California Hospitals Receive ‘Mixed Reviews’ in Statewide Industry Survey

Californians who have spent time in the state's hospitals said they generally received necessary pain medication, did not experience long waits and were treated respectfully before surgery, according to a patient survey conducted by the California HealthCare Foundation and the California Institute of Health Systems Performance. However, the survey, released Aug. 29, also found that many hospitals did not "sufficiently" inform patients about medications or recovery once they left the hospital. Slightly less than one-third -- 113 -- of hospitals statewide agreed to take part in the voluntary study, which required a $1,500 participation fee. The survey was sent to patients who had spent at least one night in a participating hospital; 21,151 patients responded (Hayasaki, Los Angeles Times, 8/29). Survey questions were divided into seven groups, including respect for patient preferences; coordination of care; information and education; physical comfort; emotional support; involvement of family and friends; and transition to home. Specific questions included, "Were patients treated with respect, dignity and as a partner in the health care process?" and "How organized and efficient were doctors and nurses?" (CHCF release, 8/29). The 294-page report did not ask questions about other "key factors" such as clinic safety, treatment success rates and medical staff "competence," the San Jose Mercury News reports (Lyons, San Jose Mercury News, 8/29).

According to the survey results, most maternity, medical and surgical patients reported that they received needed pain medication or did not have "overly long waits to have their call buttons answered." In addition, surgery patients had "favorable" responses to survey questions concerning coordination of care, respect for patient preferences and involvement of family and friends, and maternity patients responded favorably to questions about coordination of care and information and education. However, medical and maternity patients had "significant concerns" about how well prepared they were to go home. Surgery patients responded "better" in that area, the survey says. Overall, people hospitalized for maternity care or surgical procedures had more positive feedback than did patients admitted for medical reasons ("Patients' Evaluation of Performance in California," 8/29).

Ann Monroe, a survey researcher and director of CHCF's Quality Initiative, said the study was not intended to be a guide to "good" or "bad" hospitals, but added, "This data is a really good opportunity to have a dialogue between patients and doctors, and for patients to say, 'What are my choices among hospitals?'" Jan Emerson, spokesperson for the California HealthCare Association, said that the survey should not be the only source that patients consider when choosing a facility. She added that the participating hospitals should "definitely be commended ... because they ... agreed to having this publicly reported regardless of where they ended up in terms of survey results" (Los Angeles Times, 8/29). Ellen Wu, executive director of the California Pan-Ethnic Health Network, said that hospitals should heed the survey's message that "patients just don't want to be treated -- they want to be treated with respect." Dolores Gomez, patient care leader for Kaiser Permanente South Bay, said that her hospital "wanted to see where there were some areas for improvement," adding that the survey "showed us there were significant areas for improvement, and we're trying to correct those." Kaiser received below-average scores for many of its 27 hospitals, the Mercury News reports (San Jose Mercury News, 8/29). Monroe said CHCF will follow up with additional reports on hospital care, "possibly every other year" (Colliver, San Francisco Chronicle, 8/29). The report is available at http://hospitalguide.chcf.org/.

Noting that there is "little publicly available data about the quality of doctors and hospitals and the usefulness of specific treatments," a Los Angeles Times editorial says that Californians should "welcome [the] admittedly cursory survey of patient satisfaction with hospital care." The editorial points out that the survey does have flaws: Fewer than one-third of hospitals statewide participated and patients were asked questions about waiting times and pain medication, rather than surgical success rates and physician competence. Still, the editorial notes that the survey has prompted some hospitals, including UCLA and some Kaiser units, which ranked "average or below on some criteria," to do some "healthy soul searching." The editorial says that the survey should serve as the starting point of a "wider state effort to collect and publicly release hard data about quality of care in the state's public and private hospitals." The editorial concludes: "The patient satisfaction survey released this week should be welcomed, even though it may not tell us much about the practice of medicine at a particular hospital. It can be expanded. It is a foot in the door" (Los Angeles Times, 8/31).