April 7, 2021

In his book, Why Not the Best, Georgia governor and presidential candidate James Earl (“Jimmy”) Carter, Jr. described an incident involving “the father of the nuclear navy”—Captain Hyman Rickover—who would later become a four-star admiral and the longest serving member of the U.S. armed forces in history. Then a lowly ensign, Carter was asked by the demanding captain if he had done his best while at the U.S. Naval Academy at Annapolis. Upon reflection, Ensign Carter’s honest response was “no”—to which Rickover inquired, “why not?” The young officer learned from that encounter and endeavored from that day forward to push toward perfection in all that he did, to strive for the best.

The Goal of Perfection

If perfection is the standard, then it is clear that we often come up short, depending on the task. However, it is the push toward that goal that puts us on the path of improvement, constant improvement. This is the real message of Carter’s retrospective account: to simply get better. That is something we can all achieve.

For those who work in our nation’s hospitals, the goal should be perfection in patient care, which means working every day to get as close to that goal as possible. So, what does that look like? Well, first of all, it should involve an effort to achieve zero clinical mistakes. There should be protocols in place to prevent them. There are certain mistakes that must be stopped in their tracks. Surgical scissors should never be accidentally left in the patient’s abdomen. The wrong kidney should never be removed. An incorrect drug or dosage should never be administered. But not only should hospitals work toward the elimination of critical mistakes, there must also be a concerted effort by the entire staff to “wow” the patient and his/her family members so that they leave the hospital singing the praises of the clinical treatment, the food, the nursing staff and their overall experience.

Why is this important? Because we should be striving to be the best at what we do; because doing our best for others matters; and because the pursuit of perfection in patient care will not be lost on people who live in your market area. There is a hospital in one of the nation’s large metroplexes that sits right across the highway from a middle-class subdivision. It is well-known that many people in that subdivision will bypass that local facility and drive 20 minutes up that same highway to a different hospital. Why? Because the local hospital’s reputation as it pertains to quality is poor. Quality matters. Excellence matters. And striving for perfection will ultimately lead to quality and excellence.

Measuring Your Progress

The nation’s premier patient satisfaction survey organization—Press Ganey (PG)—recently performed an analysis of 175,334 patient comments arising from a major teaching hospital between November 2018 and March 2020. In a summary of their findings provided to Harvard Business Review (HBR), the PG researchers found the following results:

On a Positive Note. On every floor, the most common positive theme was that patients felt that they had been treated with courtesy and respect. The study further found that patients in every setting within the facility valued the following elements: empathy, coordination of their care, and good communication.

Room for Improvement. As far as the negative comments, there was a wide variation found by the PG analysis. For some units, the most common note of discord involved long waits for assistance. In other units, the most common issue was noise. Another negative finding involved patient complaints over a disorganized discharge process. As the researchers noted in the HBR article:
Variation abounds. One specific issue may emerge as the most common problem on one patient care unit, while another issue is likely to emerge on another unit—and next week, the problems might be reversed. A bad experience—e.g., a patient feeling vulnerable to catching Covid-19 because the bathrooms are not clean—can ruin a good experience created through technically excellent and empathic care.
Most of our readers are aware of the old adage, “you can’t fix what you don’t measure”; but how tenacious is the hospital in reviewing the results of their patient satisfaction surveys and addressing the concerns expressed therein?

Control What You Can

We can all agree that not every hospital stay will be free of difficulty for the patient in terms of physical discomfort or treatment resolution. This is simply due to either the nature of the patient’s condition or the nature of the treatment. However, every hospital can increase its satisfaction scoring by keying in on what it can control: a caring environment where empathy, understanding and patience abound. Here is how the PG researchers put it:

Ensuring that these positive themes characterize every patient’s care requires the establishment and reinforcement of social norms for caregivers. That work begins at the top for every organization—i.e., leaders must show how important these values are to them, and managers must ensure that they are standards of care, not mere guidelines or recommendations. At many organizations, “disrespect events” in which patients are not treated with dignity, are reviewed in the same daily meetings as safety events and near misses.
The message we would leave with you, then, is this:

Do whatever it takes to systematically route out clinical mistakes. This may require process controls, additional training, removing certain personnel, etc.
Strive hard to staff your facility with highly competent healers and care-givers, with the equipment they require to be successful.
In spite of the above efforts, you can’t always control patient outcomes; but you can always control how you treat the patient and their family members. Provide them with a kind, courteous and caring environment. Make that a priority, and make sure that priority is being carried out from the person who delivers the food tray to the physician making rounds.
Your hospital may never achieve perfection, but it can make great progress by reaching for it.

MiraMed Global Services is a leader in business solutions for hospitals. Please contact us to find out how we can help improve your processes in pursuit of the healing mission. You can reach us at info@miramedgs.com.