“The idea that hospital patients might benefit from redemptive surroundings is far from new.”—Robert Cork, The Healing Presence of Art
My last blog post reimagined a hotel stay through the eyes of a patient. I received numerous responses about the post(ok one person queried me about the post. And that person was actually looking for Flansbaum) regarding the difficulty of comparing hospitals and hotels. Hospitals are matters of life and death, and it can be seen to belittle their missions by comparing life saving hospitals to consumer driven hotels.
Patient satisfaction incentives and competitive business practices seem to be transforming hospitals into 5 star atmospheres. This has been written about in several posts here and here. Last year, the NY Times nailed this sentiment in a short quiz aimed to spot differences between hotels and hospitals.
Have we gone too far in transforming our bulwarks of illness into bastions of comfort? Or as my post alluded, perhaps we could learn a few lessons from the hospitality industry. Where’s the balance?
Hotels and hospitals share many similar characteristics. Seeking comfort, succor, with short term stays requiring food, lodging, and extensive support staff. There are individual rooms, room service, activities throughout the day, and uncomfortable mattresses.
They also share the same etymology, as does the word hospice, from the Latin for strangers: hospes. Hospitals evolved from hospices, which both care for strangers. The original hospices housed pilgrims offering rest, food, and shelter before they ventured off to their next way station. Eventually the poor, elderly and orphaned found their way into these facilities, and they became more than simply sources of food and shelter, but healing spaces.
The original centers for healing, old temples in Egypt and Aesculapian Temples in Greece, may be considered the ancient ancestors of hospitals. These facilities were closer to modern day spas, built around natural springs with salubrious surroundings, providing entertainment, music, and even pet therapy.
Today, when you walk in a room and spend more time talking to your patient about the lack of sleep, the noisy neighbor or nursing station, the beeping IV at 2AM, the blood draw at 3, X-ray at 4, and vital signs at 5, you wonder if perhaps we’re doing this wrong. Especially when you realize that some of these patients with the early AM vitals don’t need them, the labs were ordered as daily without stop dates, and the follow up KUB could have be done later in the morning. And why isn’t the IV beeping remotely to the nurse instead of loudly in the patient’s ear? For an hour.
And I hear some of you. The hospital is no place for comfort. This is the place of disease and sickness, healing and wellness can be at home, at the spa, or the Ritz.
This is the hospital, we need vitals, we need data, better alarms(or at least an IV with a toy gun alarm), the understanding that we can’t alleviate all pain, that much of what happens in the hospital is uncomfortable and unpredictable. As Alexandra Robbins with The Atlantic rightly pointed out earlier this year, the patient satisfaction craze has us tipping the scales the wrong way in many cases.
The conversation is important: Hotel vs. Hospital. The hotel side of hospitals is occurring. And if we can pick the right elements without sacrificing quality for patient satisfaction, we will emerge on the right side of this debate.
Our hospitalist blog has some recent posts and research regarding sleep and comfort in the hospital. Our patients want to heal, and they may heal better with some rest, sleep, comfort. They don’t need to be woken up all night for vitals and we can improve their routine to reduce dangerous night time sleeping aids.
Thirty years ago, this study recognized that a window view as opposed to a brick wall, accelerated the patient’s recovery and perception of their care. An architect reminds us of the importance of design and architecture in a patient’s recovery. Other arts are linked to healing as well. Some places are taking that advice, as the University of Michigan provides a cart for patients to choose their own art work for the hospital.
The crystallization of how we can provide high quality patient-centered care is highlighted in the development of MRI scanners for pediatric patients. A GE tech recounts his pride and joy in his brand new MRI scanner, and was giddy with excitement to see it in action. He quickly was disheartened to watch a frightened child undertake a scan and begin to understand that numerous patients are sedated in order to use his machine.
He had an epiphany and as a result he created an Adventure MRI scanner, with the patient at the center of the story. Instead of tears in the patients’ eyes, they leave the MRI scanner without sedation and asking for another turn through the ride. You can see his story here or read about it here.
We can create healing spaces that are patient centered, defy the current thought, and ultimately lead to better outcomes. A space that’s not a hotel or traditional hospital or hospice. We should be embodying another word that originated from hospes. Something closer to hospitality. Hotels offer hospitality. Hospitals offer that and much more, building empathy and compassion into our walls as well as our hearts, and meeting the needs of the patient with generosity, quality and without placing our needs first.
Why do I need vitals on a stable patient at 2AM? Is this for me or for the patient? Why do we walk into rooms without knocking? Why isn’t there room for family meetings? If I’m mad at my cable guy for making me wait sometime between 8-12 for a slot visit, why should we nurses and patients not know when we will show up?
The spaces can connote the patient partnership we aim for and that is central to our mission. A place that represents healing and caring and comfort.
Notions of hospitality transforming a hospital into a patient centered, high quality, healing space should be the vision.
Beyond a hotel, redefining a hospital.
Jordan is a hospitalist at Morton Plant Hospitalists in Clearwater, Florida. He currently chairs SHM’s Quality and Patient Safety Committee. In addition, he’s been active in several SHM mentoring programs, most recently with Project BOOST and Glycemic Control. He went to medical school at University of South Florida, in Tampa, and completed his residency at Emory University.
He recognizes the challenges of working in a hospital that lines the intracostal waterways of a spring break mecca. Requests that if you want to be selected as a mentored site, you will have a similar location with palm trees and coastline nearby. He tries to find time to sit on the beach with his family to escape the hospital’s miasma. While there, he looks forward to reading about the history of hospitals/medicine, and how it relates to quality (Anti-UpToDate reading material). But inevitably will get a five year old dumping sand on him, and then has to explain why she is buried up to her neck.