Role of Hospital Dichotomy

Posted on April 3, 2012

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Two articles that encapsulate a current philosophical conflict in healthcare design are Theresa Brown’s March 14 op-ed piece “Hospitals Aren’t Hotels” in The New York Times, and Kylie Wroblaski’s article “Home Sweet Hospital” for Interiors & Sources magazine.

The articles are not direct analogs in content or style; however, they do deliver two distinct, opposing messages.  Ms. Wroblaski outlines how patient rooms have evolved to be more homey and luxurious as a means to improving “the patient experience”, which is watched by the Centers for Medicare and Medicaid Services (CMS). In the rising tide of resource dedication to improve patient satisfaction, an expectation was created where hospitals should be recognized as domestic environments of comfort than institutional ones.

Ms. Brown feels hospitals and Medicare pay too much attention to customer satisfaction (aka ‘feeling good’ about the care received). She emphasizes the role of hospitals is to heal by whatever means necessary—even if it is unpleasant. Her most cogent point:  a lot of medicine ‘hurts’ despite being the best and most appropriate means to a healthy outcome.

Healthcare has the potential to get in trouble if it caters too much to how the customer feels because feeling good isn’t the goal, wellness is. To her point, a hospital may not score well with patient satisfaction not only because it happens to be creating patient discomfort during the healing process (has physical therapy ever felt good in the moment?), but because patient satisfaction and healing may be mutually exclusive in many cases. This is a strong argument against payment via ‘satisfaction’.

Patient satisfaction is a superficial metric unless it is tied to markedly improved patient healing. From a historical business standpoint, patients (customers) cannot be relied upon to know what the best solution to their problem looks or feels like because they are uneducated about both their needs and the science and technology behind the care (product or service); it is the classic innovation dilemma. A patient only knows they want to feel better, yet he does not inherently know what a successful hospital treatment or stay feels like. The patient may expect an outpatient procedure with a follow-up appointment in two weeks when the best approach is actually three surgeries over six weeks with two specialists, rehab and drug therapies. And even if the malady and care regimen was recognized and understood, can it even be measured to satisfaction at the time of care?

Compensating hospitals for patient satisfaction scores is like celebrating parents for making their kids happy. Good parenting does not always make kids feel happy, but in the long run, kids are better for it. Similarly, kids do not know enough about life, nor have the judgement to determine what good parenting is. More importantly, good parenting cannot be judged at the time each decision is made; it should be judged over a lifetime of decisions that hopefully contribute to the positive development of a child into an independent, moral adult.

On some level, healthcare design is a casualty of an inappropriate incentive system:  patient rooms are made more luxurious because that is what makes patients happy, and making patients happy is something CMS measures. Happier patients therefore reinforce more investment in comfortable, luxurious hospital surroundings.  All of this distracts from the actual care that contributes to quality outcomes, which should be the real focus of hospitals. Architects must challenge client hospitals to invest in care first, and creature comforts second. Patient satisfaction may be what pays the bills in the near term. In a few years, when hospital and physician outcomes and quality scores are made public, patient voting will most likely be done in a more objective way than on how they feel in their newly-appointed, all private room.

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