Peter Pronovost, a renowned expert in clinical quality and safety, argues that it’s a mistake for hospitals to focus on patient satisfaction surveys and states that instead it would be more helpful to ask selected patients what proposals they would make in order to improve the hospitalization experience. For example, one of the people Johns Hopkins chose for this assignment was Podge Reed Jr., a double lung transplant patient who had amassed six hospitalizations, two surgical and four medical, eight anaesthesia outpatient procedures, more than one hundred visits to appointments and 700 laboratory tests. With this curriculum, the hospital felt that Mr.Reed should be a person with a clear opinion.
In the article, Jane Hill, Johns Hopkins’ Patient Relations Director, says that most hospitalised people, although appreciating the technical quality of services, also ask to be treated with kindness and care. Not surprising, given that being bedridden in a hospital is not a pleasant experience for anyone. As a result of patients' contributions, Jane Hill has developed a Decalogue that should be read as a basis for transforming hospitalization rooms, on one hand from the perspective of tasks, functions and competencies and on the other hand, with a view of patients’ experience.
Decalogue of the hospitalized patient (elaborated from what the patients themselves say):
1. Let me sleep. Do not take vitals throughout the night or draw blood between 10 p.m. and 6 a.m. unless it is critical. If it is critical, please make sure I understand. My sleep helps me recover and feel better.
2. Keep the noise levels down at the nurses’ station. This is so important — especially at night when my sleep is needed. Turn off the TV, radio, computer screen, etc., at night in my room so there is not a glare or noise that can disturb my sleep.
3. Don’t lose my personal belongings. Take an inventory and label everything with my name and medical record number so my personal belongings do not get misplaced. These belongings are an extension of me and make me feel more at ease. Taking care of my stuff feels like you are taking care of me.
4. Knock on the door before entering. This shows respect for me as an individual and my privacy. Introduce yourself to me and shake hands or make eye contact when you do this. Call me by my preferred name (formal or first name).
5. Please keep my whiteboard current and up to date. It gives me a quick reference of who is caring for me and my daily plan. Provide a notebook at the bedside so I can keep all my important papers and cards from my health care team and other staff members in one place. Please make sure my name and my location — nursing unit, room number and room phone — are listed on the front.
6. Update me and my family if you notice changes in my condition. Keep communication open. Please keep me informed of delays — it lessens my anxiety during an already stressful time
7. Keep my room clean. Mop the floors every day, wipe surfaces to prevent the spread of germs, empty my wastebasket and keep my bathroom really clean so it even smells clean. If you are my housekeeper, please introduce yourself to me and say hello. I like to know who is taking care of me.
8. Listen to me and engage me in my care. Use plain language and make sure I understand my plan of care.
9. Please orient me to my room and the hospital so I know where important things are located, how to work the television, how to order food and when my linens may be changed. I am a guest here and don’t know these things, yet these are important to me.
10. Please maintain professionalism in all areas of the hospital. While you may be on your break, you are still a hospital employee and a reflection of the hospital. How I perceive you is often how I perceive the hospital and care that I am receiving.
2. Keep the noise levels down at the nurses’ station. This is so important — especially at night when my sleep is needed. Turn off the TV, radio, computer screen, etc., at night in my room so there is not a glare or noise that can disturb my sleep.
3. Don’t lose my personal belongings. Take an inventory and label everything with my name and medical record number so my personal belongings do not get misplaced. These belongings are an extension of me and make me feel more at ease. Taking care of my stuff feels like you are taking care of me.
4. Knock on the door before entering. This shows respect for me as an individual and my privacy. Introduce yourself to me and shake hands or make eye contact when you do this. Call me by my preferred name (formal or first name).
5. Please keep my whiteboard current and up to date. It gives me a quick reference of who is caring for me and my daily plan. Provide a notebook at the bedside so I can keep all my important papers and cards from my health care team and other staff members in one place. Please make sure my name and my location — nursing unit, room number and room phone — are listed on the front.
6. Update me and my family if you notice changes in my condition. Keep communication open. Please keep me informed of delays — it lessens my anxiety during an already stressful time
7. Keep my room clean. Mop the floors every day, wipe surfaces to prevent the spread of germs, empty my wastebasket and keep my bathroom really clean so it even smells clean. If you are my housekeeper, please introduce yourself to me and say hello. I like to know who is taking care of me.
8. Listen to me and engage me in my care. Use plain language and make sure I understand my plan of care.
9. Please orient me to my room and the hospital so I know where important things are located, how to work the television, how to order food and when my linens may be changed. I am a guest here and don’t know these things, yet these are important to me.
10. Please maintain professionalism in all areas of the hospital. While you may be on your break, you are still a hospital employee and a reflection of the hospital. How I perceive you is often how I perceive the hospital and care that I am receiving.
The exercise proposed by Pronovost and Hill is very timely and, I think, very effective. The essence is: instead of spending money on costly surveys, just listen to patients, especially those with complex illnesses that force them to use hospital resources intensively.
Jordi Varela
Editor
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