Hospitals vs Hotels

Although the previous post was a little tongue-in-cheek, it's not that far from the truth. In the last decade, there has been a huge shift to focus on customer satisfaction. Even going from medical school to residency, I noticed a lot of changes. Flat screen TVs, loaner iPads, and menus became popular. Even though it's a tiny thing, this last detail really surprised me. In the hospital, physicians determine a patient's diet; we write an order for a low salt or diabetic or renal (kidney) diet. We (along with our speech and swallow therapists) decide whether a patient can have a regular diet, puree foods, liquids only, or some other strange consistency. That a hospital can still come up with menus that adhere to the medical requirements but give patients choice is really impressive. There were many times when I thought that patients ate better than residents (but only if the patients didn't have congestive heart failure, kidney disease, or liver disease).

Why has this been the case? In the last few years, hospitals have become obsessed with customer experience. Physicians are encouraged to care about and improve their Press-Ganey customer satisfaction surveys. For some of us, reimbursement is tied to how many "excellents" we get. Insurance companies are starting to pay attention to what their customers want. Businesses pick HMOs that their employees like. Physicians start worrying about their online reviews. In a society and world where everything else - hotels, restaurants, museums, babysitters - are reviewed, physicians and hospitals now have to start thinking about the customer experience.

So all of a sudden, we have valet parking, artwork in the hallways, gadgets for patients, consultants to help us dazzle up the experience. These things improve our surveys. But unfortunately, the quality of medical care matters less. Patients really aren't aware of most of the medical decision making. How do they know if the antibiotic prescribed was appropriate or if the X-rays they got were actually necessary? Poor outcomes may occur despite appropriate care, and good outcomes may happen even if care was egregiously wrong. For the most part, I think patients cannot easily assess the quality of their care. Even if that's probably the most appropriate metric to rate a hospital, patient satisfaction happens to be easier to survey and validate. Hence the recent rise of hotel-like hospitals.