Occasionally, A Health Care Story Leaves Me Speechless (Well, Almost)

As long-time HealthBeat readers know, I have some reservations about hospitals plunging huge sums into plush hotel-like amenities—spas, gourmet food, marble lobbies, mahogany-paneled doctors’ lounges  . . ..  See “Who Will Pay for the Waterfalls?”

I tend to think that hospitals should plow any extra money into programs that will protect patients: infection control, electronic medical records that would prevent medication mix-ups, and so on.

But patients can’t see these improvements. And in competitive urban and suburban markets (where, typically, too many hospitals are vying for well-insured patients) hospital CEOs know that the cosmetic improvements appeal to upscale, well-insured patients.

In recent years, as hospital competition has become more desperate, some hospitals have taken the amenities race to yet another level. Thanks to HealthBeat reader Brad F. for calling my attention to a story on Boston.com  which reports on recent “luxury” improvements to Boston-area hospitals.

For instance, Boston.com reports, Newton-Wellesley Hospital has added 48 new private rooms that  Dr. Michael Jellinek, the hospital’s  president describes as magnificent: “They are larger, very airy and all have nice big windows.”

Moreover, these private rooms have, not one thin-screen television, but two. One for the patient, and you guessed it, “one for the visitors.”

Keep in mind that, these days, most inpatients are pretty sick. (If you’re having a simple procedure, such as knee surgery,  you are normally treated in the outpatient clinic and sent home.)

Imagine that you are an in-patient who has undergone a major procedure; you  may be pretty tired, you may be in pain. But when a relative or friend comes to visit, you’re grateful.  

Consider how you would feel if, after talking for 10 or 20  minutes, your visitor looks around, and asks: “Hey, should we turn on the TV?”

“Sure,” you say. You don’t really care. You are exhausted.

Twenty minutes later, your brother-in-law comes into the room. “Sue is coming later . . .  so how are you doing?” He notices your other visitor: “Aren’t you watching The Game?”

Within ten minutes, your brother-in-law has settled into The Game on the second TV.

Two televisions are now broadcasting into your room, keeping your visitors entertained. No doubt, they will tell everyone they know that this is a First-Class hospital.

And this is supposed to be restful?

26 thoughts on “Occasionally, A Health Care Story Leaves Me Speechless (Well, Almost)

  1. Maggie,
    This highlights why the public needs good, unfiltered data from hospitals in order to make informed decisions. From the patients perspective, it is these ameneties that form their impression and cause hospitals to continue to build to impress.
    In looking over some of the posted data that is starting to become availible, I have found it interesteing to see many of the premier institutions with the major money either fall short of much smaller and less atractive institutions in quality measures. This was also the case in Boston where it was discovered that Partners was being paid higher rates from the Blues, even though their quality was measured inferior to many of their competitors. We need this information more transparent to patients to make informed decisions and not reward those hospital CEOs that decide that glitzy facilities and advertising is the way to go.
    I worry that presently most of this data is self reported with lots of potential to alter it if it shows the hospital in an unfavorable light. If hospital pay structures are further linked to quality measures, I suspect there will be a big incentive to massage the data. We will need to have stronger oversight to prevent this possibility.

  2. And people wonder why health care costs are skyrocketing?
    I’ll have to admit, I’ve never been in a hotel room with 2 flat screen TV’s. I’m glad I haven’t…I can’t even begin to imagine that bill for a weeks stay!
    Heather

  3. What amazes me is the insensitivity of the patient’s visitors. But they wouldn’t have the opportunity to be that insensitive if the hospital hadn’t provided an additional TV for visitors. What is everybody thinking? You are right, Maggie, a hospitalized patient these days has to be pretty sick to be there. Have we lost our minds in thinking that visitors need to be entertained by a second TV in the patient’s room? What happened to helping out the patient to feel more comfortable such as bringing in a meal (if okay with the patient’s primary nurse) or asking the patient if they want a cool washcloth on their forehead or pajamas/bathrobe brought in from home? Isn’t this about the patient and their recovery?

  4. For a while now hospitals have been emulating Las Vegas casinos. These magnificent new rooms are like the high-roller suites (with free food and drink, and even companionship if desired) Las Vegas offers to keep the well heeled coming back. Another feature of the hospital hospitality chase is the construction of fancy hotels next to the hospitals.
    Money driven? Yes. Reckless driving? Very.
    nick

  5. Let’s not go overboard here while we are making trade-offs. There’s plenty of evidence that patients, especially cardiac patients (those are the ones who have been studied), do better and leave the hospital sooner when they can view trees and other green stuff and when the setting is not so clinical (cardiologists seem to be especially open to contributing to research because they understand the connection between behavior, environment, and medical conditions). The Environmental Design Research Association has contributed to the theory and empirical design knowledge about the connection between health and environmental design (www.edra.org), and their practitioners attempt to be as evidence-based as they can. The AIA has a community of practitioners, the Academy of Architecture for Health, for those who focus on medical settings, and they usually try to apply this kind of research in the field. http://www.aia.org/practicing/groups/kc/AIAS074687#
    There is also the Planetree movement: http://www.planetree.org
    It’s the client’s responsibility to demand this kind of value and knowledge for their facilities and their patients. I can see the roots of much of this wrong-headed and wasteful decision-making for the sake of “competition” in the way I was trained to be a hospital manager as well as the proliferation of MBA’s as hospital managers and administrators; and I can see the roots of the horrendous patient safety statistics and the wasteful delivery system in this training as well. (In the meantime, my urban community has lost 15 maternity/OB departments in the last 2 years). But there is nothing incompatible, from a policy perspective, between re-instituting Certificate of Need regulations on the local and state level and regional health planning (yes, “social engineering”), and also providing evidence-based medical and healing care for patients.

  6. Can someone point to a study that supports flat screen TVs reducing the number of hospital inpatient days and decreasing the overall cost of healthcare?

  7. There should be a law against such misuse of resources.
    Its the cost of care that is the big problem here.

  8. This is not a problem of individuals, but a systemic problem–the perceived need for “competition” for patients among providers, the need to make profits and to satisfy shareholders (or public funders, including taxpayers) and to attract patients who can pay top dollar for medical care that they might not really need and that might even hard them. Therefore, how does punishing individuals improve the system or solve the problem?

  9. Why don’t you recommend we just ban TVs from all hospitals. They aren’t needed for healing. Same with telephones. Meals should be Ramen noodles for lunch and dinner. Shredded wheat, no frosting for breakfast. Others:
    Coffee for family gone. Get rid of couches and padded chairs.
    Folding metal chairs only. White paint, Linoleum floors, crappy food, you might have something here. People will want to get the heck out to lower costs. There is no reason we can regulate the most regulated industry in the world down to the lightbulbs and caulk around the windows.
    Seriously misuse of funds? A 500 dollar TV over the 15-20 year life of a hospital room compared to 15 grand for an electric hospital bed that might last 5 years is nothing, then add in call buttons, O2 hookups, code buttons, wall suction, handicapped bathroom and shower. The cost of a 2nd TV is a joke. The 2nd TV is a drop in the bucket for the overall cost of remodeling a room.

  10. How does 2 TV’s in a room have anything to do with healthcare and waste? Any hospital I ever been in, the TV and phone are paid for in cash by the patient, around 4 or 5$ a day. Insurance does not pay for private rooms either, so that cost is out of patient pocket also.

  11. well, why not end this competition by closing so many hospital beds so that hospitals can keep them filled without having to compete with one another — in terms of amenities or even care? like the hotel and airline biz, these folks have a perishable commodity and have got to do what they can to keep their occupancy rate up irrespective of whether they’re profit making entities or not.
    I don’t claim to be an expert on medical economics, but suspect it is better to have a hospital with flatscreen tvs and 90% occupancy than one without and 60%

  12. d’cm–
    Most insurers now pay for private rooms.
    And patients are no longer charged for television.
    (They were in past, but are not these days–at least on the East coase.

  13. Keith
    I agree that we need more info on infection rates, etc.
    And self-reported dats is not reliable.
    At the saem time, I would say that is difficult to make hospital info entirely transparent(it needs to be adjusted for risk– a larger percentage of poor, sick patients, etc can skew the results. But risk-adjustment, while not perrfect can be done — as long asthe hopsital and pool of patients is large enough.
    Finally, I agree that many of the premier, brand-name
    institutions fall short when it come to safety , outocmes, patient satisfaction . .

  14. Martine–
    Yes– what patients need is comfort.
    And as the wife of a patient who was in the hospital for 90 days wrote on this blog:
    Sometimes, instead of visiting the patient, you migtt be more helpful if you offered to: mow the lawn, pick the kids up at school, bring over a cooked dinner . . . .
    Sometimes, when people are in the hospital, visitors are a burden; they feel that they should sit up and entertain their
    guests.
    Certainly, patients need to know tha they have friends who care about them. But doing something for the family–rather than visitng the patient in the hospital– might make them feel even better.

  15. My husband was in the hospital 108 days and visitors were indeed an unwelcome nuisance, for the most part. 2 tv’s? Why? And the reasoning is competition for patients? How often do we get to choose which hospital we go to anyway?

  16. Dear Maggie,
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    I’m contacting you because I found your site in a health reform blog search and want to tell you about my newest blogging platform —the public concern of health care and its reform. Our shared concerns include health reform, tort reform, public health, safe workplaces, and asbestos contamination.
    If you’re confused by the nation’s debate over health care reform, you are not alone. While nearly everyone agrees our health care system is in trouble, the nation is nearly at war with itself over what to do about it. Some say the entire system needs to be overhauled. Others urge caution, pointing to the costs of reform and warning of high taxes and “big government.”
    To increase awareness on these important issues, my goal is to get a resource link on your site or even allow me to provide a guest posting. Please contact me back, I hope to hear from you soon. Drop by our site http://www.maacenter.org in the meantime.
    Thanks,
    Barbara O’ Brien
    barbaraobrien@maacenter.org

  17. I’m going to play contrarian here. Because for years I believed patient friendly hospitals were an oxymoron.
    For example,until valet parking was learned (in the 1980s) from the hospitality industry, patients LITERALLY could not park to access many inner city Ivy League level academic medical centers.
    I believe the costs involved in making the hospital stay more patient friendly are neglible compared to the waste in our high tech hospital medical care systems and reimbursement schemes.
    Keith Olberman of MSNBC said last week that “being a patient inside a hospital is like living inside a huge,constantly ringing,cash register”
    Am I advocating gourmet meals and expensive Art collections?- No
    But I am advocating for patient friendly hospital experiences. And certainly safer and saner hospitals.
    Dr.Rick Lippin
    Southampton,Pa

  18. Rick it’s a good point, but spending time and money designing waterfalls and deciding how many flat screen TVs are too many doesn’t create a good patient experience. Hospitals should be spending time creating efficient process that reduces how much time a trip to the ER or an inpatient visit takes, how many times you have to fill out the same form, how many times you’re taken to different rooms on different floors for a what should be a fairly simple procedure, how difficult it is to get your own medical records, etc.
    Hospitals are terrible at process and that’s a lot of the reason why it sucks to be in one. But still Lean and Six Sigma are mostly foreign concepts to hospitals. They seem to have no interest in doing anything to actually improve the patient experience on the things that matter (checklists anyone???)

  19. Maybe if the experience wasn’t so pleasant, people would avoid going to the hospital or doctor unless it was really needed. I hvae heard that there are studies that some folk see going to the doctor as a social experience and plan their day around it.

  20. Joe- Actually older people (who by definition have more illnesses) DO spend a disportionate amount of time going to doctors, talking about illnesses and doctors and getting admitted to hospitals-some repetitevly.
    Some seem to have it as a “lifestyle” but I hope it is not by choice?
    There are surely better ways to pass our waning hours.
    Dr. Rick Lippin
    Southampton,Pa

  21. I just got back from visiting a family member in the local hospital here in Central Florida when a knock was heard at the door … “Room Service” I thought I was at the Hyatt.

  22. Denise, NG, Mike C., Dr. Rick, ACarroll, Nick, Heather
    Denise– Yes “Room Service!” sums it up very well.
    NG– Thanks for sending the link –an Excellent article in Time (I recommend it to others.)
    Mike C–
    I agree that hospitals need to invest more time and energy in checklists, and less on aesthetics.
    And I agree, it is very heartening to see such an informative and well-informed piece in the middle of the mainstream press.
    Journalists– whether in print, on TV or on online– just need to keep on getting the truth out there. Many are now trying to do that, and ultimately, this should make the difference.
    Dr. Rick–
    I agree that patients need saner and safer environments.
    But I found Keith Olberman’s take on hospital care rather disturbing. He kept repeating that “death is the enemy.” My feeling is that Keith O. is terribly afraid that his father will die–because that means that he will die too.. .
    (Have to admit, I have mixed feelings about Olberman. Much better than most TV pundits–but I greatly prefer Rachel M. . And Mark Shield on the Lehrer New Hour.)
    ACarroll–
    I tend to agree that we should take a second look at “Certificate of Need” regulations (which require a hospital to show that the community has a medical need for more hopsitals beds more MRI units or whatever before investing in them.)
    I also agree that “green” can be healing–but I think that this doesn’t mean the hospital has to be located on a site with a panoramic view and huge windows (impossible in most urban areas.)
    Well-kept plants– in hallways, in patient rooms (where advisable) can offer “green” at a very low cost. I agree that, whenver possible, natural lighting (windows) are great.
    But it’s most important that hospitals are as infection-free as possible, and that we do everything to minimize errors.
    We also need to spend more on staff, less on amenities, so that someone is availabe when a patient calls for help–and that someone has the time to comb hair, massage a back–provide the comfort that patients need, more than any amenities.
    In Germany hospitals are extraordinarily Spartan, but very clean and generally very safe. Hospital workers are kind and friendly.
    (My step-son and his wife live in Germany, have been in the hospital a couple of times, and just had a baby there a year ago.)
    Since neither of them is German they were especially impressed by what a warm reception they received as hospital patients. Patient satisfaction is higher than it is here.
    Nick– I hate to say it, but the Las Vegas parallel is all–too-accurate.
    Heather–
    Yes. . . the cost of the two TVs isn’t a major cost in the larger context, but it is a symbol of the hospital’s prioriites which explains how and why so many health care dollars are wasted.

  23. Ed–
    I would need to know more about the hospital that is closing.
    And how difficult or easy it would be for people in that poorer area to get into the city? You say it’s only a few miles away.
    On the whole, I think we need fewer larger hospitals that can enjoy eonomies of scale–and where surgical teams can do the same surgeries over and over-at such high volume that they become expert.
    That said,if people are going to travel further to a hospital, they need transportation. . .
    Also, I wonder if a community clinic in the area where the hospital is being closed might be able to offer better primary care–and shuttle patients who need specialist care to a hospital in Pittsburgh. .
    As to why they are building new facilitues in Pittsburgh– here I have to wonder if they are needed. What I do know is that the politics of healthcare in Pittsburgh are fraught.