It’s the age-old dilemma of doctors: Dr. House or Dr. Dorian? The first provides exceptional clinical care, always nailing his diagnosis, even if it is a tad late now and then, while giving absolutely nothing to you in terms of bedside manner. The second will make you laugh and enjoy your stay, but is a bit of a novice and might make a mistake here and there.
Why not both, you might ask. Well, according to a new study from the Ohio State University, the two are naturally at odds with one another, with better clinical care usually coming at the cost of patient experience.
In 1999, the Institute of Medicine released a report revealing that nearly 100,000 people died every year as a result of preventable medical errors in the United States. Naturally, that seemed like a bit of a high number. Since that time, the U.S. Centers for Medicare and Medicaid Services (CMS) has striven to standardize the way patients receive care for four biggies in the health care department: heart attack, heart failure, pneumonia and surgical care.
As hospitals began to adopt these standardized procedures, they also were required to keep track of how well the adhered to the guidelines, with the best performances tied to financial incentives. Of course, other things are tracked at hospitals too. Many institutions take patient surveys to rate how well of an experience people are having at their facility.
It is, after all, a business too.
So Aravind Chandrasekaran, assistant professor of management sciences at Ohio State, decided to take a cross-look at the data. Together with co-authors Kenneth Boyer, professor of operations management, and Claire Senot, a management sciences graduate student, he discovered that while adherence to the guidelines helps hospitals take care of their patients, it hurts how the patients feel like they’re being taken care of.
“Clinical quality is about doing things correctly – strict guidelines, standardization and checklists, for example – so when you consider experiential quality is about customizing health-care delivery to an individual patient’s needs, there is a tension there,” said Chandrasekaran.
Whether its clinicians being too busy remembering regulations and filling out forms to explain exactly what is going on to the patient, or the lack of listening to individual problems in order to adhere to guidelines, personalized care is going down the tubes.
At least, in the short run.
The studies also show that after a hospital has implemented the standards and worked the system to a well-oiled machine, the patient experience did improve.
“Legislation encourages hospitals to improve clinical quality, which in the short run can lead to taking one step backward on patient experience quality,” Chandrasekaran said. “In the long run, getting better at clinical quality – doing the right thing – frees up resources and leads to two steps forward on the patient experience as well.”
Of course, the study also showed absolutely no correlation between clinical quality and patient satisfaction. Either patients don’t have a clue as to how well procedures and guidelines are being followed, or they care more about how they feel than whether or not they get better.
People are dumb. They choose Dr. Dorian.
I choose Dr. House.