The Solution to Better Patient Experience in a Hospital Lies Outside the Hospital

“I’ve realized how na?ve I was about what it is like to be a patient.” That was one of the big things I took away from a near death experience with COVID-19, which landed me in the ICU for a week over the summer.

Hospitals have been on a multi-decade journey to make being there seem great. These days they are measured on patient satisfaction, with “chief experience officers” and staff who are trained and rewarded to help. Such efforts have born results: Today’s hospitals — with their relatively expansive room size, privacy, and amenities — bear little resemblance to hospitals of the 20th century. Even the food is often a culinary delight. Yet, the actual experience of being a patient in a hospital is not only miserable, it’s still dangerous and extremely disruptive to the human body.

We must do better — and I believe the real answer lies outside the hospital.

A harsh reality

If you’re a patient in a hospital, you’re probably very sick. That usually means you’re scared and, oftentimes, in a great deal of pain. Hospitals can’t offer you the comforts of home. There is no way around bright lights, noise, and commotion. Staff members must monitor your vitals and run frequent diagnostics. The risk of infections is so great that human interaction is limited and workers don’t quite appear as friendly and reassuring in medical garb. And that was true before COVID-19 shut off nearly all person-to-person contact. It’s hard to create a peaceful and hopeful environment for patients when people around them may be going into and out of codes, or, worse yet, dying.

I’m not telling hospital executives to give up. There are many things to work on around the edges. As a recent ICU patient, I can tell you that a big dose of empathy for knowing what it truly feels like to be hospitalized is the right place to start. I called being hospitalized “dying in solitary confinement” — and that was at a hospital that did amazing work, had a staff that cared deeply, and saved my life. As a primary care physician, my big takeaway was that our effort is misplaced if we only bet on improving the hospital experience for inpatients. Our real attention must be focused much farther upstream.

Prevention: The missing piece

We’ve all heard the refrain that, “when life gives you lemons, make lemonade.” Trying to fix hospital patient experience is trying to turn those lemons into lemonade. My question: why accept that life has to give you lemons? The original sin is that our medical system didn’t keep you from needing a hospital. If we spent our time and money in primary, preventive care, we’d have the opportunity to save countless people from needing to go through any inpatient experience. Yet, in America, our investment is in the wrong place. We spend more than $11,000 per year on healthcare per person, eating up nearly one-fifth of our economy: and close to 40 percent of that spending is for hospitalizations, while just five percent goes to primary care.

If you had a leaking pipe soaking the floor of your house, we wouldn’t focus on making the experience of living in a wet house better. We’d solve why the pipe leaked, fix it, and monitor it to make sure it doesn’t leak again. In reality, we actually work to build pipes up to certain standards and have installation guidelines and checks to reduce the risk of any leaks in the first place. That simple logic is missing in healthcare. We spend our time thinking about how to offer some modicum of satisfaction once the proverbial pipe is already leaking.

Sure, some hospitalizations are unavoidable. But, at least half are preventable. It’s all built on close patient-doctor relationships so that there is trust. Trust for patients to reveal the truth. Trust for patients to feel supported, rather than judged. Trust to follow advice — from wearing masks to getting flu shots to stopping smoking to eating better. Trust for patients to follow prescribed medication or care plan protocols. Trust to share problems before they get too serious. Preventing hospitalizations also requires easy, immediate access to primary care for every American. Easy enough that a trusting relationship can be built in the first place. Easy enough that the relationship becomes about more than sick care response, but rather evolves into health management. Easy and immediate enough that primary care issues don’t land people in the emergency room.

Let’s not forget that health is influenced by social factors and lifestyles and behaviors far more than it is by clinical care. When primary care doctors can build relationships with patients, when they can lead and coordinate a care team of health coaches, nutritionists, and social workers, they can do more than deliver healthcare. They can deliver health — by shaping social factors and lifestyles and behavior.

A path forward

I hope never to be tethered to a hospital bed again. And, I hope hospitals keep turning the crank on making the hospital experience better. We need, however, to solve the inpatient experience problem by addressing the inpatient part of that phrase, not the experience part. Preventing hospitalization gives patients the best experience possible.

Every hospitalization avoided is tens of thousands of dollars saved. We can redirect these resources to improving our primary care system. The stronger primary care gets, the more hospitalizations we can prevent. Which means more resources for a more robust primary care offering. It’s a virtuous cycle.

We could end up making salaries for primary care doctors more on par with the high salaries that specialists pull down. We could end up meeting the shortage of primary care doctors. We could end up enriching what people get from their primary care provider —transportation, technology, and more — to ease the access barriers and engage more people in preventive health.

I thank the great doctors and nurses who gave me the best care they could. But I ask the healthcare world to take the realization of just how miserable it is to be a patient in the hospital and don’t just try to serve inpatients better: Instead, see the path forward as being outside the hospital and commit to going upstream and investing in primary care to solve the problem.

?This article first appeared on the ChenMed blog.