No One Knows: Informed patients make hospitals better

Hospitals would disappear without the communities that support them.

We pay their bills through our insurance premiums, co-pays, and out-of-pocket payments. We help them buy new equipment or add new wings and centers by bidding at charity auctions and running a 5K for a fundraiser.

And we complain.

Hospitals may not always see complaints as signs of support. But when a hospital or health system has problems – like the long wait times at VA hospitals – it can only get better if the community within it and around it helps it get better. And the community cannot push for solutions when it is being kept in the dark about the problems.

I wrote last week about how disclosing more information to patients helps empower them to make good decisions about their care and their family’s care. That’s an inward-focused benefit. Disclosure also can have an outward-focused benefit, sometimes unintentionally so.

When patients are in the dark, they may complain generally about something they think went wrong with their care. When they are brought into the information loop, their complaints can become more specific and more helpful. If parents had been told in 2009 that there were multiple children who had developed fungal infections from the linens at Children’s Hospital New Orleans, they could have talked with hospital staff about practices they had seen at the hospital that may have contributed to the problem.

After all, parents often spend more time in the hospital room than any single hospital staffer – far more than any doctor or manager – and are more likely to notice patterns.

If a parent, for example, saw a hospital orderly putting linens and trash together – as was alleged in a story by The Times-Picayune – they might be more likely to complain if they knew there was a fungus problem. If they noticed that the linens were dusty – the CDC found that they were being delivered uncovered to a loading dock with visible dust – they might have been more likely to complain.

But, just because patients complain doesn’t mean hospitals will become safer, right?

James Pichert and a team at the Center for Patient and Professional Advocacy at Vanderbilt University Medical Center performed an analysis that was published in 2008 in “Advances in Patient Safety: New Directions and Alternative Approaches” that provided good evidence that complaints do lead to improved safety. The Patient Advocacy Reporting System (PARS) that Vanderbilt created is worth its own long post, but here’s a quick summary:

More than 20 hospitals gather patient complaints, code them and create a “complaint index” for every physician who receives a complaint. If a doctor’s index hits the 95th percentile, the hospital’s physician committee goes into action. They send a peer physician to talk directly with the physician who has a high number of complaints. They call these “feedback sessions.” And when Vanderbilt analyzed the data for one academic medical center, they found a reduction in claims and lawsuits as a result. The researchers wrote:

We conclude that patients can indeed play important roles in promoting safe medical care. One of those roles is to make concerns about their health care experiences known to appropriate medical center or medical group personnel. To be effective at identifying patterns, medical center and medical group personnel must solicit, value, and support patient input, especially from populations who are culturally less likely to complain; centralize complaint reporting for systematic analysis; and institutionalize physician-driven processes for providing constructive feedback to those associated with high complaint scores.

One impact of this approach has been the exodus of problem doctors. The researchers found that one in five doctors who generated the most complaints left the hospital. This doesn’t mean they stopped practicing, of course. As the researchers note, “Perhaps their intention to move or retire distracted them from fully caring for patients, or perhaps they left seeking a ‘geographic cure’ for perceived shortcomings of their practice environments.” But awareness is the first step toward a solution.

It’s true for health care providers. And it’s true for patients.

Photo by COD Newsroom via Flickr.