The New York Times
During a conversation with the wife of one of my former surgery patients, I was surprised to learn that her husband had chosen to receive his postoperative chemotherapy treatments at a hospital across town from mine. His wife assured me that he had liked the highly respected colleague I had referred him to; what had troubled him was that the doctor’s office and the hospital chemotherapy infusion suites were, well, depressing.
I knew those rooms well; they hadn’t been painted in at least a decade. The walls were a dull white decorated only with the occasional scuff mark; the chemotherapy rooms were crowded with 1990’s-issue blue vinyl loungers and chairs; and patients connected to medication drips had to sit in straight rows. In that rigid schoolhouse configuration, they were forced either to begin awkward conversations with their neighbors or to silently contemplate their collective fates.
The other hospital, my patient’s wife recounted rather breathlessly, had a brand new cancer center. Its lobby was decorated like a hotel, and the walls were painted in soothing colors. Doctors and nurses moved about noiselessly on floors covered with wall-to-wall carpeting, and the rooms used for chemotherapy were not only private but also large enough to hold family members.
“I’m embarrassed to say it,” my patient’s wife said after reeling off the list of enviable amenities, “but even the art on the wall makes us feel good.”
There was great clarity to her statement, the kind of personal insight that made the disingenuousness of my own professed stance on the subject of hospital “perks” all the more obvious.
Like most clinicians, I had always been quick to assert that good clinical care — the right treatment, the most appropriate technology and a strong patient-doctor relationship — was all that really mattered in health care. Nonclinical amenities just added unnecessary costs and fueled profit-driven medicine.
But I also knew how meaningful a pleasant lobby, private rooms and good food could be for patients and doctors. Whenever possible I had accommodated patient requests for services that made them feel comfortable, less like a sick person, and I had offered no protests when the hospitals I worked in became embroiled in costly renovation projects.
I was reminded once more of that conversation and my own profession’s discomfort with the subject while reading a recent editorial in The New England Journal of Medicine that asserted that amenities are a critical part of the patient experience and possibly even a valuable component of patient-centered care. The authors, economists at the Schaeffer Center for Health Policy and Economics at the University of Southern California in Los Angeles and the Rand Corporation in Santa Monica, go on to warn that unless we finally acknowledge the importance of the patient’s nonclinical experience, we risk losing these services altogether, as well as the clinical productivity these amenities inspire.
In other words, it’s time to acknowledge the writing on the (pastel) walls.
“These amenities may be important drivers of clinical outcomes and, more broadly, satisfaction with care,” said John A. Romley, senior author and a research assistant professor in Policy, Planning and Development at U.S.C.
While it is has long been known that certain environments and building designs can influence patient outcomes, researcher have only begun looking at the role of hospital amenities in patient decision-making. Recent studies have shown that when choosing a hospital, patients are more likely to consider nonclinical services than their doctors’ recommendations, the distance from home or hospital-specific mortality rates. Even patients who need to go to the hospital for more critical conditions, such as a heart attack, will place great importance on hospital amenities. “At some level,” Dr. Romley observed, “people are probably willing to trade off clinical quality for a very pleasant experience.”
Some of this emphasis on services may arise from the fact that many patients have difficulties finding and interpreting public reports on hospital safety and quality. Without that information, they resort to evaluating what is easiest to notice — a hospital’s appearance and the array of services offered — and then use these measures to gauge a hospital’s commitment to patient-centered care.
“It’s like cars,” said economist Dana P. Goldman, a professor of Medicine and Public Policy at U.S.C. and lead author of the article. “You may not know how good the engine is; but if there’s shiny paint and it looks good and smells clean, you tend to assume that the car will work for you.”
While most of us, doctor and patient, would agree that having at least a few amenities would be nice, they don’t come cheap. Improving a hospital’s nonclinical services has been shown to be more costly than similar adjustments in clinical care; and it’s unclear whether the benefits are worth the cost. Third party payers like Medicare currently underwrite a large portion of these services when they pay a fixed amount for each patient discharged with a certain diagnosis. But under the Patient Protection and Affordable Care Act, these expenditures could come under more scrutiny. Hospitals will be reimbursed according to a value-based payment system; and those “values,” which have yet to be determined, may not include the nonclinical aspects of a patient’s experience.
That is unless all of us, doctors and patients, can finally acknowledge that all aspects of a patient’s hospital experience count.
“Whether Medicare dollars should be used for these services is an important question,” Dr. Romley said. “But the happiness and joy that these amenities provide for patients over the course of what is otherwise a difficult experience is something we should respect.”
Added Dr. Goldman: “It’s not just about patient survival anymore; it’s also about the patient experience.”