Patient Experience: Safety, Transparency & Healthcare Reform

Introduction

Although the United States is home to some of the most highly respected healthcare institutions in the world, high-quality care is lacking in many critical areas. While individual hospitals may not be able to remedy this fact on a national scale, they can seek meaningful ways to improve the patient experience — both in terms of safety and in empowering individual patients to exercise greater autonomy when navigating the healthcare environment.

Standardization and Prioritization of Patient Care

Healthcare is a lucrative, for-profit industry in the United States, but it is also one in which decisions can mean life or death for consumers. Ensuring that patients receive high-quality care is essential not only on a human and ethical basis, but also for healthcare institutions to remain financially viable. As noted in the 2016 podcast "The State of Patient Experience," institutions operating within the competitive, capitalist healthcare marketplace are attempting to leverage safety and quality to gain an edge over rival hospitals — attracting patients and the support of organizations that provide funding.

Jim Merlino, president and chief medical officer of the Strategic Consulting division of Press Ganey, has pointed out that while patients might hope all institutions meet certain quality standards, this cannot be taken for granted. Approximately 440,000 deaths occur in U.S. hospitals each year due to preventable medical errors. While risks are highest for senior citizens, they are present for all patients — arising not only from surgery or medication errors but also from hospital-acquired infections. Merlino notes that the essential components of marketing are product, place, price, and promotion, and if the product in healthcare is care itself, then keeping patients alive is its most basic requirement — one that some institutions have tragically failed to meet.

Of course, patients and providers alike expect more than simply sustaining life; they demand that care be optimized. This requires leadership, according to Merlino, to set standards at the very top that exceed current industry benchmarks, and to create a concrete plan for doing so. Safety must be openly discussed, consequences for failing to follow safety standards must be enforced, and violators must be held accountable. Yet while executive leadership plays a central role in setting expectations, all members of the organization must be equally invested in quality improvement. This means investing in provider training to ensure adherence to the most current and effective standard operating procedures, tracking what is working and what can be improved, and staying current with technology and evidence-based medicine.

What was considered the industry standard in the past may not remain so in the future. Technology and medical knowledge are constantly evolving, and educating providers while instilling a sense of urgency about standardizing and improving procedures is essential to ensuring appropriate patient care. Understanding high-risk patient populations is equally important — for example, elderly patients may be at higher risk for hospital-acquired illness, while certain historically underrepresented groups may carry a higher risk for conditions such as diabetes.

Transparency in Healthcare

One of the most frequent complaints about healthcare institutions is that patients lack the information needed to make informed choices. Unlike other major purchasing decisions, patients are rarely given upfront cost information for procedures. It is also extremely difficult for patients to compare physician ratings and safety records — particularly because patients are often laypersons who do not fully understand the implications of raw medical data and must rely on secondary sources to make that information digestible. According to the podcast, institutions have a responsibility to inform patients about such issues. Doing so can also add value for institutions with strong physician ratings and safety records, building patient confidence, encouraging institutional selection, and generating goodwill that attracts funding and support. The Leapfrog Group, an independent rating organization, offers evidence-based evaluations of hospitals across a variety of benchmarks, including patient safety, care outcomes, and overall healthcare grades.

A complication arises when an institution is struggling with a particular quality metric and may wish to conceal that information. Patients may recognize a red flag in the absence of such data, but because their health insurance network limits their provider options, they may have little practical ability to switch to a higher-performing institution. Some degree of government-mandated public reporting is likely necessary to ensure that complete, easily comparable data is made available to the public. It is also important to acknowledge that in emergency situations, rural settings, and other constrained contexts, patients may still have limited choice — even when an institution is fully transparent about its quality deficits.

Transparency thus serves as an important mechanism for accountability, but it is not sufficient on its own. Transparency from a healthcare institution, even an excellent one, does not automatically translate into increased patient volume — outcomes depend heavily on a patient's insurance coverage and the type of care being sought. Higher-quality, safer outcomes for complex surgeries and high-risk procedures may meaningfully benefit providers offering such critical care, as patients are more likely to research those decisions carefully. This dynamic is less pronounced in primary or emergency care settings. The internet has made patient research easier than ever, but interpreting and evaluating the quality of health information online remains a significant challenge for many consumers.

References

Affordable Care Act. (2010). Retrieved from: https://www.hhs.gov/sites/default/files/ppacacon.pdf

French, M. T., Homer, J., Gumus, G., & Hickling, L. (2016). Key provisions of the Patient Protection and Affordable Care Act (ACA): A systematic review and presentation of early research findings. Health Services Research, 51(5), 1735–1771. Retrieved from:

Leapfrog. (2016). Official Website. Retrieved from: http://www.leapfroggroup.org/

Perspective: The state of patient experience. (2016). SoundCloud. Retrieved from: https://soundcloud.com/healthcaresuccess/perspective-the-state-of-patient-experience