Better quality hurts patient experience

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It may seem counterintuitive, but adopting mandated quality measures could hurt patient experience--at least in the short-term, according to a study scheduled for publication in Manufacturing & Service Operations Management.

Calling it a "tradeoff," Ohio State University research shows a negative link between clinical quality and a patient's hospital experience after implementing quality strategies to meet state or federal requirements.

Researchers surveyed directors of quality or chief nursing officers at 284 hospitals in 44 states about their adherence to guidelines from the Centers for Medicare & Medicaid Services, as well as state patient safety guidelines, mandated in 2003. The researchers weren't surprised to find that implementing techniques to reduce medical errors and improve patient safety did, in fact, improve outcomes. However, they unexpectedly found that "these improvements sometimes came at the expense of the quality of the patient experience," according to a research announcement.

For example, a hospital could get good marks for following recommended clinical guidelines to prescribe a beta blocker to a patient who had a heart attack, but it might not effectively relay that information to the patient.

"Clinical quality is about doing things correctly--strict guidelines, standardization and checklists, for example--so when you consider experiential quality is about customizing health-care delivery to an individual patient's needs, there is a tension there," said Aravind Chandrasekaran, assistant professor of management sciences at Ohio State and lead author of the study. "But we don't want to lose sight of the patients, who are often treated as commodities these days," Chandrasekaran continued.

However, the study isn't all bad news. Researchers noted there is no direct correlation between clinical quality and patient satisfaction but did suggest that in hospitals with high levels of patient experience, also known as experiential quality, there also was a positive relationship between clinical quality and patient satisfaction.

They found that the sooner hospitals adjusted their operational changes, they could improve the patient experience. "In the long run, getting better at clinical quality--doing the right thing--frees up resources and leads to two steps forward on the patient experience as well," Chandrasekaran said.

"When leaders were more patient-centric, our analysis showed that they were able to overcome that tension between clinical quality and the quality of the patient experience," Chandrasekaran said. "Leaders have to be thinking about patients when they design their operations. That way they can cater many of their design principles to individual patients."

The commitment of quality and patient experience must come from the top. Jason Wolf, executive director of The Beryl Institute, a patient experience community, echoed the sentiment in a previous Hospital Impact blog post: "Hospitals cannot focus their efforts to improve the patient experience on only a checklist of activities, but rather make them part of a broader strategic direction."

For more information:
- here's the press release

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