My father is of that certain age and condition where he is now a regular guest of hospitals and, much like the man who eats not just at McDonald’s but samples the wares of Burger King and Wendy’s too, his frequent trips to some of Boston’s finest have made him a discerning consumer. And so recently while at Beth Israel Deaconess Medical Center he was struck, just like Sherlock Holmes in “Silver Blaze” (“the curious incident of the dog in the night-time” — the animal didn’t bark), by something that didn’t occur.
During the night, no one woke him up.
If you have had the pleasure of a stay in the hospital, you know exactly what I mean. Patients rarely get any sleep. Every hour or so the overhead fluorescents flash on as a nurse makes his or her rounds. Pagers sound, machines beep, alarms blare, and cart wheels squeak. Room doors are open and the sound of staff chatter filters in. One eventually leaves the hospital exhausted.
Indeed, one’s malady aside, the experience of being a patient can be miserable. It isn’t only the sleep deprivation. The food can make grade-school cafeteria lunches seem gourmet. New teams of physicians pop by routinely asking the same questions over and over (a problem especially in teaching hospitals). The revolving cast of healers makes it hard to figure out who is in charge and at times impossible to understand what is going to happen next and why. Roommates can be unpleasant; Kardashian-like family dramas are played out bedside. And far too many of the hospital staff treat patients as commodities; subjects to be poked and probed, not individuals with families, jobs, and dignity. My father recounts a recent incident (not at Beth Israel) where his roommate was screaming in pain as the staff — ignoring his protestations — tried to adjust him in his bed. “Stop!” he bellowed. “I am somebody!”
None of this is to discount the clinical excellence of Boston-area hospitals. They rank tops in the world; US News & World Report, in fact, just named Massachusetts General Hospital the best in the nation. But those ratings don’t look at patient satisfaction, a concept that seems almost alien to the culture of health care.
That may be changing, as evidenced by my father’s experience at Beth Israel. Just over two years ago the hospital hired Anissa Bernardo, its first-ever patient satisfaction coordinator. My father’s uninterrupted sleep is a direct outgrowth of her work, a program billed “Quiet at Night.” First piloted in one unit, Bernardo worked with the floor staff to institute numerous changes, some large, some small. Instead of turning on room lights to check on patients, for instance, staff members now walk around with small flashlights. During newly-designated quiet hours — 9 p.m. until 6 a.m. — pagers are set to vibrate, and staff members are urged to keep their voices down. Cart wheels are oiled to stop squeaking; keypads are beep-free. Room doors are shut (unless otherwise medically required). And to top it off, each patient gets earplugs.
The pilot project went well. Bernardo says survey results of patient satisfaction improved markedly, and the program last year was rolled out across the hospital. She concedes it’s been difficult at times. Staff members understand the whys, but making nights quiet often requires changing decades-old patterns of doing things.
The push for this comes, interestingly enough, from the much-maligned Affordable Care Act, or Obamacare: Beginning in October, the law ties a portion of hospitals’ reimbursements to patient satisfaction. So too, there is increasing evidence that one’s state of mind affects morbidity and mortality. Help patients feel better about themselves and outcomes also improve. As Beth Israel itself says, “Silent Hospitals Help Healing.” As a result, Beth Israel is not alone in its newfound interest in customer service.
Still, it’s remarkable it’s taken so long to figure out something almost every other business knows implicitly: Customer satisfaction matters. I point out to Bernardo that a reputation for great customer service could give Beth Israel a marketing edge in the intensely competitive Boston market. They’re not there yet, she says, but perhaps soon. One hopes. Patients want good results, but they wanted to be treated decently too.