The quainter part of Johns Hopkins Hospital, in Baltimore.
The Johns Hopkins Armstrong Institute for Patient Safety and Quality, in Baltimore, will work with 750 U.S. hospitals to improve surgical care.
Johns Hopkins Medicine physicians will share with other hospitals insights on achieving better care to surgical patients in the effort to improve outcomes and reduce risks to patients nationwide.
The American College of Surgeons will collaborate on the initiative with the Hopkins Armstrong Institute, which has long been a leader in developing checklists and other means for reducing medical errors.
“What’s a little different about this is that it focuses on safety, preventing harm that happens to patients in the hospital, but it also focuses on quality,” Michael Rosen, M.D., an associate professor of anesthesiology and critical-care medicine at the Hopkins Institute, told The Baltimore Sun. “That means making sure after they go in for a surgical procedure that they return to a normal qualify of life as soon as possible.”
This article in Academic Medicine discusses the difficulties of an Accountable Care Organization formed by Johns Hopkins Medicine, some Washington, D.C.-Baltimore area hospitals and three medical practices.
One big problem was electronic health record systems that didn’t communicate with each other.
Other problems included trying to getting and analyzing claims data, governance issues and getting the full cooperation of providers.
The authors’ conclusions included this observation:
“Network strategies among AMCS {academic medical centers}, including adding community practices in a nonemployment model, will continue to require thoughtful strategic planning and a keen understanding of local context.”
Here’s a list, as summarized by Becker’s Hospital Review, of the 10 biggest complaints of hospital patients as compiled by Peter Pronovost, M.D., director of the Armstrong Institute for Patient Safety and Quality and senior vice president for patient safety and quality at Baltimore-based Johns Hopkins Medicine, and Jan Hill, Hopkins’s patient-relations director:
MedStar Georgetown University Hospital during one of Washington’s paralyzing two-inch snowfalls.
In an obvious effort to build on its affluent clientete, “MedStar Georgetown University Hospital has applied to build a new six-story, $560 million building featuring a 33-bay emergency room, a surgical pavilion with expanded operating rooms, underground parking and a rooftop helipad, ” The Washington Post reported.
“This facility {is meant] to accommodate the natural growth in terms of our market: Northwest Washington, near-in Maryland, Chevy Chase and near-in Northern Virginia,” Richard Goldberg, M.D., president of the hospital, told The Post.
The Post noted that “MedStar’s application for approval would undoubtedly improve facilities at the existing hospital, but it comes as the District continues to struggle with broader geographic and racial health disparities.
“For instance, recent research from Rand Corp. with the support of the D.C. Cancer Consortium found far fewer providers offer cancer treatment and palliative care east of the Anacostia River, and that ‘cancer incidence and mortality among black residents of the District are dramatically higher than for white residents of the District.”’
“MedStar Georgetown is near two other highly rated hospitals that are competing for market share in Northwest D.C. and the nearby suburbs; it is two miles from George Washington University Hospital and three miles from Sibley Memorial Hospital, which has been affiliated with Johns Hopkins Medicine since 2010.”
“Meanwhile residents of the rest of the District have less enviable options for emergency and specialty medical care. Howard University Hospital, in Shaw, was the recent subject of a takeover after suffering deep financial losses. The beleaguered United Medical Center remains the only full-service hospital east of the Anacostia River.”
Patricia Quinn, director of policy at the D.C. Primary Care Association, told the paper that, in The Post’s words, “she hoped that officials from the District’s State Health Planning and Development Agency would push MedStar Health, a $4.6 billion, nonprofit health system, to do more to partner with community health organizations on cancer treatments and other services.”
The sleek hospital tower that Johns Hopkins Medicine built in 2012 has the frills of a luxury hotel, including a meditation garden, 500 works of art, free wi-fi and a library of books, games and audio.
As Dr. Zishan Siddiqui watched patients and some fellow physicians in Baltimore move from their decades-old building into the Sheikh Zayed Tower, the internist saw a rare opportunity to test a widespread assumption in the hospital industry: that patients rate their care more highly when it is given in a nicer place.
For decades, hospital executives across the country have justified expensive renovation and expansion projects by saying they will lead to better patient reviews and recommendations. One study estimated $200 billion might have been spent over a decade on new building. Hopkins’s construction of the tower and a new children’s hospital cost $1.1 billion.
Patient judgments have become even more important to hospitals since Medicare started publishing ratings and basing some of its pay on surveys patients fill out after they have left the hospital.
Siddiqui’s study, published this month by the Journal of Hospital Medicine, contradicts the presumption that better facilities translate into better patient reviews. Siddiqui examined how patient satisfaction scores changed when doctors started practicing in the new tower, which has 355 beds and units for neurology, cardiology, radiology, labor and delivery and other specialties.
Siddiqui discovered that for the most part, patients’ assessments of the quality of the clinical care they received did not improve any more than they did for patients treated in the older Hopkins building, which had remained open. Units there were constructed as early as 1913 and as late as 1980, Hopkins officials said. They functioned as the control group in the study, since a hospital’s satisfaction scores often change over time even when a hospital’s physical environment remains constant.
The study used the responses both to Medicare-mandated surveys and private ones from Press Ganey, a consulting company that administers surveys. In the study, Hopkins patient ratings about the cleanliness and quiet in new tower’s rooms — elements Medicare uses in setting pay — soared, as did views on the pleasantness of the décor and comfort of the accommodations. But patient opinions about their actual care — such as the communication skills of doctors, nurses and staff — did not rise any higher than they did in the older building.
“Despite the widespread belief among healthcare leadership that facility renovation or expansion is a vital strategy for improving patient satisfaction, our study shows that this may not be a dominant factor,” Siddiqui and his fellow authors wrote.
Newer buildings allow for some medical benefits, such as better organized nursing stations and private rooms that protect against the spread of infectious bacteria and diseases. But the Hopkins researchers said “hospitals should not use outdated facilities as an excuse for achievement of suboptimal satisfaction scores.”The study’s results were startling because previous studies have found that patients in older hospital buildings give lower scores on the quality of their care.
Hospital executives have noticed it anecdotally as well; for instance, when NYU Langone Medical Center relocated its cardiology unit to a renovated floor, its patient experience scores rose.
A nationwide survey from 2012 conducted by the consultants J.D. Power and Associates reached similar conclusions to the Hopkins paper about the influence of the physical environment on satisfaction scores. That survey found that communication by doctors, nurses and other staff was most important, while the facility accounted for a fifth of patient satisfaction.
After reading the Hopkins study, Dr. Bradley Flansbaum, a physician at Lenox Hill Hospital, in Manhattan, wrote on the blog of the Society of Hospital Medicine that “it just might be that what doctors do and say matters, and a first-class meal and green gardens cannot paper over, or in the converse, sully our evaluations.”
