Putting the Care Back into Health Care
Americans are obsessed about the cost of health care; and many find it unconscionable that 30 to 40 million citizens are uninsured. But these are not the only woes that beset the gargantuan industry. Of equal importance: The term "health care" is often an oxymoron. In particular, our largest medical centers are often more in love with high-tech gizmos than the healing process. Moreover, hospitals, we are learning, are places that make you sick.
"Only about 15 percent of all contemporary clinical interventions are supported by objective scientific evidence that they do more good than harm," according to Dr. Kerr White, retired deputy director for health sciences at the Rockefeller Foundation. "On the other hand, between 40 percent and 60 percent of all therapeutic benefits can be attributed to a combination of placebo and Hawthorne effects, two code words for caring and concern." In the book Verdict Pending, patient advocate Fredonia French Jacques systematically traces the origins of malpractice suits. One hospital administrator's comment captures the spirit of this well-researched treatise: "It is patients who have been slighted or treated abruptly ... who have been depersonalized, whose feelings have been hurt, who will sue. ... Patients seldom sue those who have cared for them with kindness."
Some have chosen to take such concerns seriously. Consider:
* Sunset Manor Alzheimer's Care Center, in Brush, Colorado, won a 1992 Quality of Life award from Provider Magazine, the Journal of the Nursing Home Industry. The staff is devoted to helping patients achieve tiny success in their daily routines. A series of small, esteem-enhancing interventions has dramatically reduced depression and even incontinence among patients.
* According to Provider, Eventide Lutheran Home of Morehead, Minnesota, turned its first-floor central corridor into Main Street. Patients can stop by a "shop" to have coffee and doughnuts with friends, visit the "library," and pop into the "post office" to mail letters. A host of similar features resulted in stunning, measurable improvements in patients' health and spirits.
* In San Francisco, California Pacific Medical Center's Planetree project has garnered substantial international attention as a model for care giving. Planetree's overarching objective is to fully involve patients in the healing process. Little touches include floral sheets, a bookcase next to each patient's bed, and a handy bulletin board for personal material. Patients have ready access to a substantial medical library that includes educational videotapes. Nurses stations have been opened up to patients, who are encouraged to review their medical records and even write comments on them. (Families are encouraged to do the same.) Tests are scheduled at the patient's convenience. And so on.
* The Wall Street Journal describes an Australian study of 48 cancer patients. Immediately after seeing patients, Dr. M.H.N Tattersall dictated a letter to 24 of them summarizing the visit; he sent no letter to the others. During follow-up interviews, those who'd received letters ranked their overall satisfaction with the physician higher than those who hadn't; in fact, over three times more (13 of the 24 who got letters vs. four of the 24 who didn't) said they were "completely satisfied," the highest rating. Letter recipients were also relatively more satisfied with Tattersall's explanation of their problem, remembered more of what they'd been told and incredibly, felt that they'd had a better opportunity to ask the doc questions.
* Little deal, big impact: "Patients whose windows overlooked a small stand of trees needed fewer doses of narcotic pain drugs," reports the September-October 1992 issue of Healthcare Forum Journal. Could it be that simple? Just about.
Such small considerations can recast the health care experience—and mightily abet healing. But consultant Leland Kaiser urges health care providers to be bolder still. "When I meet a patient who has just returned from a visit to the hospital, clinic, or doctor's office," he writes in Healthcare Forum Journal, "I ask, 'Did you have a good time?' This is the same question I might ask of a friend if she or he had just returned from a trip to Disneyland. A visit to a health care facility should be a great experience." Now that is a novel idea.
Harvey Mackay, author of Beware the Naked Man Who Offers You His Shirt! told Industry Week magazine about his experience with a Manhattan cabbie who took him to La Guardia:
"First, this driver gave me a paper that said 'Hi, my name is Walter. I'm your driver. I'm going to get you there safely, on time, in courteous fashion.' A Mission Statement From a Cab Driver!
"Then he (offers me) the New York Times and USA Today and ... a nice little fruit basket, with snack foods. Next he asks, 'Would you prefer hard rock or classical music?' He has four channels. ...
"You know what? This man makes $12,000 to $14,000 extra a year in tips! You should see the tip I gave him!"
Taxi-driving and open-heart surgery turn out to have a lot in common. The basic service can be totally transformed by attention to a host of unsung concerns—which cost pennies at most.
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