Finding the Right Hospital

What's good for patient satisfaction may not be good for medicine. Awash in marketing, the key questions to consider when choosing a hospital
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Hospital marketing has reached a frenzy. It is nearly impossible to drive around metropolitan areas in the U.S. without being barraged by billboards trumpeting hospitals' cutting-edge technology, luxurious facilities, or the lives of patients they have saved. In many markets, more than one hospital claims a "Top 100," "Top 10," or even "#1" rating for the same type of service. Especially while recalling a day when such advertising would have seemed sordid, it's easy to feel bewildered.

Some of the most important events of our lives, including birth and death, often take place within their walls. We entrust our lives to the nurses, physicians, and other health professionals who populate them. And the services they provide cost a great deal of money -- last year one-third of all healthcare expenditures, or nearly $900 billion. For those who have a choice, how should we determine which hospital is right for us?

Suppose one hospital's program has a 99 percent success rate, while another has only a 95 percent success rate. It would be tempting to suppose the first is better.

One option is to choose according to amenities. How much original artwork adorns its corridors? How high is the thread count in its sheets? Does it offer the services of a concierge or gourmet chef? Of course it is quite possible to be comfortably ensconced in the lap of luxury yet mishandled medically.

We might go from lot to lot to find the best deal on a car, but few of us are able or willing to invest the time and effort that would be required to shop around for the best hospital. And even if we did, which healthcare parameters would we track? Merely finding out how many patients with a particular condition lived or died does not necessarily tell us much, in part because some hospitals' patients are sicker than others.

Take the case of heart surgery. Suppose one hospital's program has a 99 percent success rate, while another has only a 95 percent success rate. It would be tempting to suppose the first is better. But in fact, it might actually provide poorer care. For example, the 95 percent hospital might perform the procedure on the sickest patients in most dire need of the surgery, while the 99 percent hospital may only perform the procedure on relatively young and healthy patients, many of whom do not need it so much.

Another source of guidance is hospital choice might seem to be the satisfaction levels of former patients. Good hospital care should naturally produce satisfied patients, while bad care should produce unsatisfied ones. If only we could collect, quantify, and then make widely available the hospital experiences of former patients, we could determine where we are likely to get the best care for ourselves and our families.

In fact, both the Centers for Medicare and Medicaid Services and the National Committee on Quality Assurance require participating organizations to publicly report their patient satisfaction data. With such data in hand, the thinking goes, patients will be able to make more informed choices about where to seek care, and this in turn will spur competition between hospitals to improve patient experiences.

Yet the situation is not quite so simple. For one thing, it can be difficult for patients, most of whom have no background in healthcare, to distinguish between hospital staffs that are merely adequate and those that truly excel. In the case of surgical technique, for example, patients are generally unconscious, and when it comes to serious illnesses such as cancer and stroke, most of us happily have little or no prior experience with which to compare.

To be sure, we can generally discern whether the food is delicious or insipid, and whether someone is treating us in a polite or surly fashion. But we may not be able to tell whether or not the hospital staff arrived at the correct diagnosis, prescribed the appropriate therapy, or delivered the medications and procedures in a competent fashion. Especially when you are feeling poorly, it can be difficult to appraise quality of care.

High patient satisfaction may actually be associated with poorer care.

Despite having received first-rate medical care, some of us might rate a hospital experience poorly because we had to wait a long time, or personnel were brusque, or the food was not to our liking. On the other hand, we may rate another hospital experience highly because parking was both easy to find and free. Such parameters are not unimportant, but when it comes to choosing the best hospital for open-heart surgery, they may not be paramount.

Presented by

Richard Gunderman, MD, PhD, is a contributing writer for The Atlantic. He is a professor of radiology, pediatrics, medical education, philosophy, liberal arts, and philanthropy, and vice-chair of the Radiology Department, at Indiana University. Gunderman's most recent book is X-Ray Vision.

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