Rather than turn hospitals into expensive resorts, healthier patients require happier nurses

Invest in humans, not spa tubs.
Invest in humans, not spa tubs.
Image: Reuters/Jonathan Bachman
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In 2012, Medicare began to use the results of patient satisfaction surveys to calculate how much they would pay hospitals. They called it the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey—a short questionnaire asking patients what they thought of their stay—and used it to withhold up to 1.5% of revenue from hospitals that scored poorly. In an industry that survives off of razor-thin margins, hospitals heard the message loud and clear: protect your money by keeping patients happy.

Ever since, the healthcare system has been looking to the hospitality industry to learn how to improve the patient experience. Hotels may indeed have the answer, but hospitals are looking in all the wrong places. Many of them are focused on imitating the five-star experience, complete with butlers and spas. Instead, they should follow high-end hotels’ lead by fixing the dismal culture of the employees that patients see the most: nurses.

Hospitals should not try to act like resorts

In a frenzy to raise HCAHPS scores, many hospitals have brought on board executives hailing from the likes of the Ritz-Carlton and Marriott, all well-trained executives used to keeping guests happy at any expense.

But amidst this sudden shift in priorities, some hospitals are coming under fire by physicians for investing millions in spas, private chefs, and luxurious rooms to make their patients feel more like resort guests. Yet at the same time, hospitals engaging in this type of patient pampering are also seeing their HCAHPS scores—and reimbursements—shoot up. HCAHPS scores for the Cancer Treatment Centers of America national chain landed in the top 7% nationwide (one of its hospitals has the third highest scores in the US) after former Ritz executive Gerard van Grinsven became CEO and emphasized its spa, salon, and celebrity chef offerings.

According to Medicare, the HCAHPS survey “creates new incentives for hospitals to improve quality of care.” The fact that they’re partially wrong is old news. Studies in recent years show that patient satisfaction is strongly affected by factors totally irrelevant to quality of patient care, cushy services included. This creates an opportunity for hospitals to exploit the gap between satisfaction and quality in a bid to increase their Medicare reimbursements without improving outcomes like death or post-surgery infection rates.

This is a dangerous strategy: hospitals can’t afford to let patients equate a good hospital with a luxury hospital. More importantly, they can’t let patient satisfaction dictate patient care.

Hospitals view hotels as role models—but they’re making a flawed comparison. In the hospitality industry, guest satisfaction is the ultimate measure of success; in health care, it’s just a weak proxy for quality of care.

As such, the hotel mentality is not automatically applicable to hospitals. High-end hotels know that extravagance begets satisfaction, so the costs of famous chefs and full-service spas are justified. In a 2009 interview with Forbes, former Ritz-Carlton president Simon Cooper revealed that all employees are given a $2,000-per-guest budget to make absolutely anyone’s stay more memorable through unexpected gestures like champagne for their birthday.

But patient satisfaction is totally different. Ideally, it’s a measure of whether the hospital was quiet and clean, and whether the staff provided a healthy and respectful recovery.

Spending on frills has been climbing across the hospitality industry since 2010 and is now at a record high. This might make perfect sense for hotels—but with hospitals’ patient care costs already spiraling out of control, is this really the model they want to follow?

To increase patient satisfaction, focus on the caregivers 

Nurses spend more time with patients than any other hospital staff. So it’s no surprise that patient interactions with nurses are among the strongest predictors of HCAHPS scores. There’s one problem, though: according to a national survey of nurses conducted by healthcare staffing and management services company AMN Healthcare, a large fraction of them across the US wish they could quit.

Outside of luxury amenities, nurses bear the brunt of most patient satisfaction efforts. Some hospitals looking to bump up HCAHPS scores have instituted policies requiring them to answer call lights in under 30 seconds and memorize scripted comforting comments. Some have even made a portion of nurses’ incentive pay contingent upon patient satisfaction. Nurses meanwhile report some of the highest levels of job stress in healthcare. How do you expect a drained, overworked nurse to act welcoming in every patient encounter?

In some ways, hospitality faces the same paradigm. Employee interactions are the strongest predictor of guest satisfaction, yet hotel staff have a 60% to 70% annual turnover rate. But a select few hotels have figured out how to keep employees around, make them love their jobs—and translate that success into happier guests.

The Ritz-Carlton’s turnover rate has long been heralded as among the lowest in the industry, something company executives maintain through a relentless focus on culture. It engages their front-line workforce by highlighting individuals with “wow” stories of exceptional service daily. (“Local fame is a powerful motivator,” noted former Ritz-Calton president Cooper.) It empowers their employees with the authority to solve clients’ problems quickly. Remember that $2,000-per-guest budget? “That displays a deep trust in our staff’s judgment,” Cooper told Forbes.

The Ritz doesn’t give its staff a litany of rules—instead it motivates them with a mission they will want to live up to.

Happy nurses create a happier 

patient environment

Hospitals should be following successful hotels’ lead in driving a culture change among their nurses, rather than investing in costly—and unnecessary—luxury amenities. Engaged nurses would not only produce happier patients, but better quality of care, too.

A culture shift might not be as hard as it sounds: what better place than a hospital to motivate employees? “Wow” stories of exceptional nursing care are everywhere, and deserve to be shared. Happier nurses will effortlessly pass their satisfaction along to patients—no spa required.