Succeeding as a Safety Net (Part 2 of 3): Thomas Jefferson University Hospital

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SNH-thumb1Among those groups who are advocating better-tailored quality standards for safety-net hospitals is The National Association of Public Hospitals and Health Systems, Cheryl Clark at HealthLeaders Media reports.

Like certain other groups, this association believes current federal quality standards make “the road for these safety-net hospitals…too steep.” Xiaoyi Huang, assistant vice president of policy, says the HCAHPS survey “‘lacks measures of cultural competence, and therefore fails to capture key aspects of healthcare quality’ important to minorities.”

Nevertheless, as the article relates, there are safety-net hospitals that are succeeding with current quality metrics. On Friday, we wrote about Ronald Reagan UCLA Medical Center’s marginal success in turning its scores around. Likewise, the 969-bed Thomas Jefferson University Hospital in Philadelphia, Penn., has experienced similar improvements.

David P. McQuaid, FACHE, president, in fact, has come to believe that the entire safe-net/quality-metrics argument is centered on the wrong issue: “Don’t waste your time debating data and targets. Your focus should be on the best possible outcome, and if you’re doing the kinds of things that need to be done in a patient-centered model, your outcomes will follow.”

Medicaid and uninsured patients account for 20 percent of Thomas Jefferson’s volume. McQuaid and his executive team became curious about the impact providers were having on patients and discovered that “certain behaviors—terse or quick answers or rushed visits—may seem insensitive and uncaring when viewed from the perspective of the patient.”

Knowing many of these providers probably were unintentional with these behaviors, the organization put together a training and educational film highlighting different patients who had bad experiences with the hospital’s providers, Clark writes.

Some of the patients in the film relate experiences such as, “I remember when my doctor first came in to see me after my procedure. He looked at his watch three times in the two minutes he was there,” or “I feel I could have used a little more honest communication, certainly with me, but also with my family.”

Perhaps it’s no surprise then that physician-patient communication was found to be Thomas Jefferson’s biggest weakness. To improve this, the organization, in collusion with its physicians, began working on specifics of the patient encounter, such as where chairs are positioned in the room and placing white boards and notepads in each room on which patients can post specific concerns, questions, or requests.

Furthermore, in order to provide accountability for each department, McQuaid decentralized the task force responsible for the entire patient population’s experience and set up separate teams in each area of the hospital.

As with Ronald Reagan UCLA, Thomas Jefferson is seeing promising results from these changes, Clark reports. “For the period April 2011 to March 2012, Medicare’s Hospital Compare shows Jefferson’s HCAHPS were better than both national and state averages in six of 10 questions and were similar in a seventh. In response to the last question—would patients definitely recommend the hospital?—76 percent said yes, compared with 68 percent in Pennsylvania and 70 percent in the nation.”

Jennifer Jasmine Arfaa, PhD, chief patient experience officer, said, “Our patients are our No. 1 priority, and every patient is treated the same, with dignity, respect, and integrity.”

What are some of the ways in which your organization has tried to improve the patient experience? What key lessons have you learned in the past few years about keeping patients satisfied with the care you’re providing?

-by Pete Fernbaugh

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