Thursday, January 6, 2011
More on when hospitals are like hotels
[Editor's Note: This post originally appeared at Medical Lessons]
A recent NEJM perspective considers the Emerging Importance of Patient Amenities in Patient Care. The trend is that more hospitals lure patients with hotel-like amenities: room service, magnificent views, massage therapy, family rooms and more. These services sound great, and by some measures can serve an institution's bottom line more effectively than spending funds on top-notch specialists or state-of-the-art equipment.
Thinking back on the last time I visited someone at Sloan Kettering's inpatient unit, and I meandered into the bright lounge on the 15th floor, stocked with books, games, videos and other signs of life, I thought how good it is for patients and their families to have a non-clinical area like this. The "extra" facility is privately-funded, although it does take up a relatively small bit of valuable New York City hospital space (what might otherwise be a research lab or a group of nice offices for physicians or, dare I say, social workers) seems wonderful.
If real health care isn't an even-sum expense problem, I see no issue with this kind of hospital accoutrement. As for room service and ordering oatmeal for breakfast instead of institutional pancakes with a side of thawing orange "juice," chicken salad sandwiches, fresh salads or broiled salmon instead of receiving glop on a tray, that's potentially less wasteful and, depending on what you choose, healthier. As for yoga and meditation sessions, there's rarely harm and, maybe occasionally, good (i.e. value).
But what if those resources draw funds away from necessary medicines, better software for safer CT scans and pharmacies, and hiring more doctors, nurses or aides? (I've never been in a hospital where the nurses weren't short-staffed.) As for employees who clean hospital floors, nursing stations, patients' TV remotes, IV poles, computer station keyboards and everything else that's imperfect and unsterile, they should get more funding, everywhere. Clerks and transport workers are frequent targets in hospital layoffs, but they're needed just the same.
Two years ago when a family member was hospitalized, his doctor, a senior cardiologist, personally wheeled him in the stretcher from the X-ray area back to the emergency room bay where he waited for a room, so that he wouldn't spend more than the half hour or so he'd already been in the hallway, after the film was taken, waiting for the escort service.
What's wrong is not so much that the physician helped with a menial task that isn't his job. He's a really nice and caring sort, and I believe he didn't mind, really, except that he does have a wife and family at home who surely were waiting on that day. The cardiologist might have used that time, instead, to examine more closely someone's neck veins or heart sounds, or spent a few more minutes reading a journal article, which would make it more likely he'll make the right recommendation to his patients about, say, a drug for congestive heart failure or a new blood thinner.
We can't short-change hospital workers in such a way that physicians fill in on ordinary tasks because there's no one else to perform those, while patients get first-class meals and art classes to make them happier.
I'm reminded of boarding airplanes. I fly coach, and as I pass through the first class section I often think how nice it would be to sit in front and have pleasant flight personnel attend my every need to maximize my comfort during what's typically a miserable trip. But then, I'd be paying perhaps $3,000 instead of $680 for the same flight.
As passengers, maybe we're not so discerning about our pilots or the model of airbus as we should. A pleasant, cheery place isn't always the safest.
In the NEJM piece, Goldman and colleagues write: "Why do amenities matter so much? Perhaps patients simply don’t understand clinical quality. Data on clinical quality are complex, multidimensional, and noisy, and they have only recently become systematically available to consumers. Consumers may be making choices on the basis of amenities because they are easier to understand."
The authors note the potential value of amenities in patients' experiences and outcomes: "One could argue that they’re an important element of patient-centered care. If amenities create environments that patients, providers, and staff members prefer, then providers and staff members may give better care and service in those environments and patients may have better health outcomes."
Amenities are costly, but they attract patients: "[T]he value of amenities is important because our health care system currently pays for them. Under its prospective payment system ... Each hospital receives the same amount of reimbursement for each patient with a given diagnosis and is free to decide what mix of resources to devote to clinical quality and what to spend on amenities. In our research, we found that improvements in amenities cost hospitals more than improvements in the quality of care, but improved amenities have a greater effect on hospital volume."
I'll remind my readers that health care costs in the U.S. total over $2.3 trillion per year, and that number is growing.
Hospital amenities are really nice, and I believe they can help patients heal. But I don't know if it's right to spend limited health care dollars on more than essentials.
This post originally appeared at Medical Lessons, written by Elaine Schattner, ACP Member, a nonpracticing hematologist and oncologist who teaches at Weill Cornell Medical College, where she is a Clinical Associate Professor of Medicine. She shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology and as a patient who's had breast cancer.
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