Changing Hospitals To Treat Patients Better
NEAL CONAN, HOST:
This is TALK OF THE NATION. I'm Neal Conan in Washington. There have been lots of polls about health care in this country but very few that focus on those who are actually sick. This month, NPR, the Robert Wood Johnson Foundation and the Harvard School of Public Health surveyed people who have been in the hospital over the past year to ask about the quality of care, the cost of care, value received and about the problems they encountered.
One key finding showed that just about half were very satisfied with care during their hospital stay. The other half pointed to some of those problems. If you've been in the hospital over the past 12 months, did you get good care? Give us a call, 800-989-8255. Email us, email@example.com. You can also join the conversation on our website. That's at npr.org. Click on TALK OF THE NATION.
Later in the program, New York police say a man's come forward to say he murdered Etan Patz, the six-year-old boy who disappeared in New York 33 years ago tomorrow. But first NPR health policy correspondent Julie Rovner joins us here in Studio 3A. Nice to have you with us again.
JULIE ROVNER, BYLINE: Nice to be here.
CONAN: Just over half reported being very satisfied. Well, can't be too negative about it. Some - another big group said they were somewhat satisfied, but that's not to say there aren't a lot of problems.
ROVNER: That's right, and, you know, granted going to the hospital is not something anybody does for fun, and I guess that's sort of - the good news is that half the people say that things are good or OK, but a third of those respondents said things could have been better.
About a third of respondents say that nurses were not available when they were needed, and another third said that communication was really lacking. That seemed to be, you know, a fairly pervasive problem, communication between them and their caregivers or between the caregivers who were taking care of them, meaning doctors and nurses, didn't have communication or other aides didn't have good communication. That seems to be a fairly pervasive problem in the health care system in general but particularly in the hospital.
CONAN: And I guess no surprise, after all the attention devoted to all those other health care surveys, cost is a big issue.
ROVNER: Yes, cost is a big issue. You know, it was interesting, a lot of people that we surveyed said that they thought they were getting pretty good value for their money, but an awful lot of people are still saying that being sick really puts you at risk for having a serious financial problem, and these are even people with insurance, that more and more people with insurance are spending more and more money, and if...
CONAN: Out of their own pockets.
ROVNER: Out of their own pockets, and if you get sick, obviously you are going to be spending even more. And some of these people are saying that they put off care because of the financial hit, and those who did not put off care suffered serious financial problems because of that.
CONAN: And some of the problems you referred to communication, that's a pretty serious problem, it can lead to mistakes. And a lot of people said wrong diagnoses, tests that weren't necessary or for the wrong thing.
ROVNER: That's right, and, you know, you have to take some of these with a little bit of a grain of salt because these are self-reported - what we're asking is from these - we're asking people to report on their own. So we don't know for a fact that these are necessarily wrong diagnoses or tests, things that they didn't need. So we don't know exactly for sure. But that's what we're getting.
And certainly we do know that there is a significant amount of that sort of thing that does go on in the health care system. There is excess, if you will, and there are certainly wrong diagnoses.
CONAN: If you - as you looked at this survey data, what jumped out at you?
ROVNER: Well, you know, I think what we pretty much knew, which is that as - certainly over the last decade, more and more of the cost is being passed on to the patient, and indeed, it's what a lot of people have referred to as a sick tax. If you happen to be sick, you're going to be paying even more, that those people who use the health care system are the people who pay the most.
This survey actually showed that people were generally relatively satisfied with the quality of the care that they're getting, relatively. There were some complaints, but indeed the cost seemed to jump out, and that there are a lot, still a lot of ways that this system, you know, always - the mantra used to be that, you know, we have the best system in the world, you know, we just need to stop spending so much.
Now, the best system in the world, there's a lot of people complaining about that.
CONAN: We want to hear from those of you who've spent time in the hospital sometime over the past year. How good was your care? Give us a call, 800-989-8255. Email us, firstname.lastname@example.org. Later in the program, we're going to be looking at new approaches that some hospitals are taking. But in the meantime, we want to hear from you guys. Let's start with Carol(ph), Carol's on the line with us from Newark, Delaware.
CAROL: Yes, hello, and thank you for addressing the topic. I was seriously injured in a car accident in Philadelphia and was taken to a well-known hospital, where I was misdiagnosed and treated I think the only appropriate word is abusively. I gave them four telephone numbers to call, and no one was called. So no one knew where I was, and I wound up on the missing persons list.
No one - so therefore no one could come in and come to my rescue, and because multiple fractures, I couldn't walk, and yet they were, you know, coming in frequently into the room that I was in and just commanding me to get up and walk, and there was no way I could do it.
CONAN: It sounds like a nightmare, Carol.
CAROL: Yeah, and I was in the trauma unit for 11 days and kind of dumped into a nursing home, and despite the fact that all of the injuries were orthopedic, I never saw an orthopedist until I left the nursing home. And I left. I was not discharged; I left and finally saw an orthopedist that all of the exercises and things they were trying to force me to do were of the completely wrong thing.
And they also confirmed by MRI in the hospital, broke my back because I had had an MRI just prior to that accident, when I finally got out alive, I don't know how, only by the grace of God. Another MRI was taken and showed that the back was broken, as well. That did not occur in the car accident.
CONAN: So how are you doing now, Carol?
CAROL: Well, because of the - I'm doing well, but because of the misdiagnosis I've, you know, had to go on disability and of course lost my job and all of that, but that's not significant. I'm hoping that someone, one of the people you interview today, will address how we can go about addressing this. I've contacted all of the agencies that I was told to and reported it to everyone that I was told to, and nothing has been done.
And in fact I became aware of Medicare and Medicaid actually paying people who never even saw me, and I found out by accident that Medicaid was paying these people, and I reported that to the attorney general, and that was also sloughed off. So I would love to know the appropriate way to address this, if one of your guests can tell us.
CONAN: I'm not sure that we can do that for you, but you may want to contact a lawyer, you may have already.
CAROL: Oh, I have.
CONAN: All right. I'm glad you're doing better, Carol, and I'm sorry for your experience.
CAROL: No, no, but thank you so much for addressing it.
CONAN: All right, thanks very much. And that sounds like an usual case, Julie Rovner, but there are so much - so many instances where records get lost in the bureaucracy, that initial complaint of, you know, I was there and gave them four numbers, nobody was called, and I went up on the missing persons list, wow.
ROVNER: Yeah, that does sound unusual. Normally, you know, any hospital they will try to find someone to come and be with, you know, a patient if only to pay the bills.
CONAN: Now let's see if we can get another caller in. Let's go to Jean(ph), Jean with us from Oklahoma City.
CONAN: Hi, Jean.
JEAN: I was hospitalized in April and had hepatic hemangioma, which is a benign blood tumor of the liver, and I had it removed, which going into it was supposed to have been a simple operation, but once they got in, they found out it was more extensive than they thought, ended up losing 55 percent of my liver.
The people that took care of me were outstanding. They had me up and walking within a day, and I was out of the hospital in less than a week.
CONAN: And how are you feeling now?
JEAN: I'm feeling terrific.
CONAN: That's fantastic.
JEAN: I'll be going back to work June 1, and I was at the medical center, the same medical center, adult side, of the one that I work at. And so it was very interesting to see life at my medical center from the other side of the bedrail.
CONAN: I bet it was, and what either impressed you or caused your eyebrows to raise?
JEAN: Well, I was very impressed with the kind of values I try to treat my patients with, I found I was treated with. So I was very impressed by how well people went out of their way to make sure I was comfortable, to make sure that I got taken care of, that communications were done, which is what we do with our department with our children.
CONAN: Well, I'm glad it all worked out.
JEAN: It did very nicely. Also, about five years ago, my son had an emergency appendectomy in Mumbai, India. And I went flying over there to get him up on his feet, and the care, while not nearly as high-tech as in the United States, was absolutely fabulous.
CONAN: That's good to hear, Jean.
JEAN: And so we've had good experiences on both sides of the ocean.
CONAN: Well, thanks very much, and we appreciate it, and we hope your son's doing well, too.
JEAN: He is, he is.
CONAN: All right, thanks very much for the phone call, and Julie Rovner, it's fair to point out the majority of the respondents either very satisfied or somewhat satisfied.
ROVNER: That's right. Yeah, you know, not to say that the system is a complete disaster. You know, the complaints are significant, but they are not the majority.
CONAN: And the complaints about care, are these about insurance companies, about the kinds of issues that we've been talking about so much in the last few years about health care coverage, or are these more individual?
ROVNER: No, we didn't - well, we didn't ask mostly about those. We asked about things like quality - did it cause a financial hardship, did you have a, you know, a misdiagnosis. We asked about those kinds of things. So we asked a little bit different. We asked more about their experiences with the health care system as a whole.
CONAN: So whatever those institutional systems may be, people are paying more and more out of their own pockets, at least that's what they say.
CONAN: All right. NPR's Julie Rovner is here with us in Studio 3A. As we said, almost half of those in our recent poll said they were, to varying degrees, not fully satisfied with their hospital stay. In a moment we'll talk with one hospital administrator hoping to change that. If you've been in a hospital over the past 12 months, did you get good care? Give us a call, 800-989-8255. Email us, email@example.com. Stay with us. I'm Neal Conan. It's the TALK OF THE NATION from NPR News.
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CONAN: This is TALK OF THE NATION from NPR News. I'm Neal Conan. We're talking about some of the problems cited by patients about hospitals, part of a recent poll by NPR, the Robert Wood Johnson Foundation and the Harvard School of Public Health. You can find full results of that survey at our website. Go to npr.org.
If you've been in the hospital over the past 12 months, did you get good care? 800-989-8255. Email us, firstname.lastname@example.org. You can also join the conversation on our website. That's again npr.org. NPR health policy correspondent Julie Rovner is here with us in Studio 3A. And joining us now from his office in Warrenton, Virginia, is Rodger Baker, CEO of Fauquier Hospital. Nice to have you with us.
RODGER BAKER: Thank you, glad to be here.
CONAN: And this is a place - we heard you in Julie Rovner's story the other day on MORNING EDITION, and this was a moment of epiphany, you described it, where you realized that things could improve.
BAKER: Yes, that's a good way to put it, and I guess things changed. I guess I had been here for quite a while, and through the '90s, we were focusing on all of the problems of financing and staffing and a host of issues. And I think that, you know, the American Hospital Association, folks were doing surveys much the same as the Robert Wood Johnson Foundation survey that you have participated in.
And even in the '90s, folks were disenchanted with this health care in America for a lot of reasons, primarily because of the - what I would term the impersonalization of care. And there was - there were probably a lot of reasons for that, and we probably don't have time to go into all of those, but I think that, you know, our focus here was to sort of search for a way to bring that back and to really return to those human interactions that are so important in terms of enhancing communication and care coordination and all of those things that I think many of the folks that are in health care, those are the reasons that they got into health care was to do good by patients and to care for patients.
CONAN: And when you talk about the impersonalization of care, it goes from, well, seemingly small things that turn into big things. The patients are treated almost as if they're invisible.
BAKER: Well, I think that that - and again I think part of the reason, not necessarily the reason for that, but, you know, part of things - some of the things that we did to try to remedy that was to as we began to roll out our patient-focused-care model here at Fauquier Health, we focused on making sure that the caregivers, literally all of the employees within the health system, understood what it was like to be a patient and understood the helplessness that some patients may feel as a result of not being listened to.
You know, during that time, we conducted retreats for the whole staff to try to change the culture, if you will, and the attitude of the staff towards patients, and I'm not saying that, you know, the entire staff was thinking that way, but in order to get consistency and to - I mean, our objective was to make sure that every patient had a consistent experience as they were here.
You know, we had to - everybody had to understand what it's like to be - to feel this helplessness. I mean, there were, during these sessions, there were experiential, you know, exercises that we conducted with employees in terms of doing such things as a blind man's walk or having employees feed one another and let them sort of understand what it was like to perhaps have a stroke and someone having someone feed you for the first time in 60 or 70 years, you know, since you were an infant, which you probably didn't remember.
But - and, you know, the whole idea behind the (unintelligible) model of patient-focused care is to really personalize the care, humanize it and demystify it. I mean, many folks don't necessarily come to hospitals on a regular basis unless they have some sort of a chronic condition.
So when they do have an acute care episode, I mean, we do things, you know, for years and years and years we've done things, sometimes strangely in terms of - and they've been for our own convenience. When I say our own convenience, I mean the convenience of the employees or, you know, the health care system or the physicians and taking another look at that and let's say let's do things for the convenience of the patient, and...
CONAN: Julie Rovner, you've obviously been to a lot of hospitals as a reporter, and...
ROVNER: Yes I have.
CONAN: And what is different about a Planetree hospital, and tell us a little bit more about that.
ROVNER: Well, yeah, and Planetree, I think we haven't talked about this yet, is this organization that was founded by a patient, in fact, who went to a hospital, decided that she had excellent medical care but really disastrous, you know, care as a human being, and she founded this organization to try to bring back, you know, some of that humanity to the medical care, to particularly the hospital care experience. Now Planetree also has long-term-care facilities that are part of it.
And really it does sort of mesh this idea of having, you know, patient-focused, patient-centered care.
CONAN: Well, what do you notice that's different?
ROVNER: And what you notice, I mean, the first thing you notice is that it's quiet, that they don't use the overhead paging system almost at all, that there...
CONAN: Can we adopt that here?
ROVNER: You know, I thought about that when I got back here. It would be nice. That it - you know, that there's carpet in places that there normally aren't in hospitals, that it's - that people are - when you ask directions, people don't just say oh go down there and make a left and a right and a left, they take you. And that's not just - you know, that's...
ROVNER: Doctors will do this. I mean, it's amazing. People actually - and this is part of the culture there, that people are - you don't see raised voices for the most part. I mean, it's quiet. The nurses' stations, they don't have like these big glass nurses stations, where everybody's cut off. All the rooms are private rooms. You know, there's a garden where they grow some of their own food, that patients get to order the food when they want, it's not just brought around in carts.
I mean, so, you know, some of this is sort of, you know, fancy kind of, you know - you would think oh, it's just sort of frou-frou hospital stuff, but a lot of it is also there are not set visiting hours, that people can come and go, families can come and go, that families are sort of an integral part of taking care of the patient. It really is sort of a different atmosphere than at a lot of other hospitals I've been to.
CONAN: And Rodger Baker, clearly changing the culture, as you described, it involved a lot more than a couple of retreats.
BAKER: Well, that's - I mean, we've been on this journey for 12 years now, and we're still learning things about where we are and what we're not doing right. But, you know, we get a lot of feedback from patients, sometimes good, sometimes bad, and we try to react to that.
Some of those things that Julie discussed in terms of the patient engagement, and Planetree calls into what's called a healing partnership with the patient and their family, doing things such as inviting them to bring a care partner with them to the hospital, providing a space in the room where the care partner can stay overnight, if they have that luxury, and assist in that.
Oftentimes, I mean, our lengths of stay are fairly short in the acute-care facilities like this, you know, two-and-a-half or three days on average. And, you know, the patients are sick. So they may have a temperature or a fever, and they may not clearly understand exactly what's going on. And having a care partner person there to assist in terms of listening to the nurses and technicians and understand, all right, this is what we need to do now, if I were in the hospital, and these are the things that we're going to need to do when we get home.
Sometimes they may go to a rehab center as - or a step-down unit of some sort, but they're still going to need some care once they leave the facility. So having a care partner is again really important.
I mean, Planetree, you know, they had such novel ideas as providing open access to the medical record. It's offering it to patients to read if they want to. Having patients be actively involved in the care planning process. You know, someone mentioned 24-hour visiting times, you know, not wanting to exclude patients and their - excuse me, family members from visiting patients when it's convenient for the family members.
Not everybody, you know, have the same work schedule. So if they need - if it's all right with the patient, you know, at 9 or 10 o'clock at night, I mean, that can be accommodated, of course.
CONAN: Here's an email we have from Mark(ph) in Boston: My father was recently in the ICU for a craniotomy. We had a hospitalist on the floor who seemed to be absolutely useless to the care process. He was impossible to find, unresponsive to questions, in conflict with the neurosurgeon, the nurse practitioner and practically every other staff member involved in my dad's care.
And Julie Rovner, not this particular hospitalist, maybe, but that's another innovation that a lot of places are using now.
ROVNER: That's right, and in fact Fauquier Hospital uses them. A lot of hospitals use them. The idea is that the hospitalist takes over from the family doctor and the community and oversees the care.
CONAN: And interacts with all of the other parts of the hospital.
ROVNER: That's the idea, that's right, to coordinate the care while the patient is in the hospital. In fact, I have heard complaints, though, that hospitalists - hospitalists can be - yeah, it depends how well they do their job, but whether or not they're...
CONAN: Like every other doctor.
ROVNER: Like every other doctor.
CONAN: Let's get another caller in. This is Olivia(ph), and Olivia is with us from Eagle in Idaho.
OLIVIA: Hi. How are you?
CONAN: Good. Thanks.
OLIVIA: It's interesting listening to what your guest just was saying, because I didn't realize that what I just went through is, maybe, unusual. My baby was born April 27th, and she was a month early. And she ended up going to the neonatal intensive care unit for two weeks. And having never done that before, I was kind of nervous and scared and trying to figure out, you know, what was wrong with my baby, and I was very impressed that they let me be very hands-on.
I actually had a patient care coordinator who found a place for me to sleep, so I never had to leave, even though there's not space in the room. She kind of found a closet and stuck a cot in for me. And it was interesting because my baby physically did better when I was there with her. A lot of her problems were breathing related. And when I would leave to go take a shower, she would start going - needing more oxygen and crashing more often. But when I was there with her, she would do better.
And I was really impressed that they let me be hands-on. I gave her, her bath. I changed her diapers, even though she was connected to all these machines. And, you know, it was kind of a scary environment. But because they let me be her mom, I think it definitely helped her heal faster and get out of the hospital sooner but also made me feel more in control of a situation that was out of my control and kind of scary. And they also allowed me to order room service from the hospital, free of charge - well, on the baby's bill, you know, as part of the things, I was able to stay there with her.
The only thing about it is, it was a fantastic experience as far as having a baby in a hospital, but our bills ended up being about $60,000. So even with insurance, we're still going to owe about 20,000 of that, being about 40 - $500 a day. And I have to kind of wonder, you know, that - to me, that seemed excessive. I appreciate the care that she got, and actually, she's home and healthy. But we're still left with a pretty hefty bill with insurance...
OLIVIA: ...(unintelligible) baby situation.
CONAN: Julie, Olivia seems to be hitting about seven out of the eight points on the survey.
ROVNER: Yeah. Neonatal intensive care is among the most expensive types of hospital care. On the other hand, you know, exactly what she's saying is, you know, that is...
OLIVIA: Yeah. But I'm grateful.
ROVNER: Yeah. Right. That's, you know, that's exactly what patient-centered care is supposed to be about. And the idea and your - that's what experts say, is that, you know, that being there, you know, being part of the care, you know, that that you may well be right that, you know, that you're being there helped her get out sooner and probably kept your bill lower, but...
ROVNER: ...and that you're right that you're now paying a bigger portion of your bill and so...
OLIVIA: But I was very, very grateful and impressed. They let me be so hands-on because, you know, neonatal intensive care unit is kind of high tech, and it has a lot of machines, a lot of stuff going on, and they let me be right in the middle of it. And I also appreciate it that the neonatologist would come by and check on her, and I can ask him any questions I wanted. And I got - I actually learned everything that was going on, and so I felt very well informed and very well involved with what's going on with my baby, rather than just telling me what's going on. And as a mom, I really appreciated that.
CONAN: Well, Olivia, I'm glad it worked out well, and I hope you win the lottery.
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OLIVIA: Thank you.
CONAN: All right. Thanks very much for the phone call. We're talking about hospital care after a survey conducted by the Harvard School of Public Health and the Robert Wood Johnson Foundation and NPR. NPR's Julie Rovner is here with us in Studio 3A. We're also speaking with Rodger Baker, CEO of Fauquier Hospital in Warrenton, Virginia. You're listening to TALK OF THE NATION from NPR News. And I wanted to add this email from Susan: What people who run hospitals don't seem to understand is the greatest stress of a hospital stay is sharing a room and a bathroom with a total stranger. Roommates hear every interaction the other has with doctors, nurses; sometimes, see each other's bodily fluids, et cetera.
Where is HIPAA when you need it? The only time I didn't feel anxious in the hospital was the blissful four hours between the departure of one roommate and the arrival of another. And, Rodger Baker, I know at your hospital all of the rooms are private, but some people are going to say with private rooms, a garden where they cook your food, all these other services, doesn't drive the cost up?
BAKER: It's not inexpensive, certainly, but we had the opportunity beginning in 2003 to provide for new inpatient bed facilities. And there are some advantages to having all private rooms. You don't have the problems of mixing males and females. You can actually build fewer beds because typically when you...
CONAN: And we seem to be having some problems with the connection there with Rodger Baker at Fauquier Hospital in Warrenton. We hope to get him back on the line in just a moment. But, Julie Rovner, as he, I think, was getting to the point, cost can actually come down.
ROVNER: Yeah. And I think a lot of hospitals - not just this hospital - a lot of hospitals are going - newer hospitals are going to all private rooms. That is - but, you know, a lot of other places, you know, the U.S. - even with our mostly semi-private rooms, look - people come here and say, you know, oh, you only have two people in a room. A lot of other - in a lot of other countries, they have, you know, four or eight people in a room. We're actually sort of spoiled about having two people in most of our hospital rooms.
CONAN: Let's see we get another caller in. This is Jennifer. Jennifer with us from Farmington in Michigan.
JENNIFER: Hi, Neal.
JENNIFER: My daughter was born last July, and I had a lot of complications. Some of which were just, you know, occurred, you know, because I was pregnant. Some of which were the hospital's fault, including - I was kind of talked into an epidural, which I hadn't really been planning on having. And I had a reaction where my blood pressure crashed. And this is a reasonably common reaction, but the epinephrine which they used to treat it wasn't there. They - no one could find it for a while. And both of our lives were in danger because of that.
CONAN: And that seems like a pretty elemental mistake.
JENNIFER: It's something where any kind of anesthesia, it's supposed to be there. It's adrenaline. And they actually didn't believe - the staff didn't believe that it wasn't on the cart, like they had to send someone running around the ward trying to find it because it just wasn't there. And it was like, just completely impossible for them to even comprehend that it wouldn't be there.
CONAN: Well, did everything work out OK?
JENNIFER: It did. I had a lot of other problems. They were unrelated to that. They were just, you know, because of the way my body reacted to the pregnancy, but that was actually the most dangerous time was because of the error and not because of the other problems that I was having that were not related to that.
CONAN: Well, thanks. And I'm glad it worked out.
JENNIFER: Thank you.
CONAN: Thanks for the call. Julie, as we're talking about these different approaches, why don't more hospitals do that culture change like we've been talking about these Planetree hospitals?
ROVNER: Well, it's an interesting question. You know, some are. You know, hospitals - right now, it's a huge time of change, obviously, for hospitals, you know, with the health law. And one of the reasons we decided to do this survey now, is we're in this kind of waiting period for - waiting to see...
CONAN: Waiting for the Supreme Court.
ROVNER: Right, waiting for the Supreme Court, to see what they're going to do. But, you know, certainly one of the big changes that that the law has called for, well, we'll have a major impact on hospitals or trying to get hospitals to work more to, you know, with doctors to coordinate care better, to change some of the incentives so - but certainly, the idea of having more patient-centered care, making care more efficient, having better incentives, you would think that there would be a push towards this sort of thing. Perhaps not to the extent of the Planetree-type care which, you know, embraces alternative medicine, spirituality, but certainly towards more thinking what patients want.
CONAN: Julie Rovner, as always, thanks very much.
ROVNER: You're very welcome. Rodger Baker, I guess, we've got you back, and I apologize for not getting back to you.
BAKER: No, that's fine. Thank you very much.
CONAN: Rodger Baker, CEO of Fauquier Hospital in Warrenton, Virginia, he spoke to us from there. And when we come back, we're going to be talking about the case that haunted New York for the past 36 years, and that is Etan Patz. Stay with us. I'm Neal Conan. It's the TALK OF THE NATION from NPR News.
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