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Could A Simple “Fix” Exist For Influencing the Patient’s Perception of Care?

Posted By Marlena Jareaux, Tuesday, October 29, 2013
Updated: Sunday, October 27, 2013

HCAHPS, enacted by Federal policy makers in response to the uneven care among hospitals, seemingly attempts to even the playing field. The primary goal is to lower the skyrocketing medical costs in our country while simultaneously giving more weight to the actual patient experience. This, in and of itself, is timely, very much needed, and will benefit our society as a whole in the long run. The problem is, as is often the case when a decision is made that attempts sweeping changes that affect many people, the mandate to essentially "fix it or be penalized” has made hospitals scramble to find fixes to a problem that many have found not to be as simple as it sounds. Or is it?

Recently, while doing a search on the internet on the phrase, "medical decision-making preferences,” I was struck by the synopses found within the first four pages of results.

Are there cultural differences in patient’s shared decision-making preferences
(of course there are)
Variability in patient preferences for participating in medical decision-making
(I would assume so)
A theory of medical decision making under uncertainty
(Is there just one?)

My favorite is the lecture notes from a medical education course on medical decision making. The first sentence reads, "This week we enter the strange and fascinating world of preferences, utilities and feeling.”

NOW, we’re onto something!

Tempting as it is to hope that your task of increasing your patients’ perception of quality care can be accomplished by a one-size-fits-all approach that can be purchased and implemented, it just doesn’t exist. Preferences change (don’t yours?), people change (gosh, do we), and circumstances change (the only thing that is constant, IS change). Fortunately, one of the greatest tools that can be used to keep abreast and stay ahead of the "strange” and seemingly complex world of your patients’ perceptions and expectations, is already embedded into the roots of every single healthcare organization that exists into this country and the healthcare workers working in them. CARE enough to ask. If you are human, you can care enough to ask.

I’m sure that in our pay-for-performance and results world that we live in, people will say "we don’t have the time to ask.” I’ve seen versions of this for myself: the revolving-door environments where the patient can barely see the eyes of the doctor or nurse to be able to even recall the color of those eyes, much less to detect any compassion in them. Or the seemingly thriving practice that delivers results for their patients, but can’t figure out why their scores for "likely to recommend” aren’t moving upwards.

Bottom-line is this: previously, hospitals could always rely upon patients walking through their doors because, well, they needed care and the hospital was there. Patients had to accept the care that they got, and only the truly-bad encounters got reported by those who bothered to take the time to do so. That landscape has changed. Like it or not, HCAHPS is here to stay, your patients are having their perceptions elicited, and you are being graded and rewarded (or penalized) according to those grades (and thereby, perceptions). Not only are those grades being publicized on the largest billboard that exists (the Internet), but so are the neon signs telling your patients and prospective patients to view your grades and choose in accordance with them.

On page one of the Hospital Quality Initiative Overview, found on the CMS website, you will read, "This will encourage consumers and their physicians to discuss and make better decisions on how to get the best hospital care…”

One powerful "fix” then, for all of you looking for one, is as simple as this: ASK.
Marlena Jareaux

Tags:  HCAHPS  patient experience  pay-for-performance  perception  quality of care 

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