Can patients have a lousy experience in the hospital and still have a good technical outcome (or vice versa)? If there is such a disconnect between patient satisfaction and clinical outcomes, it can have serious implications for the hospital's mission.
Many disorders are self-limiting, meaning patients will recover with or without care. Care itself often doesn't "cure." Some patients receive care designed to yield only a diagnosis, not a direct cure. Others' care is anticipated to result only in palliation of discomfort or temporary remission of symptoms. Some care is given to minimize impairment, with no hope of returning to health. End-of-life care certainly is designed not to cure but to minimize discomfort and maximize the temporary quality of life of the patient-with death (not a cure) the inevitable outcome.
Care for some patients results in an intended and ostensibly permanent remission of disease, dysfunction and/or symptoms. This latter situation is the "pure" manifestation of "cure"-the ideal but frequently unrealized goal of care.
It is essential to recognize that the hospital's provision of care and the patient's experience of this care are two very different phenomena. Patients are not passive recipients of care. They process it, evaluate and respond actively to it-both during and after hospitalization or clinical treatment. The experience of care is always idiosyncratic and subjective, filtered through cultural, familial, ethnic, social class and generational elements of patients' personalities. Every aspect of care-from the parking lot to room comfort to starting an IV to discharge instructions-predisposes the patient positively or negatively toward the next event or contact. This ongoing experience can affect levels of stress, trust, compliance and tolerance of uncomfortable or frightening procedures.
A hospital stay is always stressful and personally threatening, regardless of outcome. The experience of care itself can be relaxed or anxiety-provoking, therapeutic or counterproductive. A significant element of "care" is thus independent of outcome or "cure." That's why attention to the patient's experience is as much the provider's responsibility as is the cure. Indeed, care is more readily predictable and within the hospital's control than a cure. If patients are highly satisfied with care, the most manageable part of the hospital's mission is achieved. If a hospital's patients are dissatisfied with care, that care is of lower quality, regardless of subsequent technical outcome.
Press Ganey Associates
South Bend, Ind.
IT changes needed
I applaud Todd Sloane for his editorial about investing in technology that improves outcomes and how far we are from it ("The right stuff," Aug. 9, p. 21).
To date we have automated faulty processes with inflexible technology. We need to enlist clinicians and administrators who want to embrace change and work together to create the most efficient and effective standard process that can demonstrate proven outcomes and then automate that process on a flexible platform. The flexibility is necessary for basic customization and continuous improvement of the process.
The challenge is that so many people have made their lives off of this broken process and resist any effort to build the right process.
Chief operating officer
Covering health centers
For as long as I have read your publication, I have seen very little space devoted to one of the major providers of primary care in this country: community health centers. Hundreds of such facilities across the nation have been created over the years with one expressed mission: ensure access to those populations who otherwise would have difficulty securing basic health services.
I urge you to take a closer look at the community health center movement, its history, its current focus and what policymakers at all levels have come to appreciate as one of the most critical elements in our delivery system today.
President, chief executive officer
Manchester (N.H.) Community Health Center
Editors note: Please use our archives search tool at modernhealthcare.com to read our past coverage of community health centers, which includes a recent article ("Piece of the pie," Aug. 16, p. 17) and a special report on Jan. 13, 2003 ("A community solution," p. 26).