Perchance to Dream: Improving the Hospital Patient Experience
Earlier this week I was invited by Wego Health (whose unique corporate mantra is “Empowering health activists to help others.”) to participate in a videotaped Virtual Patient Panel to help the company ExperiaHealth (“Experia”) (whose corporate motto is “Humanizing the Healthcare Experience”) in improving the “Hospital Patient Experience,” and in this case, specifically the Discharge Process. Unbeknownst to me, Experia has been doing this for quite some time in at least 15 significant hospitals across the country. Who knew that while I was being hospitalized all over the country being constantly awoken at 3 AM to take a sleeping pill or harassed by the hospital’s television collection service for $6.00 when I was practically in the surgical recovery room, that such an incredibly necessary company was implementing many of the things I had been complaining about after 200+ hospitalizations. I guess if you live long enough, life will pleasantly surprise you. That’s why, incidentally, I always tell chronically ill people with incurable illnesses such as Crohn’s Disease that, “the longer you live, the longer you live.” What I mean is that the longer you live, the better your chances are for new and more effective treatments, or even a cure, being discovered. Hence, this Blog Entry is indirectly about how a dream of mine, i.e., attention being paid to improving the “hospital patient experience,” is now being actualized and I am also involved in helping to carry out this new reality of mine and of thousands of hospital patients around the world.
The Business Side of Healthcare
When I got to meet the Experia Patient Panel Moderator, Elizabeth Boehm (“Liz”), whose title is Director, Patient Experience Collaborative; I was shocked that such thoughtful and compassionate people worked on the business side of healthcare. Up until now, I had assumed all healthcare executives were solely focused on providing the best patient care at the lowest price paying no mind to the often physically and mentally painful & unnecessarily demeaning experiences patients must undergo to achieve these corporate objectives. More specifically, I always envisioned the healthcare “business” functioning like the inner-workings of an automobile manufacturing company which always developed the coolest looking, fastest driving and most fuel efficient cars without giving any consideration to the driver “experience” or if a typical-sized driver could even fit into these sleek fast-moving machines without their ever-expanding waistlines rubbing up against the steering wheel and preventing a tight left turn.
Perhaps the car drove too “hard,” the seats were too stiff and the drivers developed hemorrhoids within the first 5,000 miles or the driver’s seat had to be so low and devoid of lumbar support that spine fusion surgery was inevitable within the time frame of the usual bumper-to-bumper warranty. Despite these rather significant driver inconveniences, the automobile company’s marketing programs for these slick new macho machines created great demand and the general public assumed that drivers just lied or never mentioned the aforementioned downsides because no schmuck complains about being seen driving around in the best vehicle money can buy. That’s like dating Jennifer Lopez and complaining to the Press about her ridiculously over-sized derriere.
A stretch, maybe; but I’ve always envisioned the business-side of Hospitals operating exactly like this where patients and their friends or families of patients assumed that quality patient care came along with occasional horrific, unsanitary and demeaning personal experiences. However, I was never convinced that my friends and family understood the frequent lack of humanity and common decency encountered by hospital patients. It just went unspoken in my world until I wrote a Book about my experiences (see below). As a case in point about the public’s acceptance of quality healthcare at whatever temporary painful cost to the patient: Did television viewers ever watch the critically acclaimed show “ER” and even once witness: consistently disgusting hospital food; patient roommates who destroyed shared patient bathrooms almost as if they had a license to live like they were in a monkey cage for a few days; condescending doctors to whom patients had to follow out of their rooms like Peter Falk’s “Lieutenant Columbo” sans rain coat just to finish asking a significant question or two; or nurses with borderline evil bedside manners whose lack of compassion was only surpassed by their robotic personalities?
The Value of being a Professional Hospital Patient
But after listening to Experia’s Liz Boehm explain the Patient Panel’s objectives, style and procedures, I felt like I had been summoned into the principal’s office and instead of being chastised for my bad behavior teasing a girl I was actually smitten with, I was heralded for possessing certain unique knowledge that he found helpful in improving the effectiveness of teachers and education. I have to admit that during those first few moments of this Patient Panel, the experience felt pretty cool because my Crohn’s Disease had now apparently qualified me for something other than Miralax. I was so surprised at my almost “reversal of fortune” role in this Patient Panel that it felt as I had been sleeping for 5 years and when I awoke Tom Brady of the New England Patriots was President and Anne Hathaway was making me breakfast wearing nothing but a Tom Brady jersey.
Truth be told, I wrote a Book about this in 2001 called, “Confessions of a Professional Hospital Patient,” because there was so much wrong with the “hospital patient experience” I felt there was a story to be told which could shed some light on significant but subtle problems almost every person in the world would someday experience since everyone gets sick and most people don’t get through life without an adult hospital stay or two. Thankfully, my Book was critically acclaimed and it continues to sell as “the most accurate and honest depiction of the ‘hospital patient experience’” but to make sure Ms. Boehm’s aim was as true as Elvis Costello’s, I had a few questions for her about Experia and their hospital patient experience venture.
Who is ExperiaHealth?
In short, Experia’s website (see http://www.experiahealth.com/about.htm) lists its description and corporate objectives, which thus far I can attest to being 100% accurate, to be as follows:
ExperiaHealth is a leading experience improvement company that delivers breakthrough services and technologies to improve the patient and employee experience at hospitals and clinics nation-wide. ExperiaHealth’s aim is to accelerate adoption of practices and technologies that improve outcomes, create value for patients, and restore the human connection in healthcare.
Ms. Boehm’s qualifications are also listed on the Experia website and she too is uniquely qualified and dedicated to the cause my life has been dedicated and directed to once I was diagnosed with Crohn’s Disease approximately 25 years ago. At the risk of embarrassing Ms. Boehm for her impressive and thoroughly focused career of helping to improve various difficult life experiences, below is the website’s description of her background:
Elizabeth Boehm, Director, Patient Experience Collaborative
Liz Boehm is the Director of ExperiaHealth’s Patient Experience Collaborative where she brings a wealth of expertise on defining and implementing new innovations in healthcare experience, and helping hospitals and care providers create lasting value for patients and caregivers. Through the Collaborative, she helps ExperiaHealth’s clients create a competitive advantage via the sharing and adoption of practices and technologies that improve outcomes, create value for patients, and restore the human connection in healthcare.
Liz joins ExperiaHealth from Forrester Research where she was a principal analyst serving customer experience professionals in the healthcare and life sciences industries. During Liz’s 15 years at Forrester, she worked with the country’s top hospitals, health insurers and life science firms to craft customer experience strategies and drive business value through improved customer engagement. She joined Forrester in 1997 and co-founded Forrester’s healthcare and life sciences research practice in 1999.
Before joining Forrester, Liz was a health extension volunteer with the Peace Corps in Burkina Faso, West Africa and graduated from Amherst College with a degree in women’s and gender studies.
“Patient Experience Managers” are part of an emerging industry. Who knew?
My awareness of the efforts of people like Ms. Boehm and companies like Experia first came to light thanks to a comment I received on my Blog which pointed out that the hiring of “Patient Experience Managers,” or PEMs, is an emerging field in healthcare. It was also only a week ago during the “Best 60 Minutes on Sunday Night,” a/k/a the “Health Care Social Media” TweetChat at 9 PM EST, when a new Twitter buddy suggested the possible creation or existence of PEMs. I had responded to what I thought was his unrealistic suggestion by essentially saying, “Dream On.” Well, thanks to the tenacious efforts of true Patient-centric organizations like Wego Health and Experia, I’ve learned there are actually current formidable efforts to modernize the “hospital patient experience” so that it’s quality catches up to the technology-driven increase in Patient Care. Maybe now hospital executives won’t immediately dismiss my idea to create YouTube channels in all hospitals to distribute interesting and entertaining hospital employee-created and hospital patient-created content to replace the almost “stick-figure” and “birds and the bees” videos which are currently looped on “medical information channels” shown on hospital patient room televisions. Ever see a stick-figure drawn person get a colonoscopy? Check into an old hospital and channel-surf.
Influencing the Hospital Patient Experience
In any event, this Virtual Patient Panel consisting of myself and two (2) other experienced patients, Jody and Alicia. Wego Health had their technology guru, Aaron, somehow connect each of our computer web cams to one hub such that it seemed we were on stage together being interviewed by Elizabeth Boehm, Director, Patient Experience Collaborative, Experia. It’s funny but when I first saw Liz’s title, “Director, Patient Experience Collaborative,” I thought I was in the Twilight Zone or had just walked out of the 1973 futuristic movie, Westworld. But once she began to ask such thoughtful questions to elicit useful information about our respective patient experiences, I began to feel as if all I have gone through in 200+ hospitalizations in various cities around the United States might actually have a certain aggregate value because now someone is listening to me who has the interest, motivation and even the influence to make experience-improving changes in the “hospital patient experience.”
However, since I am always candid and also inherently suspect of think-tank studies and managerial guru bullshit and I had never seen meaningful patient-centric job titles before in the many hospitals I’ve done time at, I asked “Liz” (she insisted we call her by her first name so the atmosphere was very casual) where in the United States are these hospitals who actually care about the quality of the hospital patient experience? She then listed 15 prestigious hospitals and told me a little about other similar targeted efforts of Experia. I was sold as she had me at “15.” Moreover, after hearing my various answers and ideas throughout the 2-hour Patient Panel, Liz later commented that she was purchasing my Book, “Confessions of a Professional Hospital Patient,” for each of these 15 hospitals because I guess she was intrigued by my brutally candid yet respectful approach toward medical institutions and medical professionals despite having survived through so many nonsensical and avoidable demeaning and painful experiences within their respective control.
In terms of learning from my past experiences, especially those pertaining to the “hospital patient experience,” I try to think like a dog because I don’t want a negative experience to forever taint my intellectual capability to contribute to improving the hospital patient experience. For non-animal lovers, this means I try to have the memory of a Short-Reliever Pitcher in Baseball so that one horrific experience doesn’t haunt anything I do, say or feel moving forward. It’s like the lyrics in the Kinks song, “Attitude”:
You might have the illness, but you’ve got the cure
You’ve got the answer, you will endure
You’re the only person that’s gonna pull you through
Ooh, with your attitude
Attitude, Oo Oo Oo
Attitude, Oo Oo Oo
In my youth it wasn’t so easy to have such a short memory and pleasantly forget about the times a Nurse Ratchet-type insisted on re-inserting my Foley Catheter because, crazy me, I had been urinating into the toilet and not into a urinal container where they could measure my “urine output” since the doctor had removed the Foley Catheter earlier in the day and that was the hospital’s protocol – which I was never told about – or being hounded by the hospital television payment collection service while I was still in the midst of coming out of anesthesia from spinal fusion surgery. While the $6.00 collection episode did not leave a permanent scar on me, I will never forget this innocent 17-year-old kid carefully nudging me to tell me I owed $6.00 for 2 days of renting the hospital’s television. I do remember, though, motioning him to come VERY close to my mouth to ensure he would hear my painfully strained answer when I said: “Do you really think this is the best time to try and move me, even an inch, to get my wallet and pay you $6.00 when it has to seem patently clear to even a moron that I am not a “high risk” flight patient?” After contemplating for a few seconds the fallout he’d face from his boss Skippy, he nodded in agreement as if my answer was reasonable, but I wanted to share my surgical pain with him in the worst way. What was once a painful memory is now a funny story. It’s all in your Attitude.
Why the Focus on the Hospital Patient Discharge Process?
The questions posed to each of us on the Patient Panel seemed to focus on the Hospital Discharge process because according to Liz various studies had apparently indicated it as either the most troublesome spot for hospitals and/or that the Discharge process was an area most easily quickly improved. When asked a related question, I politely told Liz that in my humble opinion the studies seem wrong because, and just by way of quick example off the top of my mind, starting Intravenous Lines with the dexterity of a Plumber, among other aspects of the hospital patient experience, seemed a little higher on my priority list for needing improvement since patient IV lines are the standard MO in all hospitals and initiating them is likely the most intimate activity that goes on between a patient and a medical professional besides memorable rectal probes. My body gets over the occasional over-zealous rectal exam quickly but there are parts of my forearms which are still black and blue from my June, 2012 17-day hospital stay and areas around my wrist still smart and throb if they come into contact with merely fabric while I toss and turn trying to fall asleep at night.
Standardizing the times of Morning Doctor Rounds
Liz duly noted my comment and apparent well-rounded knowledge of hospital problem areas but as per her suggestion I decided to focus on the task at hand. To that end, I classified the hospital discharge process as essentially one big cluster-fuck which could only be helped if doctors committed to standard “morning round” times so that patients could properly organize the various aspects of their departure which are not under their control. This includes getting all written orders from doctors, all prescriptions, all warning signs and the patient’s coordination of obtaining a ride home from a family member or friend. This reminded me of the numerous times when the hospital patient room had a sign on the wall which indicated all discharged patients must leave the room by 10:00 AM and I would tell a friend to come pick me up at 10:00 AM only to have to wait until 12:30 PM when one of my doctors would decide to stroll into my room to finalize my “orders” and write the necessary prescriptions for me to go home. As a result, my friend or family member would have to completely reorganize their day and me and my Crohn’s Disease became an even bigger pain in the ass to them. Accordingly, besides the logical implications of a more organized “Discharge Process” which takes patient needs into account, I think a more consistently standardized “morning rounds” physician schedule would give patients back some “control” over their situations which they understandably have to relinquish upon entering the hospital for the purposes of being treated most effectively. I also think resuming control of one’s life is of therapeutic value and thus an aid toward the recuperative process so that’s another rationale for consistent standardized “morning round” times.
My Worst Hospital Discharge Experience
Liz also asked each of us about our worst experience being discharged. My knee-jerk reaction left me with no specific answer other than to discuss the myopic almost survival-like state of mind necessary to “do time” in the hospital environment such that a quick re-admission to the hospital is the worst possible scenario and could lead to scarring mental conditions such as post-traumatic stress disorder. Then I remembered when that happened to me at a world renowned hospital (from which I am now banned for life, by the way, for not letting them treat me a certain way medically when I knew they were wrong and later proved they were wrong by being diagnosed differently at another hospital) and how defeated I felt when repeated projectile vomiting in a hotel room across the street from the hospital left me with no choice but to return to the same floor in the hospital for another 15 days or so. To that end, I will never forget the words of “wisdom” some moronic Intern rationalized with me when I was initially prematurely discharged and my belly was so distended I looked like The Michelin Man. He said: “Sometimes you are healthy enough to be discharged from this hospital but not well enough to go [fly] home.” It was such a load of self-serving crap and literally put my life in serious jeopardy as I almost joined music greats Jimi Hendrix, John Bonham, and **Eric “Stumpy Joe” Childs [from the band “Spinal Tap”] in the “Big House” as a result of choking on their own vomit. [**Technically, Eric “Stumpy Joe” Childs choked on someone else’s vomit but he is a fictional character, as his band, “Spinal Tap,” was created for the hysterical 1984 parody film rockumentary, “This is Spinal Tap.”]
The Perils of Patients Letting their Mental Guards Down
The two (2) other patients had some excellent suggestions for Liz in answering her variety of questions surrounding Improvement of the Hospital Discharge Process but I will leave those for the Video I am sure Liz and Experia will be compiling. As for me, I brought up how the mental discipline required of hospital patients to maintain their sanity could get loosened up a bit once they start hearing the word “Discharge” (in much the same manner as Prisoners with the word “Parole”) so doctors need to be very careful when broaching the subject and condescending remarks alluding to Discharge could actually be hurtful to patients if they are based on style and not substance. For some patients, I suppose premature enjoyment of the prospect of being paroled from the hospital is fine but, in all seriousness, it takes such intense mental discipline to adjust to the prison-like privacy parameters of a hospital during long hospital stays that delusions of grandeur can quickly set in if the word “Discharge” is recklessly thrown about by a medical professional in the hospital patient’s room. This might sound like an exaggeration to folks unfamiliar with the hospital patient experience but some doctors use the lure of “Possible Discharge” to get their depressed patients from one day to another and there are MANY depressed patients in the hospital especially around holidays and before weekends. Perhaps this is a necessary medical tactic but when it fails, the depression becomes overwhelming.
Identifying ALL Treating Medical Professionals on Discharge Paperwork
I also conveyed to Liz that I believe STRONGLY in receiving written Hospital Discharge paperwork which includes a detailed list of all the doctors and other medical professionals who treated me so that when I receive a Bill for $920.00 for three (3) in-hospital consultations by a Dr. Kardashian, I need to know who is trying to get paid for these services apparently rendered to me. This has been a problem for me when, for example, I did not ask for the services rendered such as in the case of a psychiatric consultation sought by my condescending surgeon who couldn’t understand why I wouldn’t go along with the premise that he is God and therefore he couldn’t possibly be wrong about why I still couldn’t properly digest food so many days after his surgery.
I have also had situations where a mental specialist comes to “see me” every day I’m in the hospital just to “see how I am doing” all the while expecting to get paid by at least my health insurance company. Sometimes it has been an honest misunderstanding and the psychiatrist had the purest of intentions. But, more often than not, it appeared to be a scam once I recuperated and looked through the billing paperwork when the hospital bills started rolling in around 3 weeks after my Discharge. In such instances, I am crystal clear with the psychiatrist in the hospital that I do not wish to retain his or her services and I denote in writing the date this conversation takes place. It then becomes comical when the same doctor returns the next day offering to “discuss” why I don’t think I need his services and then weeks later I see psychiatric services “rendered” that 2nd day in the hospital on an invoice from the psychiatrist as if he treated me that day “to discuss why I feel I don’t require psychiatric care.” Accordingly, I told Liz it would be nice to have a list of the “good, bad and the ugly.” I also brought up to Liz how the Discharge process and even the entire hospital patient experience can be affected by disease-specific issues and it shouldn’t be. For example, in some hospitals, Pediatric and Cancer patients get the white-glove treatment during the entire hospital patient experience whereas patients with Crohn’s Disease, Diabetes or Fibromyalgia are treated like the brother on “Keeping up with the Kardashians.” What’s his name?
“Discharge” by any other name is still a Legal Term of Art
Liz also asked if “Discharge” should be called by another name to downplay its apparent troublesome meaning to-date or to brighten up the Discharge Process for patients who have good hospital patient experiences and positive medical outcomes. However, the attorney in me knows that some type of word or phrase is necessary to transfer medical liability away from the hospital when the patient leaves the hospital to properly apportion potential separation liability so phrases like “Recuperation Time” or “Going Home Time” are good ideas but not very practical because then lawyers wouldn’t know where to draw the line of culpability should the patient relapse or get worse after leaving the hospital.
The Conclusion: Humanizing the Healthcare Experience
Like I said at the very beginning, in my humble opinion the Discharge Process from a hospital is a cluster-fuck. While I sincerely appreciate the efforts of companies like Experia and people like Liz, I think the hospital patient experience could be more quickly modernized by focusing on basic human kindness and the logical opportunities for improvement which pop up throughout the hospital patient experience for medical professionals to treat patients the same way the medical professionals would want to be treated if they were patients. That said, however, this is all finally beginning to make sense and I feel confident that companies like Experia and people like Liz are totally on the right track especially when their stated goal is: Humanizing the Healthcare Experience.