My wife has gone to a particular hospital, which I see no point in naming, three times since June for outpatient surgery. She was treated so differently each time prior to surgery that I found myself wondering whether hospitals comprehend how easily patients' confidence can be undermined and their anxiety raised hours or days before they are wheeled into the OR. If patients believe their medical care will be superb, that initial worry can shake their trust: If a hospital can't do the simple things right, how do I know it'll get the hard stuff right?
I have yet to run across a hospital that doesn't formally pledge somewhere—in a mission statement, on a Web page, on posters in the corridors—to be considerate and humane and to see each patient as an individual. At the hospital my wife visited, the oath was this: "At [name withheld] Hospital, our goal is to treat every patient and visitor with compassion and respect. That is why we practice the philosophy of 'I C.A.R.E.,' which means we strive to be Courteous, Attentive, Responsive, and Engaged in everything we do."
They certainly succeeded the first time around. There was a call from a nurse just before surgery to review my wife's health status, verify that she had had the necessary preop tests, and go over details of the surgery. The day of surgery, the clerk at the registration desk whipped out her chart almost before the last syllable of her name was recited. The admitting representative gently extracted the requisite information. And my wife was led every step of the way from the admitting area to the surgery waiting room by a cheery, chatty staffer who knew everybody we passed. At the destination, she enfolded my wife in a hug, patted her on the back, and told her she'd be fine. Could any sendoff have been more comforting?
The second time, everything at the front end went fine until we were sent up to the surgery waiting area. We didn't remember how to get there. The admitting staffer walked us a few steps, waved in the general direction we should go, and rattled off the location of the elevator and floor. Then she was gone.
Before the final visit, no one made a preop call to check on my wife's health (which could have changed, for all the hospital knew) and verify other information. My wife was having her surgery in a different part of the hospital from before, meaning that again we didn't know where to go. The admitting clerk didn't accompany us, but she did take us farther than the last time.
Small stuff, you say, and I agree. But in a hospital, small stuff matters. No one looks forward to being a patient. It isn't unusual to be unnerved or panicky. My wife was rattled, and, despite all the hours I've spent in hospitals, I was bothered, too—especially by the lack of the preop call. That step should never be skipped.
"Quality" isn't just about medical competence. It's about the entire process of care delivery. Are there hospitals that truly understand the transition from functioning individual to passive patient and make a point of closely watching those who are part of the transition?
U.S. News's Avery Comarow has been editor of the America's Best Hospitals annual rankings since they first appeared in 1990. His reporting on clinical medicine, from the latest cholesterol guidelines to robotic surgery, has been driven by the question: What does this mean to patients? And that is the perspective he brings to his observations and commentaries on the increasing number of programs by hospitals and other healthcare providers to improve care and patient safety.
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