We've Always Done It That Way

A loved one of mine recently had to spend a few days in the hospital.  Now, the procedure went well, she’s home and recovering fine, and the staff at the hospital – from the surgeon to the people cleaning the rooms – were uniformly cheerful, helpful, and friendly.  Still, I came away from the hospital experience thinking – really, this is best we can do?

The following are some of my pet peeves about hospitals, particularly things where the patients don’t seem to be coming first.  In no particular order:

• Hospital Gowns: Let’s start with that familiar piece of appeal that is ubiquitous not just in hospitals but throughout the health care system -- the backless hospital gown.  If an evil genius wanted to design something to take away a patient’s dignity, they wouldn’t have to stray too far from the standard gown design.  They don’t have to be this unflattering.  For example, the Henry Ford Innovation Center has introduced a gown that is in use at Henry Ford Hospital that acts more like a wraparound bathrobe and is much more popular with patients.  The question is, why aren’t more hospitals (and providers’ offices) following suit?
• Semi-private rooms: Aside from a few (dubious) claims to the advantages of companionship offered by having a roommate, there is widespread and longstanding consensus that private rooms are the way to go.  Lower chance of infection, better sleep, and increased patient privacy are commonly cited advantages of private rooms.  As hospitals renovate or build new wings, they tend to feature private rooms.  But that still leaves an awful lot of semi-private rooms in our health system (I’ve yet to come up with a count but I suspect it is the vast majority).  Even worse, if a patient requests a private room when there are semi-private ones available, the patient usually has to pay the difference – at charges.  That’s crazy.  Hospitals should be offering steep discounts when patients have to use semi-private rooms.  That would speed the conversion.
• Patient monitoring: Why is it that patients get woken up several times a night so that staff can take their vitals?  It’s bad for sleep, which is bad for patients, and probably impacts the validity of whatever measurements are being taken.  Maybe hospitals haven’t noticed, but remote monitoring options have proliferated in recent years.  I’m sure that there are some patients who do need to be checked in person, but I severely doubt it is all patients, or that the checking always requires the patient to be woken.  Let those people sleep!
• Uncertainty:  A patient’s life in the hospital involves a lot of waiting around in bed for something to happen – a visit from a physician, a blood draw, a CT, etc.  The patient rarely knows when any of these is going to happen, aside from perhaps a vague time frame.  We get it: the staff in hospitals are busy, and unpredictable emergencies happen that can throw schedules out of whack.  Nonetheless, patients deserve better.  If hospitals were run like a modern manufacturing plant, with real-time inventories and tracking, they’d know where everyone was at all times, when schedules are falling behind, and how to adjust accordingly, so patients could be kept in the loop.  Maybe Toyota or Amazon should run hospitals. 
• Patient tracking: As soon as my loved one registered (a task, by the way, that could only be partially completed in the online pre-registration process), she was issued a patient ID wristband.  Each time someone did or gave something to her they first made sure they scanned the barcode on the band.  I appreciated their effort to ensure they were dealing with the right patient, but I always felt it treated her like a piece of merchandise.  These are hospitals, dealing with live people – ever hear of biometric identifications?  Again, this technology is out there; it’d be nice for patients to be made to feel they are a person in a hospital instead of a slab of beef in Kroger.
• Patient entertainment options: while patients are doing all that waiting around, it’s often hard to keep entertained.  Admittedly, having a TV for each patient is pretty standard, and many hospitals also now offer WiFi (although not always secure WiFi), but I have yet to see a hospital TV that doesn’t use the old-fashioned tethered remote that only allows patients to navigate stations one-by-one.  Since soon hospitals will be giving patients access to their electronic records (ahem, Meaningful Use Stage 2, anyone?), they might as well go to options that feature full internet access, video-on-demand, streaming, and other modern entertainment features.  This is not pie-in-the-sky stuff; the technology is out there – e.g., GetWellNetwork or Skylight Healthcare Systems – so why isn’t it used more?  BYOD should certainly be allowed but shouldn’t be the hospitals’ strategy.
• Not So Electronic After All: The room my loved one was in had a screen and keyboard attached to the wall (although not at an angle some of the nurses could easily access, mind you, and definitely not available for patient access), but I noticed that not every one of the staff used it to access her records.  Some brought in another computer, while a disturbing number carried paper records, which they either read from or wrote on.  I was disappointed, but not surprised, to see that no one was carrying a tablet.  I’ve written on this before, but the experience really highlighted how simply having EHRs doesn’t mean they are used to best effect.  I suspect that the UPS driver who delivers to my house has a more well-thought out system for accessing and updating information real-time than the health care professionals in most hospitals do for viewing and updating patient information.
• Too big: Many hospitals have grown organically over the years, often resulting in huge complexes that lack a central plan.  Patients and their families have other things on their minds when they are there, and the complicated layout and medical terminology used add to their anxiety by making it hard to navigate.  Some hospitals are advocating a process design approach called “wayfinding,” borrowed from shopping malls and airports, that is intended to help people navigate.  In a perfect world, hospitals would be designed from scratch with patient navigation in mind, but wayfinding at least tries to make some sort of recognizable purse out of this particular kind of sow’s ear.   Personally, I think the real problem is that many hospitals have simply grown too big and wish we could start over.
• What Happens Next?: One of the professionals treating my loved one confidently told her what to expect over the next couple of weeks, and I kept thinking: how would they know?  Face it, neither the physicians in the hospital, nor even the physicians in the community, really track patients once they leave the hospital.  They might get phone calls or do follow-up visits, but actually knowing how patients are faring day-to-day or even week-by-week is not typical.  It’s being done already, so – why isn’t it being done more? 

I don’t mean to pick on any particular hospital, and I suspect – in fact, I hope -- that for every example I listed there are counterexamples.  Nonetheless, I worry that they’re more common experiences than uncommon.  I’d be interested in hearing about other people’s pet peeves about hospitals – and I’d especially love to hear about counter-examples where a hospital has done better for patients.

Hospitals have a lot of caring, smart people working in them, all of whom presumably want what’s best for the patient.  I sure hope the barriers to addressing them are more than “we’ve always done it that way...”