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NATIONAL HARBOR, MD. – Hospital and physician efforts to improve patient satisfaction are just scratching the surface, according to Dr. Shaun Frost, the outgoing president of the Society of Hospital Medicine.
The missing ingredient, Dr. Frost said, is understanding the patient’s personal expectations about the hospital stay.
For instance, a patient might have a preference for tolerating pain in order to stay alert versus accepting the sedating effects of treatment with narcotics. Another patient might prefer to be discharged from the emergency department and have follow-up testing performed in an outpatient setting rather than stay overnight under observation status.
"Where we sometimes come up short in health care is failing to recognize that patient expectations transcend interests such as having their call lights answered in a timely manner or receiving warm meals on a scheduled basis," Dr. Frost said at the annual meeting of the Society of Hospital Medicine. "Although these are obviously important expectations that need to be addressed, they are relatively easy to identify and act on."
The challenge in uncovering these personally held patient expectations is that physicians have to ask about them, he said.
"Providers must empower patients to express their expectations by taking time to inquire about the social, economic, cultural, and environmental issues that dictate personally held patient values, goals, needs, interests, and preferences for their care," said Dr. Frost, who is the associate medical director for care delivery systems at HealthPartners in Bloomington, Minn.
But it’s not enough to know what the patient wants. Physicians also need to bring patients into the decision-making process by objectively explaining treatment options and avoiding the temptation to act paternalistically, Dr. Frost said.
Based on an experience from early in his career, Dr. Frost offered an example of what not to do: As a third-year medical student, Dr. Frost observed his supervising resident advising a patient with heart failure about establishing an advanced directive. The resident skillfully outlined the technical details about cardiopulmonary resuscitation, Dr. Frost said, but the explanation seemed aimed at influencing the patient to decide against resuscitation. When the resident asked the patient what he would like the team to do, he surprised everyone by emphatically stating that he wanted to be resuscitated.
The conversation ended with the resident accepting the patient’s decision, but also advising him to think about it more because they would talk about it again the next day. The following day the patient had not changed his mind, but he seemed notably disengaged, Dr. Frost said. From that point on, the patient appeared "guarded and withdrawn" and reluctant to participate in his treatments, Dr. Frost said.
"The fundamental problem here was that we spoke to this patient about our experience in running cardiac arrest code, but we didn’t speak with this patient about what it’s like for him and his family to live with severe congestive heart failure and furthermore why it was he’d been admitted to the hospital three times in the past 3 months," Dr. Frost said. "Instead of engaging this patient by inviting him into the conversation, we left him with the impression that he didn’t have a choice."
As the evidence grows that patient engagement has a positive influence on quality, safety, and affordability, Dr. Frost said it’s time for the specialty of hospital medicine to take the lead by setting standards for physician-patient collaboration.
"Enhanced collaboration with patients, their families, and their loved ones, which focuses attention on their personal unique needs and preferences, is the next great opportunity in health care team work," he said.
NATIONAL HARBOR, MD. – Hospital and physician efforts to improve patient satisfaction are just scratching the surface, according to Dr. Shaun Frost, the outgoing president of the Society of Hospital Medicine.
The missing ingredient, Dr. Frost said, is understanding the patient’s personal expectations about the hospital stay.
For instance, a patient might have a preference for tolerating pain in order to stay alert versus accepting the sedating effects of treatment with narcotics. Another patient might prefer to be discharged from the emergency department and have follow-up testing performed in an outpatient setting rather than stay overnight under observation status.
"Where we sometimes come up short in health care is failing to recognize that patient expectations transcend interests such as having their call lights answered in a timely manner or receiving warm meals on a scheduled basis," Dr. Frost said at the annual meeting of the Society of Hospital Medicine. "Although these are obviously important expectations that need to be addressed, they are relatively easy to identify and act on."
The challenge in uncovering these personally held patient expectations is that physicians have to ask about them, he said.
"Providers must empower patients to express their expectations by taking time to inquire about the social, economic, cultural, and environmental issues that dictate personally held patient values, goals, needs, interests, and preferences for their care," said Dr. Frost, who is the associate medical director for care delivery systems at HealthPartners in Bloomington, Minn.
But it’s not enough to know what the patient wants. Physicians also need to bring patients into the decision-making process by objectively explaining treatment options and avoiding the temptation to act paternalistically, Dr. Frost said.
Based on an experience from early in his career, Dr. Frost offered an example of what not to do: As a third-year medical student, Dr. Frost observed his supervising resident advising a patient with heart failure about establishing an advanced directive. The resident skillfully outlined the technical details about cardiopulmonary resuscitation, Dr. Frost said, but the explanation seemed aimed at influencing the patient to decide against resuscitation. When the resident asked the patient what he would like the team to do, he surprised everyone by emphatically stating that he wanted to be resuscitated.
The conversation ended with the resident accepting the patient’s decision, but also advising him to think about it more because they would talk about it again the next day. The following day the patient had not changed his mind, but he seemed notably disengaged, Dr. Frost said. From that point on, the patient appeared "guarded and withdrawn" and reluctant to participate in his treatments, Dr. Frost said.
"The fundamental problem here was that we spoke to this patient about our experience in running cardiac arrest code, but we didn’t speak with this patient about what it’s like for him and his family to live with severe congestive heart failure and furthermore why it was he’d been admitted to the hospital three times in the past 3 months," Dr. Frost said. "Instead of engaging this patient by inviting him into the conversation, we left him with the impression that he didn’t have a choice."
As the evidence grows that patient engagement has a positive influence on quality, safety, and affordability, Dr. Frost said it’s time for the specialty of hospital medicine to take the lead by setting standards for physician-patient collaboration.
"Enhanced collaboration with patients, their families, and their loved ones, which focuses attention on their personal unique needs and preferences, is the next great opportunity in health care team work," he said.
NATIONAL HARBOR, MD. – Hospital and physician efforts to improve patient satisfaction are just scratching the surface, according to Dr. Shaun Frost, the outgoing president of the Society of Hospital Medicine.
The missing ingredient, Dr. Frost said, is understanding the patient’s personal expectations about the hospital stay.
For instance, a patient might have a preference for tolerating pain in order to stay alert versus accepting the sedating effects of treatment with narcotics. Another patient might prefer to be discharged from the emergency department and have follow-up testing performed in an outpatient setting rather than stay overnight under observation status.
"Where we sometimes come up short in health care is failing to recognize that patient expectations transcend interests such as having their call lights answered in a timely manner or receiving warm meals on a scheduled basis," Dr. Frost said at the annual meeting of the Society of Hospital Medicine. "Although these are obviously important expectations that need to be addressed, they are relatively easy to identify and act on."
The challenge in uncovering these personally held patient expectations is that physicians have to ask about them, he said.
"Providers must empower patients to express their expectations by taking time to inquire about the social, economic, cultural, and environmental issues that dictate personally held patient values, goals, needs, interests, and preferences for their care," said Dr. Frost, who is the associate medical director for care delivery systems at HealthPartners in Bloomington, Minn.
But it’s not enough to know what the patient wants. Physicians also need to bring patients into the decision-making process by objectively explaining treatment options and avoiding the temptation to act paternalistically, Dr. Frost said.
Based on an experience from early in his career, Dr. Frost offered an example of what not to do: As a third-year medical student, Dr. Frost observed his supervising resident advising a patient with heart failure about establishing an advanced directive. The resident skillfully outlined the technical details about cardiopulmonary resuscitation, Dr. Frost said, but the explanation seemed aimed at influencing the patient to decide against resuscitation. When the resident asked the patient what he would like the team to do, he surprised everyone by emphatically stating that he wanted to be resuscitated.
The conversation ended with the resident accepting the patient’s decision, but also advising him to think about it more because they would talk about it again the next day. The following day the patient had not changed his mind, but he seemed notably disengaged, Dr. Frost said. From that point on, the patient appeared "guarded and withdrawn" and reluctant to participate in his treatments, Dr. Frost said.
"The fundamental problem here was that we spoke to this patient about our experience in running cardiac arrest code, but we didn’t speak with this patient about what it’s like for him and his family to live with severe congestive heart failure and furthermore why it was he’d been admitted to the hospital three times in the past 3 months," Dr. Frost said. "Instead of engaging this patient by inviting him into the conversation, we left him with the impression that he didn’t have a choice."
As the evidence grows that patient engagement has a positive influence on quality, safety, and affordability, Dr. Frost said it’s time for the specialty of hospital medicine to take the lead by setting standards for physician-patient collaboration.
"Enhanced collaboration with patients, their families, and their loved ones, which focuses attention on their personal unique needs and preferences, is the next great opportunity in health care team work," he said.
AT HOSPITAL MEDICINE 13
