Let me start this story by telling you the end: I am just fine. For those of you who like me, there is nothing to worry about and all is well. For those of you who don’t like me, sorry to disappoint you, but you’re stuck with me for a while.
I’m telling you these things—news to make you happy or disappointed, depending on your point of view about me—because this story is about my recent trip to the hospital, an unexpected journey that I wasn’t sure I was going to talk about publicly. First of all, I didn’t want people calling and fretting and thinking I was suddenly in need of hushed whispers and pats on the head and casseroles. Second of all, I didn’t want people thinking they were finally rid of me and gladly so. But mostly I wasn’t sure I was going to tell this story because I just didn’t want to make a big deal about it. But in the end, I couldn’t help myself. I decided I learned so much on my little stint on the other side of the healthcare desk that I felt I had to share.
It started as a bit of tachycardia, sadly brought on not by a George Clooney sighting, but rather by some anomaly of life which will likely never be known. As my heart started to race faster and faster over a series of hours, and when it became clear that I couldn’t count as high as my pulse was going, I called 911. I was in a hotel room and not at home, and that, combined with my inability to stand due to dizziness, rendered me helpless on my own–a situation I am neither used to nor happy to experience. Nevertheless, the paramedics were good-looking (I figured if this was the last sight I was going to see, at least I had that going for me) and the female paramedic in charge of taking care of me was awesome—totally in charge of the situation and, to my amusement, totally in charge of her retinue of male assistants in the process.
Before I get back to the story line, I just want to remind those of you who care that one of my areas of greatest interest in healthcare is how patients engage with and are treated by the healthcare system. Too often the patient is the last person to be thought of in these situations, despite the situation’s inability to occur without their presence. As I moved from healthcare “expert” to healthcare patient during this experience, I was hyper-aware, almost in an out-of-body experience kind of way, about my patient experience. I was also hyper aware of the 240 beats per minute at which my heart was going at its peak, and how scary and clueless I felt despite all of the knowledge I have from nearly 30 years in the healthcare field and a bunch of cardiology investments. Looking back, I can only imagine how much worse it would feel for someone who didn’t talk healthcare every day of their lives or even know to call 911.
Anyway, back to my little personal drama. The ambulance ride was surreal but fine and I got the mandatory ebola screen in the ambulance bay before admission. Fortunately my recent visits to Berkeley do not count as an at-risk foreign visit and they put me right in a room and didn’t leave me in the hallway like so many other people. And that’s when my story got interesting, at least to me.
I have lately been paying a lot of attention to the whole concept of hospital patient experience. I am actually running a competition for a client (Avia and HX360) on this very topic at the upcoming HIMSS conference (click here if you want to know more about this—entrepreneurs encouraged to apply!). And thus this became a real world experiment in walking the talk.
My patient experience actually started out pretty well, considering the circumstances. The paramedics and EMTs could not have been more communicative, sensitive and responsive (although the hotel manager’s creepy presence during their treatment process continues to baffle me). The Emergency Room personnel that first night were also wonderful. The nurse assigned to watch over me, a pretty big dude who looked more like an NFL fullback than Florence Nightingale, kept me very up-to-date, brought me a never-ending stream of warm blankets and even complimented me on my admittedly outstanding pedicure when checking out my vitals. He made me feel safe and relatively unafraid, considering.
But when I got moved to a room on the cardiology floor, well, it wasn’t quite the same. By the time I was in a room, I wasn’t feeling quite so out of control and, while tired, I could spend some of my energy concentrating on my experience rather than my situation. And while some of the nurses were incredibly kind and attentive and while, frankly, the food wasn’t bad, here are some of the things that actually happened to me during my hospital experience:
- I was told to ring the bell if I felt my heart racing. So I did on two occasions. In both of those situations, no one responded to the call bell. Since the nurses had no way of knowing if my reason for ringing was a crisis or not, it was quite discomfiting when I later walked into the hall to get attention by interrupting the very loud discussion the nurses were having about their favorite TV shows at the nursing station. On that occasion I was told, “Oh sorry, we just never hear the bell.” Later, when it happened again, I was told that the nurses are simply too busy to respond to patients calls. True story.
If you need me, call me; But I may not answer - I got downright bullied by a doctor who wanted to rush me into procedures that I felt to be unnecessary, premature and excessive. When I questioned his recommendations (based on my own wonderful doctor’s input), he tried to guilt me into compliance and treated me with unbelievable rudeness. He scoffed—literally scoffed—when I told him that if I needed any actual procedures I would see my usual doctor, thank you, who happened to be at a different hospital than where the ambulance took me. He told me that I was being shortsighted and that the services at both places are the same so it made no difference. Lord, I hope that isn’t true.
- That same doctor, and his retinue of residents, “attended” to me without ever speaking to me, looking me in the eye or asking me how I was feeling. It was not until I asked the doctor a question did any of them look or talk to me. It was insulting and made me feel like a diagnosis, not a human. When the chief resident finally spoke to me, she asked me questions that made it clear she had not read my chart, inconveniently located in her hand.
- In the first room I was put in there was a seriously disturbed person in the next bed who started screaming and swearing at me when, at 3 am, I asked her to turn down the volume on the television. Granted, I was immediately moved (the nurses did hear the lady screaming at me if they couldn’t hear the call bell), but the new room had a very ill person in it who hacked and coughed and spewed lord knows what around the room. If they ever answered the nurse call bell, I would have asked for a Lysol bath. I was pretty sure that I didn’t enter the hospital with ebola, but I was not so sure I’d leave without it.
- I was told, “don’t worry, since this hospital and that hospital where your doctor works both use Epic, your doctor can get all the records by just signing in.” Hahaha…that’s a good one! These two hospitals are in entirely different health systems and I got to tell my new case manager friends about how Health Information Exchanges work and how the absence of one would mean that I needed a paper copy of my records to take along, thank you. I’m guessing that most patients don’t know that and walk out without their information–a nightmare in the making when you have a lot of follow up to do.
- Incidentally, I found out that none of the information collected in the hotel room or ambulance made it into my hospital record. None of it. So in other words, the data from the most critical part of the experience was apparently lost since ambulances generally do not transfer clinical detail to hospitals. Fortunately (?) some of this information was recovered eventually since the paramedics had left all of the original EKG readings on the floor of my hotel room. Hello HIPAA. This made me realize how important this connectivity between emergency responders and hospitals really is. I kind of knew that (hence my support of Beyond Lucid Technologies, which helps solve this problem), but the lesson was brought home in a big way through direct experience.
- I was given test after test without being given results unless I specifically asked for each one. Since each test result was going to determine the next steps about my care, my stay, my life, I was kind of annoyed to have to keep on asking what the hell was going on. I was particularly annoyed when, at midnight, I was carted off to a CT scan that hadn’t been mentioned. OK, uncle, I figured. I’ll have the test, but I did not enjoy being told that I had to figure out how to jam my shoulder down flat despite the fact that a twenty-year old botched shoulder surgery makes that literally impossible. The tech “helping” me with this told me she would just “push my shoulder down” and strap it if need be. That would have sent me right back to the orthopedic wing of the hospital as they frantically searched for the nails falling from my shoulder to the floor, so I firmly suggested we find another way. She was overtly exasperated at the inconvenience.
- And speaking of Epic, I watched my nurse and doctor argue about the doctor’s mistakenly putting in test orders using the wrong time convention (“regular” time vs. military time), thus accidentally scheduling my test 12 hours after it was supposed to happen. The doctor took serious umbrage with the nurse pointing out the error, even though the nurse was right, and the nurse spent much of the rest of the shift telling me what a jerk the doctor can be. Not too professional all around.
- And the crowning glory: I just received all of my claims letters notifying me that all of my charges were rejected. The reason: I am no longer covered under the plan. Well that’s exactly right, because they sent the bills to whatever happened to be in their information system rather than to the payer noted on my recently issued new insurance card, which I had produced on demand at least 3 separate times in the first 3 hours of the experience. So now I get to chase that one down.
The good news: I am fine, nothing serious, a weird situation that doesn’t pose a risky medical threat. My regular doctor and his colleague, who helped me with all the follow up care, were wonderful and responsive and they made sure I got everything I needed quickly and kindly and conveniently. The people at the imaging center were really wonderful. These aftercare experiences gave me hope that the system can actually work well.
The bad news: the above set of complaints actually represents experiences from two different SF hospitals. I had a bit of a scare later in the week after being discharged from the first facility; that sent me back to a different ER as a “just in case.” So I was pretty bummed out that the odds of having a bad hospital patient experience seemed to be pretty much 100%, at least in my own set of patient experiences.
While I definitely don’t look forward to shopping for an inpatient experience ever again, the odds are that, someday, I will have to; if not for me, then for a family member. I am very aware of how my experience colors my desire to return to these places. To put a finer point on it, if Nordstrom had treated me this way, I would be doing all my shopping at Macys.
As patients become more and more aware of their right and responsibility to take a more active role in their own healthcare experience (and pay a more considerable financial chunk of it out of pocket), we all know how important it is for those who want our healthcare business to treat us like desired customers. Yeah, we may come in to shop by ambulance, and no one really wants to be there in the first place, but considering the odds of each customer having to come back someday, you would like to think the hospitals would pay a bit more attention to ensuring a relatively decent experience.
Hospitals and the clinicians in them can’t guarantee you will be happy or even healthy, but they can make you feel like a person, not a disease; they can be responsive and kind, not indifferent. They can make you feel like they are trying to make you feel better, not uninterested in what you feel at all. And the hospitals that are becoming known for great patient experiences are creating regional and even national brands for themselves that enable them to grow beyond their headquarters to build diverse, enduring businesses that draw people to their doors (and websites).
In his excellent book about patient experience called Service Fanatics, Dr. James Merlino (formerly Chief Patient Experience Officer at the Cleveland Clinic, now President and Chief Medical Officer of Press Ganey’s strategic consulting division) starts with this quote from Maya Angelou:
“I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.”
Truer words were never said.
Unfortunately, there are few incentives to treat patients like people in the hospital. You don’t get paid for being extra nice to patients. In fact, taking extra time to listen to patients costs your most valuable resource — time. Any extra time spent is uncompensated and your reward is to go home at a later hour and spend less time with your family. Most people who enter medicine are decent people to begin with, but decency goes out the window in the current work environment. According to Medscape: http://www.medscape.com/viewarticle/838437, physicians suffer more burnout than other American workers, and it’s only getting worse.
So glad you lived to tell this saga. No one could do it as well.
Once upon a time I visited Chiva Som, a wellness spa in Thailand. At the time I worked in wellness spa industry in the U.S. Upon arrival we were quickly guided to a pavilion, comfortably seated, given tea and an intake paper to complete.
Then a radiantly healthy man presented each of us with fragrant wreath of fresh jasmine flowers and petite roses. His hands were together in prayer position holding the gift has he gently bowed and said, “welcome to paradise”. Thank heaven I made it this far. For the next few days the experience was true to his promise.
I lusted after the idea that we could provide this level of warmth, beauty and empathy in our organization’s customer service experience. In terms of service, “paradise” is either too big a promise or feels like the end of the road.
I’m a huge fan of Jeffrey Eisenberg’s Buyer Legends: The Executive Storyteller’s Guide. In it outlines a visionary process for revising experience outcomes. Medical industry management would do well by applying their Buyer Legend process to reshape the behaviors and choices of clinicians and the patient experience. When the patient becomes the “hero” of the story everything will change.
After my “paradise” experience, our staff training included providing each with a fabulous customer experience and a “you mean nothing to me” experience. 5 star is only an abstraction until it is experienced.
Perhaps a piece of this complex puzzle will be virtual patient experiences for clinicians with the intention of waking up the latent empathy gene. Clinicians and caregivers need a library of tools and apps that help them foster self-care in their own lives. It’s impossible to give to others what you don’t give to yourself. People try but it doesn’t work in the long run.
Rhana, Love the idea of making clinicians check into the hospital for a few days and see what it’s really like. Lisa
Yes, when a “patient experience” becomes part of the experiential curriculum for clinicians, systems will change big time. Wouldn’t that be a huge brand differentiator!
Wow, I had no idea. You looked pretty damn good when I saw you on Wednesday. However I didn’t notice the pedi. Sorry to hear about the ordeal but glad you got to share the experience. Healthcare has a long way to go. We should create a Yelp for healthcare!
Thanks Craig. It was a few weeks ago but the pedicure endures! Take care, Lisa
Lisa–the problem is obvious. You’re running a challenge. That;s serious stuff for professionals,–not something for amateur pundits & former investors! Your heart can’nay take it!
BTW having read Bob Wachter’s book, the next time you have such an event, I suggest you get the AliveCor out and email the results to Eric Topol. More accurate and a whole lot safer than going any where near one of SF’s finest hospitals!!
Glad you’re OK–Matthew
PS given you live in Marin what were you doing in a hotel room in SF.(Somewhat disappointing to find out you were alone!!)
Hey Matthew, thanks for the note and you’re right, no doubt, about all of it! L
First off, so glad you’re alright after this event Lisa. The irony in the pedicure is that with this post you’ve had a 30,000 ft view of all of this. A fascinating look at how those of us in the healthcare space can still learn a thing or two through direct experiences.
Often times, it’s still the status quo to just let out a sigh and say “that’s just the way it is” but I’m hoping that as more insights and people who are not only concerned about these problems but can actually do something about it, come to the surface, we can actually start hearing about better experiences.
Gonna add that book to the list.
Hey Andre, hadn’t thought of that pedicure irony but you’re right! Thanks for the note. Lisa
Lisa, Your brilliantly written account underscores the formation of a new company called Empathetics, LLC. Based on more than a decade of research on the neuroscience of empathy, Empathetics was formed to translate evidence -based empathy training into an e-learning format. This delivery mechanism allows empathy training to be implemented at the top of organizational leadership and then percolated throughout the institutions they serve.
Although empathic and compassionate care are cited in most hospital mission statements, few organizations actually make empathic care the forefront of their missions The problem of clinician overload and burnout is reaching epidemic proportions and is shifting clinicians’ focus away from patients they serve and toward their own survival. By leveraging empathy as a core institutional value, not only will clinicians become focused back on patients’ needs, but the organizational roadblocks to providing this essential type of care will have to removed. The hospitals that put the patients first in both humane and technically excellent care will become the leaders in the healthcare industry.
Helen Riess, MD, Chief Scientific Officer, Empathetics
Helen, I agree there is a profound need for the kind of services you are providing! And the fact that they are based in scientific research will make it easier for clinicians to accept them as well. Thanks for writing, Lisa
Hi Lisa,
Welcome to the best healthcare system in the world. Imagine instead it was your Aunt Millie in St. Louis and you are the caregiver. And you fly to St. Louis and go to the hospital and then she goes to rehab. But you have to go home. I’ve been wrestling with this issue for the last couple of years with a concept called the PUP (patient universal portal) where an outside caregiver could help. So I approached our state HIE and initially they were interested. But once it was apparent there was no reimbursement model, they moved on.
As long as reimbursements are mismatched with patient care and outcomes, I’m afraid we’re collectively banging our head against the wall. Perhaps your next competition should ignore the “cool” apps and instead focus on a sustainable business model that would impact improvements in care and outcomes. Then plug in the apps.
Glad you survived your close encounter of the third kind.
p.s. Had a similar experience a year ago http://brucefryer.blogs.com/weblog/2014/03/living-in-the-healthcare-it-bubble.html
…Bruce…
…Bruce…
Hi Bruce, yes, it was not lost on me that this would have been even worse for an uneducated healthcare consumer or if I had no advocate with me. Not pretty. Lisa
Lisa – we’re all glad you’re ok, but this was such a telling story. In contrast, I recently had occasion to test out the NHS. I fell running to catch a cab, in the rain, in the traffic, at night… a recipe for disaster, and I was lucky to get badly banged up and bloodied, but nothing worse. In shock when I woke up in the rain, lying on the street, I declared I would just go to my hotel room to clean up; instead, my wonderfully protective friend insisted on getting me checked out at an ED. So off to St. Thomas’ we went, and Lisa, it couldn’t have been better – skilled, thoughtful, attentive care. Full information about what was happening at every step, and the results of every test, including the CT scan, and a clear printed copy of the full report to take away with me. The only thing missing was a wallet biopsy — there was absolutely no charge. I’m not sure I’d volunteer for this kind of “secret shopper” expeditions on a routine basis, but this shopper was very satisfied.
Hi Molly, and thanks for the concern. Isn’t it interesting that a system that gets no additional $$ for treating you well (and which isn’t even responsible for treating Americans at all) did such a nice job. Love the wallet biopsy visual! Lisa
First of all I am glad of course that you are physically “okay” and sorry that you had this first hand experience about how the health care system fails to actually provide any real patient centered care. It also highlights the very real challenges of expecting the patient themselves to be able to change the system when they are going through an encounter. I am glad it sounds like you didn’t end up in an ICU where up to 14% of cardiac patients end up developing PTSD (as do a similiar % of women with an emergency C-section and or surgery for gyn cancer). Your brain developed to remember trauma and feeling like things are happening to you can cause stress in anyone so be gentle with yourself (do lots of yoga).
Many of the “loudest” voices in patient advocacy believe that if only we had more access to data (OpenNotes is great but it still often isn’t in real time) or if patients were better educated or if technology was in our hands (I have used an alivecore for example for family members) or better connected (I was on the team that implemented Epic at Sutter and Stanford and the advisory board of a cutting edge HIE. )
What we need to do is change the organizational view of “care” itself. This isn’t simply providing a spa level of care (they could have given you a pedicure but it would probably have cost $400) although in some hospitals in New York are very spa like floors for certain high paying patients. The kind of change we need requires far more than new technology (things like workflow redesign) and new payment models (ACO’s barely brush the surface and just move the profits/risks around with 2% goals). Organizational change and culture change are difficult but the quantified data combined with powerful personal narratives like yours are critical in this process.
It starts however by not only listening to the patients or “letting patients help” but by tying the business model to patient experience and designing for and with patients needs (and even actual patients) in mind. It also happens when we give providers (from the front desk to the surgeon) the tools and reward them for new behaviors by bring payment models into alignment.
It isn’t easy though even integrated systems like Group Health Co-Op (owned by its member patients) , doctors on salary, early adopter of EHR (also Epic), started with patient portal, medical home model, highest quality and patient satisfaction scores in the state lost 20,000 members and 40 docs last year because they couldn’t compete with the new “free” Humana plan offered for seniors. GHC switched where they deliver babies from the highest ranked lean hospital in the US (Virginia Mason) because the high cost but gorgeous competitor had a stronger brand. (despite lower quality).
In the end healthcare is obviously a business and they respond to market pressures far faster than individual patients. When you have a broken “system” you need system level solutions.
Again I am glad that you are fine and thank you so much for sharing your experience as well as your very well informed insights.
Sherry
Thanks for the note Sherry and for the good wishes. I guess and hope that forcing provider organizations to align compensation with patient experience (HCAHPS, etcetera) may push the discussion to the forefront, but there is a lot of culture work to do, for sure. Lisa
Relieved you are OK.
Any reason not to name names re the hospital/hospitals? And the attending? Not to shame, but as statements of fact and to support your account. (The equivalent of anonymous sources in a news story; names add credibility, no matter whose byline.)
Also, it may well be true that both hospitals/systems can access your record via Epic. All, or virtually all, the HC systems in Western Oregon have interoperability now — a great advance and key patient safety metric.
Last, make sure to fill out the Press-Gainey patient experience survey you’l get either by email or snail mail. And send a copy of this blog post to the CEO AND the hospital’s board chair.
Naomi
Naomi, I don’t feel the need to publicly disclose the names; I’d rather deal with it privately with these organizations, and have done the survey for one of them. The other didn’t provide a method for feedback, which is in and of itself interesting. Maybe it will come later. I do like the idea of sending the blog post to people at the organizations and may just do that. Lisa
Thanks, Lisa, for the quick reply. Again, naming the orgs isn’t about shaming. It goes to (hate this word) transparency in the same way that we expect media to use names/dates/places. I trust you; others may think you embellished because you didn’t use where this happened.
And I do urge you to follow up on the safety aspect: An ignored call bell can equal a dead patient. The cavalier attitude by the nurses needs addressing, to say nothing of the underlying issue of not hearing the bell.
Good investing! Naomi in sunny — yes, sunny — Portland
Lisa,
Thank you for the post, albeit sadly a bit of an indictment of my profession. Good “Patient Experience” seems to be one of the things that is more like big foot- talked about but seldom seen. I believe that until incentives are aligned, little will change. Unlike Nordstrom’s where you are the customer, in healthcare, your insurer is the (hospital’s) customer. The insurer sets rates and the access for care. The hospital and providers are responding to their client by offering the least expensive care with an acceptable outcome. Yes, patient satisfaction is measured, but the scale varies between 88% satisfied (the worst hospitals) to 92% for the best hospitals. In my experience the “Patient Experience” administrator has a terrible job- something closer to a human complaint box, deflecting irate patients, rather than a person empowered to actively change the cultural of overwhelmed unit clerks, nurses and doctors taking care of more and more patients for the same or less pay. The ACA will only make this worse. More patients with insurance, but no more providers to care for them will likely lead to longer hours, not less, and ultimately more abrupt providers.
I believe we are moving to a 2 tiered system, one more formally where people pay with money or they pay with time (and aggravation). Once patients become customers, paying directly for services (rather than indirectly through their insurer) the relationship is altered. To date, most Americans view healthcare as an entitlement, something they have already paid for. However, your insurer’s goals may not align with yours. I expect to see more and more folks adopting concierges. Regrettably, it won’t solve the problem for the populous, but it will allow the expansion of a new culture for care delivery.