press Ganey evaluations in a natural experiment—in both newer, upgraded units, and in older active ones.
The findings surprised me. Not unexpectedly, the facility related assessments increased. However, the ratings for the staff remain unchanged, and the upgrades pre and post did not enhance patient perceptions of their docs. Non-facility ratings at the older wing also did not differ from the newer structure.
This is only one study, at one site, with a skewed patient population. However, we must be cautious; we may not like the findings and will find many reasons to dismiss the results. Like any good empiricist, I want to see further data with populations that are more heterogeneous and in varied locations. Nevertheless, for now, the Hopkins experiment serves as a good reminder that all caregivers should check their priors at the door. It just might be that what doctors do and say matters, and a first class meal and green gardens cannot paper over, or in the converse, sully our evaluations.
Bradley Flansbaum, DO, MPH, MHM works for Lenox Hill Hospital in New York City. He began working as a hospitalist in 1996, at the inception of the hospital medicine movement. He is a founding member of the Society of Hospital Medicine and served as a board member and officer. He speaks nationally in promoting hospital medicine and has presented at many statewide meetings and conferences. He is also actively involved in house staff education.
Currently, he serves on the SHM and NY ACP Public Policy Committees and has an interest in payment policy, healthcare market competition, health disparities, cost-effectiveness analysis, and pain and palliative care. He is SHM’s delegate for the AMA House of Delegates.
Dr. Flansbaum received his undergraduate degree from Union College in Schenectady, NY and attended medical school at the New York College of Osteopathic Medicine. He completed his residency and chief residency in Internal Medicine at Long Island Jewish Medical Center in New York. He received his M.P.H. in Health Policy and Management at Columbia University.
He is a political junky, and loves to cook, stay fit, read non-fiction, listen to many genres of music, and is a proud resident of New York City.