Strategic Leadership and Future Delivery Models
The issue of life expectancy at birth is a relatively novel one. Before the 19th century for instance, the United Kingdom -- the country with the longest time-series of measured life expectancy -- had not measured this variable at all. It is nevertheless estimated that the life expectancy at birth was between 30 and 40 years -- today, it is around 80 (Roser, 2016). Within the United States, it is of 79 years; in Japan it is of 84 and Monaco (the highest expectation in the world) is of 89 years (Central Intelligence Agency, 2016). There are still countries with lower life expectancies, but the people in all countries across the globe are expected to life at least 49 years, with Chad having this lowest expectancy of life at the time of birth, followed by Guinea-Bissau and Afghanistan with 50 and Namibia and Somalia with 51 (Central Intelligence Agency, 2016).
In all aspects nevertheless, the life expectancy has increased significantly over the past two centuries, and this trend is observed in both developed as well as under-developed regions of the globe and it is a result of a multitude of forces, such as increased living standards, increased access to health care, improved population education, better technologies and so on. And in this new global setting, the patients become more and more demanding and expect higher quality medical services. In response to this growing demand of today's society, the HCAHPS has been created as a standardized method of collecting and measuring information regarding the patient experience in hospitals (Centers for Medicare and Medicaid Services, 2016). Based on the findings, the patients can analyze hospitals, compare them and choose to seek medical attention at the facility they find most suitable for their needs. In terms of the medical care providers, these can use the HCAHPS surveys to analyze the means in which their patients view them, to compare themselves with other hospitals and sector averages and, based on their findings, to develop new methods by which to improve their services of medical care. This is therefore the scope of this project, to assess the current state of the Los Angeles Community Hospital and to propose methods of improvement within the facility.
A. Los Angeles Community Hospital HCAHPS scores
The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a national standardized set of assessments collected from recent patients and targeting eleven specific quality issues. The current project assesses the HCAHPS data for the Los Angeles Community Hospital in an effort to improve the quality of the medical act as this is provided to those patients with fewer resources available. The institution's most recent HCAHPS data (as of May 2016) is presented below:
Quality issue
Always
Usually
Sometimes / Never
1.
Patients who reported that their nurses communicated well
57%
22%
21%
2.
Patients who reported that their doctors communicated well
62%
17%
21%
3.
Patients who reported that they received helps as soon as they wanted
44%
28%
28%
4.
Patients who reported that their pain was well controlled
52%
27%
21%
5.
Patients who reported that staff explained about medicines before giving it to them
44%
20%
36%
6.
Patients who reported that their room and bathroom were clean
48%
24%
28%
7.
Patients who reported that the area around their room was quiet at night
28%
29%
43%
8.
Patients who reported that they were given information about what to do during their recovery at home
Yes
73%
No
27%
9.
Patients who understood their care when they left the hospital
Strongly agree
32%
Agree
50%
Disagree/strongly disagree
18%
10.
Patients who gave their hospital a rating on a scale from 0 (lowest) to 10 (highest)
9 or 10
42%
7 or 8
27%
6 or lower
31%
11.
Patients who reported they would recommend the hospital
Yes, definitely
38%
Probably
30%
Probably/definitely not
32
At an overall look, the Los Angeles Community Hospital reveals a series of patient dissatisfactions, such a high percentage of its patients (32 per cent) stating that they would not recommend this hospital or nearly a third of its patients having rated it 6 or lower. A better view of the HCAHPS scores for the LA Community Hospital will be created throughout the following section, as the survey results are compared with those in the state, the country and two other hospitals in the region.
B. Analysis of the HCAHPS scores
1. Comparison with the state and national averages
Always
Usually
Sometimes / Never
1.
Patients who reported that their nurses communicated well
Los Angeles Community Hospital
57%
22%
21%
California average
75%
19%
6%
National average
80%
16%
4%
2.
Patients who reported that their doctors communicated well
Los Angeles Community Hospital
62%
17%
21%
California average
78%
16%
6%
National average
82%
14%
4%
3.
Patients who reported that they received helps as soon as they wanted
Los Angeles Community Hospital
44%
28%
28%
California average
62%
26%
12%
National average
68%
23%
9%
4.
Patients who reported that their pain was well controlled
Los Angeles Community Hospital
52%
27%
21%
California average
69%
23%
8%
National average
71%
22%
7%
5.
Patients who reported that staff explained about medicines before giving it to them
Los Angeles Community Hospital
44%
20%
36%
California average
61%
19%
20%
National average
65%
17%
18%
6.
Patients who reported that their room and bathroom were clean
Los Angeles Community Hospital
48%
24%
28%
California average
70%
20%
10%
National average
74%
18%
8%
7.
Patients who reported that the area around their room was quiet at night
Los Angeles Community Hospital
28%
29%
43%
California average
51%
33%
16%
National average
62%
29%
9%
8.
Patients who reported that they were given information about what to do during their recovery at home
Yes
No
Los Angeles Community Hospital
73%
27%
California average
85%
15%
National average
86%
14%
9.
Patients who understood their care when they left the hospital
Also, while at the national level, only 5 per cent of the patients stated they would not return to the same hospital, the patients at LACH who stated they would not return accounted for 32 per cent of the responses.
2. Score comparison with Cedar's Sinai Medical Center and the Good Samaritan Hospital
Always
Usually
Sometimes / Never
1.
Patients who reported that their nurses communicated well
Los Angeles Community Hospital
57%
22%
21%
Cedars-Sinai
75%
20%
5%
Good Samaritan
73%
21%
6%
2.
Patients who reported that their doctors communicated well
Los Angeles Community Hospital
62%
17%
21%
Cedars-Sinai
78%
16%
6%
Good Samaritan
80%
16%
14%
3.
Patients who reported that they received helps as soon as they wanted
Los Angeles Community Hospital
44%
28%
28%
Cedars-Sinai
62%
29%
9%
Good Samaritan
60%
27%
13%
4.
Patients who reported that their pain was well controlled
Los Angeles Community Hospital
52%
27%
21%
Cedars-Sinai
70%
23%
7%
Good Samaritan
69%
24%
7%
5.
Patients who reported that staff explained about medicines before giving it to them
Los Angeles Community Hospital
44%
20%
36%
Cedars-Sinai
61%
18%
21%
Good Samaritan
60%
20%
20%
6.
Patients who reported that their room and bathroom were clean
Los Angeles Community Hospital
48%
24%
28%
Cedars-Sinai
71%
22%
7%
Good Samaritan
65%
24%
11%
7.
Patients who reported that the area around their room was quiet at night
Los Angeles Community Hospital
28%
29%
43%
Cedars-Sinai
52%
33%
15%
Good Samaritan
52%
32%
16%
8.
Patients who reported that they were given information about what to do during their recovery at home
Yes
No
Los Angeles Community Hospital
73%
27%
Cedars-Sinai
86%
14%
Good Samaritan
85%
15%
9.
Patients who understood their care when they left the hospital
Strongly agree
Agree
Disagree/strongly disagree
Los Angeles Community Hospital
32%
50%
18%
Cedars-Sinai
49%
45%
6%
Good Samaritan
41%
52%
7%
10.
Patients who gave their hospital a rating on a scale from 0 (lowest) to 10 (highest)
9 or 10
7 or 8
6 or lower
Los Angeles Community Hospital
42%
27%
31%
Cedars-Sinai
77%
17%
6%
Good Samaritan
71%
22%
7%
11.
Patients who reported they would recommend the hospital
Yes, definitely
Probably
Probably/definitely not Los Angeles Community Hospital
38%
30%
32%
Cedars-Sinai
81%
16%
3%
Good Samaritan
73%
22%
5%
In comparison to the Good Samaritan and Cedars-Sinai Medical Center:
Nurse communications are significantly poorer at the LACH
The same is true for doctor communications; for instance, while at the LACH, only 62 per cent of the respondents stated they doctors always communicated well with them, the numbers for Cedar-Sinai and the Good Samaritan were 78% and 80% respectively. While at these two later institutions only 6 and 4 per cent of the respondents stated poor communications with the doctors, at the LACH, 21 per cent of the patients stated that their doctors communicated well only sometimes or never.
Responsiveness to patients' needs is also lower at the Los Angeles Community Hospital (44 per cent comparative to 60 and 62%)
Pain management is also lower -- 52 per cent as opposed to 69 and 70 per cent; patient information in terms of medication used was also significantly lower at the LACH (44 per cent in comparison to 60 and 61 per cent)
Quiet and room cleanliness were also significantly lower at the Los Angeles Community Hospital, as was the level of information patients received upon leaving the hospital
The patients leaving the LACH were less likely to understand the treatment they still needed upon release and they were also less…
