A recent opinion piece in the New York Times was quite thought provoking. An oncology nurse,Theresa Brown, wrote "Hospitals Aren't Hotels" to discuss the challenges in placing quality measures on healthcare facilities.
"The nurse opens with a discussion of a painful procedure to keep fluid from building up in the tissue around the patient's lungs.
The pain of the initial procedure is absolutely necessary in order to ward off an even greater (and more painful) future health threat.
She then wonders about the "patient satisfaction" score that would be associated with that particular patient's experience in the hospital."
With the increased emphasis on how the "consumer" perceives their treatment, she reminds us:
The problem with this metric is that a lot of hospital care is, like pleurodesis, invasive, painful and even dehumanizing. Surgery leaves incisional pain as well as internal hurts from the removal of a gallbladder or tumor, or the repair of a broken bone. Chemotherapy weakens the immune system. We might like to say it shouldn’t be, but physical pain, and its concomitant emotional suffering, tend to be inseparable from standard care.
She points to a study that higher satisfaction scores were linked to increased consumption of services and, ironically, increased mortality.
"In other words, evaluating hospital care in terms of its ability to offer positive experiences could easily put pressure on the system
to do things it can’t, at the expense of what it should.
To evaluate the patient experience in a way that can be meaningfully translated to the public, we need to ask deeper questions,
about whether our procedures accomplished what they were supposed to and whether patients did get better despite the suffering
imposed by our care."
It's a very difficult question. Our future strategies will depend greatly on how that question is ultimately answered.
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