If You Build It…They Will Come?

“…hospitals should not use outdated facilities as an excuse for achievement of suboptimal satisfaction scores.”
– Dr. Zishan Siddiqui

I am a huge fan of National Public Radio.  I often keep it on in my house on the weekends while I’m working on projects or just cleaning the house.  I realize that a young 30-something is probably not the target demographic for programs like A Prairie Home Companion, but I do love that show.  (Or maybe it’s just the northern accent of Host Garrison Keillor reminding me of my home state of Michigan…)  Our local public radio station also plays a lot of other great programming on the weekends, like Ask Me Another (a must for any news junkies or nerds of any stripe) or any of their great music shows (I am partial to Night Crossings).  But two shows I am guaranteed to hear part of every day are Morning Edition and All Things Considered, the morning and evening news programs.  Not only do I believe that NPR is one of the last places on the planet where you can find true journalism, but they run stories that you can’t hear anywhere else.

On a Side Note:  I studied journalism a bit in university while I was considering doing a double major, but I became disenchanted the more I studied it.  After several courses I dropped that major entirely.  Looking back at what the journalism industry is currently facing, it was probably a good decision.

This week, I heard two stories aired on consecutive days that were in direct conflict with each other.  While this isn’t uncommon to run into on NPR (which is one of the reasons I enjoy it), this one was on an issue that is aligned with my current study of Health Care IT and is related to events close to home. The first story aired on February 23’s episode of Morning EditionNew Hospital Buildings Define Future of Health Care.  The story, profiling the billions of dollars that are currently being invested to update or replace hospitals and medical centers, featured a new facility being constructed at Clements University Hospital in Texas.  Many of the updates being made are a response to the Affordable Care Act emphasis on switching towards a Pay for Performance model, as opposed to the current Fee for Service model which has the spectacular effect of encouraging additional medical consumption (like tests) while discouraging treatments which may actually help the patient maintain health in the long run (more profitable to treat chronic conditions like diabetes than to pay for the nutrition counseling and/or surgery to help prevent it).  Some of the updates they are making along this line are changing the physical layout of the hospital so that staff doesn’t have to walk as far to reach patients and installing teleconferencing screens so that staff and patients can have near instant access to specialists and family.  These are changes that should improve the quality of care.  But some of these updates are not exactly medically related; for example, fine art work in treatment rooms.  The hope of these facilities is that the upgrades that they are making will attract patients, who of course pay for their use of health care facilities.

The very next day, an article written in conjunction with the Kaiser Health News foundation featured on the NPR Shots blog.  This article, Fancy Hospital Flourishes Often Fail To Impress Patients, featured the new facilities that Johns Hopkins Hospital built in 2012 that features “…a meditation garden, 500 works of art, free wi-fi and a library of books, games and audio”.  Could you argue that things like a meditation garden and artwork encourage lower stress levels, which may speed the healing process and improve health outcomes?  Sure you could.  But that’s a rather tenuous argument at best, and as the rest of the article points out, it’s an argument that is most likely incorrect. Dr. Zishan Siddiqui, an internist at John’s Hopkins, decided to use the unique opportunity to run a study and see if patients rated their care more highly when they were in the new facility as opposed to the old facility.  What did Dr. Siddiqui find?  According to the study results, the ratings scores were no better at the new facility than for patients being treated at the old facility.  Ratings from patients on questions about the atmosphere and cleanliness and such increased, as would be expected in a new facility.  But when it came to actual patient care related questions like the communication skills of staff, results were statistically the same as the scores from patients in the old building.  While this flies in the face of what many hospital administrators “know to be true”, Dr. Siddiqui’s survey results point to something which is unfortunately far more common:  Administration excusing low ratings on physical or environmental issues without addressing real issues, such as communication problems or poor staff performance.  Dr. Siddiqui even says, “…hospitals should not use outdated facilities as an excuse for achievement of suboptimal satisfaction scores.”

Now I’m not trying to argue that changes are not necessary…indeed in many cases they are.  As I am currently working in the IT field and am completing studies to be a Health IT professional, I can tell you that if you are in a hospital that was built even before 1990 you are going to run into structural problems that are going to limit your options when it comes to not only implementing technology, but also problems that are going to tie your hands on what you can do.  After all…you can’t provide MRI services if you can’t fit an MRI machine in the building.  And some of these buildings (like the one replaced at Johns Hopkins which had the first units constructed in 1913!) were built even before you had anything near approaching modern medicine…heck you didn’t even have electricity at that time!  You can do a certain amount of retro-fitting to help fill these gaps, but realistically there are times when it is more cost efficient to construct a new facility than to retro-fit an outdated facility.

Field of Dreams But what I do have issues with is this Field of Dreams-type mantra that seems to be prevalent among many of these projects.  The idea that if you build something new, they (meaning patients in this case) will come is not something that you can stake an investment of that size on.  Just ask the numerous museums (see this article on the Field Museum in Chicago’s budget woes after a construction project they couldn’t pay for) or churches that have constructed multi-million dollar facilities with this perspective in mind, only to run into dire financial problems and in some cases be forced to shut down altogether when the new facilities were not enough to attract visitors or worshipers to support it.

I tend to believe that Dr. Siddiqui has his finger on an important point: Administrators should not be using outdated facilities as an excuse for poor performance.  If I am going to the hospital (or when family members have been hospitalized), the first thing that comes to my mind isn’t meditation gardens or free wi-fi- or libraries…the first thing that comes to my mind is “Where are the best doctors?” and “Where can myself (or my family member) get the best care?”  Sure, the amenities may be nice, but if your doctors and staff are cold, uncaring, unskilled or so harried that they can’t devote proper time to each patient, I don’t care how many amenities you have.  I won’t be returning if I have any kind of choice and I certainly won’t recommend you to anyone.  These facilities also need to remember that for many of their patients, where they receive care is not a choice; it simply a matter of location.  If someone has a car accident or heart attack, they aren’t going to be shopping around for a hospital; they are going to the closest location to be stabilized and treated, and often any moves from there are entirely dependent on the referrals made by their physicians (which don’t take wi-fi or in room art work into account).

The reason these stories struck a chord with me is because our local hospital has completed an overhaul process to update its ER facilities.  Recent stories in the local newspaper have touted the additional beds, larger lobby and new landscaping.  Are many of these upgrades important for patient care?  Absolutely, and they are probably long overdue.  But I would caution against thinking that these updates are going to be a miracle cure for any facility’s reputation or any performance issues a facility may be suffering from.  As the Greek philosopher Plato cautioned in his work Phaedrus, “Things are not always as they seem; the first appearance deceives many.”


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