A September 21, 2010 article based on an interview with Trent Haywood, MD, JD, chief medical officer, VHA, Inc., Irving, Texas, and former deputy chief medical offer at the Centers for Medicare & Medicaid Services in Healthcare Financial Management (HFMA)  talked about how less-than-stellar patient satisfaction results are dragging down hospitals’ value-based purchasing (VBP) scores—a tally that CMS intends to use in calculating Medicare reimbursements beginning October 1, 2012.

 There are many things that hospitals need to do to improve patient satisfaction scores.  Haywood states, “With HCAHPS, there is a much wider distribution (in scores). While many hospitals are starting to focus on patient satisfaction, many still have room for improvement.” 

It is hard to improve scores…patients don’t really want to be in a hospital….it’s a somewhat strange environment for most … and patients lose a lot of control over their environment.  Some hospitals are trying to give patients back some control, over something that they are very familiar with…food. 

I saw this video featuring Leonard Votion, Director of Food & Nutrition Services at Trinity Mother Frances Hospital, a 395 bed acute care hospital in Tyler, Texas.  Votion is interviewed on KETK NBC 56 about the room service program that they started to offer in August 2010.  Said Votion: “Food is healing.   It is a real satisfier.”  Votion added that TMF provides ” What they eat, to when they  eat, at no additional cost for the patient.”  Room service staff  works with patients and their medical team to help ensure that patient dietary wants work in harmony with the dietary needs necessary to properly aid in a quick recovery.  I love the quote at the end from the host —food can make a difference.  

Food is not part of the HCAHPS survey, but I feel that it has a halo effect.  Sure it does NOT make up for poor care…but it does provide an additional level of comfort and control for patients who are being well cared for clinically as well.  As patient satisfaction scores become a part of CMS’ Value Based Purchasing program, hospitals that gain an edge by finding cost-effective ways to create satisfied patients —and strong clinical outcomes —will succeed.

Healthy Lifestyles can include many other issues relevant to employees around healthcare. I know leaders, like ARAMRAK Healthcare President Tim Campbell that incorporate running and working out into their lifestyle (I see him in the gym in the mornings!). The President at MD Anderson, John Mendelsohn, I understand, is passionate about healthy food choices – and this is incorporated in the food service to the employees and to the patients. The example that is set from the top surely reverberates throughout the organization.

A unique hand-washing basin is located in the reception area of the children’s hospital.

Using a waterfall design, children are encouraged to wash their hands along with “grown-ups”.  A raised adult sink with faucet allows for a gradual flow of water as it slowly but pointedly cascades to a drain in the lower sink.  Using art, and a “cool” factor, children learn the importance from staff of washing their hands.  By watching what adults are doing, the child mimics adult behavior.

Is there a connection between education of children and a low infection rate? Well, I say that if an organization puts its mind to it, and is clever enough to develop a way to engage its youngest patients to be part of the “care team”…then it is no accident that it a leader is decreasing infection rates.  Patient education is certainly a part of the approach!

Hospitals will need to improve quality measures up to avoid penalties.  Being one of the bottom 25^th percentile of all US Hospitals will lead to negative financial impact.  My feeling is that hospitals that are attuned to this are going to be pulling away from the pack.

With acuity levels higher and lengths of stay longer than those in adult acute care hospitals, there are several differences that require special attention.

Take, for example, environmental service needs. Cleaning and sanitizing patient rooms require more time and greater frequency. This is because children tend to have higher visitor traffic and parents who are bedside for extended periods. The rooms are often larger as well, to accommodate greater numbers of diverse medical equipment.

On the food service side, a number of factors change the way an effective patient food operation is run. Convenience is important for parents and visitors who use meal times to bond with their loved ones. Menus also must take into consideration the differences in preference for different age groups. A five-year old will like something different than a 15- year old, and the parent prefers options that are different than both.

And with Chefs like ARAMARK Healthcare’s own Barry Giordano on the floor creating mealtime experiences for the kids, we know that support services staff make a difference.

And we know that the little things matter. Kids want to have variety and be empowered to make their own decisions around food. They also need to encounter friendly welcoming faces in all those who come into their rooms.

What other special touches are you aware of to create great environments for sick kids?

George Porignon, Health Policy Expert at the World Health Organization, presented a healthcare model that focused around primary care practitioners, and not around the acute care hospital. What was fascinating was the discussion that followed by Indonesia’s Muki Reksoprodjo, who stated that although his country was as large as the U.S., it consists of two-thirds water, making logistical access to primary care resources difficult. Pan American Health Organization’s Ciro Ugarte talked about the difficulty in treating patients with limited primary care resources, who then come to the acute care facility for access. 

AHA’s President Rich Umbdenstock discussed U.S .approaches and the difficulty of turning the massive system around to primary care, but provided examples of how primary-care centric organizations work in the U.S. Richard deFilipppi, a trustee at Cambridge (MA) Health Alliance and the Board Chair of the AHA discussed the Massachusetts system. Erick DeRoodenbeke, the Executive Director of the International Hospital Federation, nicely summed up the discussion….that more and more, the movement to Primary Care-centric practice is being led by state, regional, and local organizations, as legislating policy from a national body is hard to implement due to local variation. Lastly, a side conversation with the German Hospital Federation Chief Executive Georg Baum focused on how Germany controlled costs, especially drug costs, by having pharmaceutical organizations come in front of a panel and justify prices based on efficacy and value.

The perspective gleaned from discussions with international healthcare leaders served to broaden my view of things….removing some of my American myopia. Almost all nations are struggling with issues; most are not as fortunate as the United States to have our deep resources. More than once, representatives commented to me that it is hard to believe that the richest, most powerful country has so many uninsured. I tried to explain why, and the history that led up to where we are now, and that the answer was not easy. I was not sure if it was the language barrier or the shortcomings of our system that left my explanation somewhat lacking.

The Romanian Hospital Association’s First Vice President, Dr. Mircea Oltenu, stated to me that along with the recession, healthcare costs are crippling his country. Healthcare’s significant consumption of resources on each nation’s productivity, no matter what system is in place, is a common characteristic. As I left the meeting, my thoughts drifted to a hope that a cure for cancer, Alzheimer’s, and diabetes may be the only solution to solving the world’s healthcare issues. The eradication of these diseases could result in the same “dividend” that the eradication of polio in the 1950s and 1960s had for society, with its concurrent impact on lowering the need for iron lungs, long term care, human caregivers, and family’s resources. From a world-wide perspective, only miracles of cures for major diseases seem like the best hope.

I thought of this interaction and implications in healthcare.  At ARAMARK, we use the words “Key Words at Key Times” to describe how we educate our associates regarding their patient interactions.  Two sessions I attended were also related to the consumer experience.  What’s interesting is that although the speakers came from different perspectives, the process was very similar.  Gail Scott called it the “Act With TACT Model” — where TACT stands for:

- Take Ownership
- Acknowledge and Apologize
- Communicate and Correct, and
- Thank, Track, Trend and Learn.

Tom Tull and Candace Jennings of Mountain States Health Alliance (TN) defined a foundation for service excellence – called WOW – Values in Action.  This process involved:

- First Impressions
- Personal Appearance
- Caring Customer Service
- Communication
- Patient Information and Education
- Customer Interactions
- Respect
- Etiquette
- Commitment

The presentation that CHRISTUS VP Mike McBride and I did focused on Succeeding in the Patient-Centered Age of Healthcare.  It defined the AIDET (Acknowledge, Introduce, Duration, Explanation and Thank You) technique popularized by the Studer Group in guiding patient interactions. A copy of the presentation can be downloaded here.

Whatever the acronyms and approach, it appears that leading health care organizations are focusing on making a positive impact the customer experience which includes a scripted support staff interaction. These folks will succeed in the post-recession future! To kick off my first Blog posting … I’m interested in hearing about approaches that your health care organization has implemented, and affects they have had on outcomes.