August 20, 2010
Continuing the series of posts previously published in “Playing Doctor”
In my hospital, one of the ways we measure quality of care is to look at patient perception of care. A nationally known polling agency sends questionnaires to patients, and from them we learn something about whether patients are impressed by the care they receive. We treat patient satisfaction scores with great reverence. Our goal is to produce at least as many satisfied patients as comparable hospitals surveyed by this agency.
The larger health system of which my hospital is a part has for several years exhorted its employees to remember AIDET – perhaps the most awkward acronym every devised in service of a noble purpose. AIDET stands for Acknowledge, Introduce, Duration, Explanation, and Thanks, or something close. The acronym is meaningless, the construction isn’t parallel, and the actions are listed out of order to create the acronym.
Nevertheless, the fundamental idea is sound. It fits with the customer service principles I learned in business school. We want everybody to ensure they’re talking to the right patient about the right procedure. We want each patient to know exactly who we are and what our role in their care will be. We want each patient to fully understand the procedures we’ll be doing. We want patients to know how long their care will take, and we want them to know what to expect when delays arise. And, finally, we want to thank patients for coming to us.
This week I accompanied a close friend to my hospital for an endoscopic procedure. I sat by her side as a series of people readied her for care and returned her to her room. Overall, she says her experience was entirely pleasant. People were friendly, reassuring, and competent. Everything proceeded briskly, nothing went wrong, nothing hurt, and the outcome was perfect. She left feeling that she’d had a good experience.
But not a great experience… She didn’t come out singing the praises of the hospital and its employees. We really didn’t surpass her expectations at any point. We simply met them competently.
Did we remember AIDET? Not entirely. Everybody reviewed her full name, birth date, procedure, and allergies – so consistently that my friend began to question whether anybody believed her or was paying the slightest attention to the work of others. It would have been useful to mention that everybody who is about to provide care would review this information.
On the other hand, few people did an adequate job of presenting their names and roles. She met one admitting clerk, two hospital assistants, one admitting nurse, two nurses from the endoscopy room, the anesthesiologist, and the endoscopist himself, whom she had met previously. Few introduced themselves by name. Almost nobody except the anesthesiologist was introduced by role. Even the anesthesiologist did not introduce himself by name. Although he and I knew each other, he didn’t know my friend, and he didn’t carefully check her ID and procedure or introduce himself. None of this occurred as rude, exactly. Neither did it say, “You’re an important person. Before we touch you, we want to be sure you know who we are and what we’ll do.”
Almost everybody gave a good explanation of what would be happening, and how long it would take. The endoscopist himself had her sign a consent without additional explanation in the procedure room right before she went to sleep.
Surprisingly, although everyone was polite and cheerful, nobody specifically thanked her for coming. Even on a small island, she does have choices. It might have been impressive if one or more people had thanked her sincerely for choosing us for her care. She was dismissed with a friendly wave and a warm smile, but not much thanks. In fact, she points out that she wasn’t even actually formally welcomed.
A further observation: our hospital looks at hand-washing in a variety of ways in order to promulgate pervasive hand sanitation. Patients are asked whether personnel caring for them cleansed their hands all the time, some of the time, or seldom (or something like that). The only person I actually saw using the hand-cleaner dispenser in the room was one of the nursing assistants. My friend saw two of the nurses and the anesthesiologist use the dispenser. Everybody may have had clean hands, but by the questionable measure of whether their cleanliness was witnessed, we didn’t surpass 50%.
What if everybody had done the good work they did AND paid attention to AIDET, with or without the silly acronym? Would my friend have come away with the sense that all these people really cared about her experience with them, even more than she did? Would she have come away with an experience that left her enthused and delighted, not just satisfied and relieved? I think so. Almost certainly we could have improved an already-good patient-satisfaction score.
Would that have been better quality medical care? More health, less disease, more result for less money?
Everybody knows the story of the fellow who comes upon an inebriate crawling on the ground under a street light. Asked what he’s doing, the inebriate replies that he’s looking for his car keys. The newly arrived good Samaritan drops to his knees and begins searching too.
After several fruitless minutes, the Samaritan asks, “Are you sure you lost them here?”
“No,” replies the inebriate, “I lost them crossing that field.”
“Well, then,” says the Samaritan, “why are you looking here?”
“The light’s better here.”
Are we hoping that we can find medical quality by looking at customer satisfaction just because the light’s better here? If we really did improve customer satisfaction, would the quality of medical care be higher?