Patient survey spotlights problem areas for Calif. hospitals

Patients ranked only one in five California hospitals as above average.

By Damon Adams, amednews staff. Sept. 24, 2001.

California hospitals get passing grades for paying attention to the comfort of their patients.

However, they receive poor marks when it comes to preparing the patient for the transition to home.

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These are some of the findings in a new patient survey of California hospitals by the California HealthCare Foundation and the California Institute for Health Systems Performance. The report, released last month, measured the experiences of 21,151 patients who spent at least one night in a participating hospital.

Approximately one-third of the state's hospitals, or 113 hospitals, volunteered to take part in the survey. They were rated from one to three stars: three stars for above average, two for average and one for below average.

More than half of the hospitals (65) rated average. Earning above average marks were 22% of the hospitals (25) while 20%, or 23 hospitals, got one star.

Organizers noted the Patients' Evaluation of Performance in California survey did not measure clinical outcomes or competence of medical staffs.

But they say the survey is a valuable tool to educate consumers and to stimulate hospital quality improvement initiatives throughout the state.

"It's not our intent to be a 'gotcha' at all," said Ann Monroe, director of the California HealthCare Foundation's Quality Initiative. "We'd like to see [hospitals] use this information to improve care for patients. We hope this will encourage dialogue between physicians and patients."

Kaiser Permanente had all 27 of its California hospitals take part in the survey. Only one garnered three stars. The rest were rated average or below average.

"Clearly, the results show we have some work to do," said Kaiser Permanente spokesman Terry Lightfoot.

Lightfoot said Kaiser would use the survey to help raise the level of service. "It provides us with sort of a roadmap of areas where we need to focus our attention," he said.

Survey questions were posed in seven categories: physical comfort; respect for patient preferences; coordination of care; information and education; emotional support; transition to home; and involvement of family and friends.

"Questions were designed for hospitals to see where their problem areas are," said Marsha Nelson, vice president of the nonprofit California Institute for Health Systems Performance.

The survey found that most patients got pain medication when they needed it and had their call buttons answered promptly. Surgery patients responded favorably when asked about respect, coordination of care and family involvement. Maternity patients praised coordination of care and information and education.

But the biggest trouble spot was discharge planning. Patients said hospitals did not prepare them well for discharge home.

"The lesson is no one hospital excelled on everything," Monroe said. "They are just better on some things than others."

Jan Emerson, spokeswoman for the California Healthcare Assn., said the report is one resource on hospitals -- but should not be the only source used by consumers.

"It's not clinical in nature, so it doesn't have anything to do with the quality of medical care provided," said Emerson, whose group represents California hospitals. "It's the patient's perception of their experience in the hospital."

From the beginning, many hospitals shied away from participation in the survey. Many hospitals have in-house patient satisfaction surveys that are not made public.

"Some of them were reluctant to take part in a project that would publicly report the scores. They were afraid they would look worse than they wanted to look," Monroe said.

Others said they didn't know about the study, although Nelson said notification went on for months. She said she hopes more hospitals will participate in a future survey.

Sutter Health had nearly two dozen hospitals in the survey. They all received two or three stars.

"It was very important that we participate to provide the public with at least a basic snapshot of how we feel we are doing," said Sutter Health spokesman Bill Gleeson. "We believe that a knowledgeable and empowered consumer is good for our industry and will help us do better."