The Problem
As a general medical and surgical hospital that has served the Queens community for more than a half century, NYHQ helps tens of thousands of people reduce suffering and regain health every year. Because the quality of NYHQ’s service is so important to residents in the community, if there are needs and possibility for the hospital to do a better job, I believe the hospital will not refuse to do so.
NYHQ needs to improve its communication with patients.
The level of NYHQ’s patient satisfaction about communicating with nurses and doctors are not good when compared to the average level of patient satisfaction in the state and in the whole nation1 (Chart1&2). It may appear that the situation is not so bad by just looking at the numbers along, but it could have serious consequence for every patient that encountered an unpleasant experience. When we check the online reviews about the NYHQ’s services, many reviewers gave positive comments. But there are also reviewers complaining about the medical staff’s poor performance, and others politely mentioned their concern about the medical staff’s attitude. The negative ones showed that the communication problem really existed in the hospital.
The consequences of communication problem in NYHQ are multiple. For patients, most of them do not have enough medical knowledge to make informed decisions by their own. Usually they are in pain, exhausted, in panic, and need help. Without enough communication and medical information, it will be very difficult for patients to understand their choices and rights, and make right decisions. For the hospital, the insufficient communication between patients and medical staff will affect the outcome of patients’ treatment because of the widened information asymmetry; it will lead to the waste of medical resources because of the unsatisfied treatment results and avoidable readmissions2; it will also increase the risk of medical errors, and threaten patients’ safety3, 4.
One cause is the existing organizational setting. NYHQ does not have a 24-hour special position for patient information consultation. The existing case management department and patient advocates department cannot provide timely service to the inpatients that come to hospital in the early morning, midnight, or weekend. Usually, these inpatients have to gather the fragmentary information by themselves from the admitting department, nurses, other medical staff, or hospital’s website.
Another cause is the nurse understaffing. The nurse staffing level of NYHQ is much lower than the average nurse staffing level of top 10 ranked hospitals in New York metropolitan area5,6 (Chart3). Because most of the communication between the patients and the doctors need to be orally conveyed by nurses, the understaffed nurses cannot fulfill their communication job effectively.
Policy Options
According to the external environment and NYHQ’s practical situation, there are three policy options NYHQ can consider to improve the communication between patients and the hospital in an economical and efficient way.
24 Hour Patient Advocates & volunteers.
The hospital could consider setting up a 24 hour patient advocate position to help patients. The position could be staffed by experienced nurses through a shift. Part of the work to provide new patients the general information about their hospital stay could be completed by trained volunteers. The hospital could also provide more on-job training to the nurses to improve their communication skills, as well as professional knowledge and skills.
Patient Brochures and Notepads
The hospital could provide patients some easy and useful information kits, like brochures and notepads, to help them improve their knowledge and health literacy skills on relevant diseases and physical status. The notepad can help patients remember their ideas and questions under the pressure of uncomfortable feelings. The positive effect of notepad has been proved by a research in 20097. The brochure could include the hospital introduction, the relative basic medical information, the list of important questions that the patients may need to ask in different situations, and the reminder of some special symptoms.
Interactive smartphone App
The hospital can use smartphone and computer applications to improve the communication among nurses, patients, and doctors. Some apps, such as PingMD, are designed to facilitate the communication between patients and medical service providers. Some hospital, such as Mayo Clinic, have developed special apps to allow patients to access hospitals’ news, health information, publications, patients’ own medical record, appointment schedule and other services. NYHQ could adopt one smartphone app, or develop a special app, to help patients and medical staff to communicate in a more convenient way.