Study: Government Compliance Could Mean a Worse Patient Experience

March 27, 2012
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According to researchers at The Ohio State University, hospitals that adopt strategies to reduce errors and meet government requirements could face an initial tradeoff between improved clinical quality and a decline in the quality of individual patients’ experiences.

As techniques that help with federal and state mandates, such as quality process management, become mainstay in hospitals, the researchers found that unsurprisingly there were improved clinical outcomes. This included reduced medical errors and improved patient safety. However, the researchers say they were surprised to find these improvements sometimes came at the expense of the quality of the patient experience.

“Clinical quality is about doing things correctly – strict guidelines, standardization and checklists, for example – so when you consider experiential quality is about customizing health-care delivery to an individual patient’s needs, there is a tension there,” said Aravind Chandrasekaran, assistant professor of management sciences at Ohio State and lead author of the study, said in a statement.

An instance of this “tension” would be the case where clinical quality guidelines recommend a beta blocker prescription for patients who have had a heart attack, but offer no suggestions for how to effectively relay that information to a patient. While the hospital gets a good mark for prescribing the drug, a patient may not understand the instructions and possibly won’t even fill the prescription.

Despite the tension, the researchers assert that quality management systems is the most effective way for hospitals to meet state and federal mandates geared toward patient safety.

The researchers wanted to examine what happened to the patient experience as hospitals focused on new techniques to improve their clinical quality. To determine this, they analyzed four sources of data: a survey of 284 acute care hospitals in 44 states; CMS clinical quality scores publicly reported between April 2009 and March 2010; state legislative mandates for reduced hospital-acquired infections passed between 2003 and 2008 in a portion of those 44 surveyed states; and April 2009-March 2010 reports from the Hospital Consumer Assessment of Healthcare Providers and Systems survey as a measure of patient experience quality.

Additionally, directors of quality or chief nursing officers at 284 hospitals in 44 states were surveyed to determine how extensively respondents were using a data-driven, quality management system to design operations and train staff with the goal of adhering to CMS guidelines.

This research found that as organizations focused on quality process management and simultaneously increased in clinical quality as reported by hospitals, they had a decrease in the quality of the patient experience as reported by patients. State legislative mandates to improve patient safety initially reinforced this tradeoff. They did find that the earlier these laws were passed, the sooner hospital environments adjusted to operational changes so they could improve the patient experience as well. 

The researchers found that that patient-focused leadership could soften the negative association between quality process management and experiential quality, allowing hospitals to excel in both areas.

This research group is continuing its studies of the benefits of patient-centered care. Chandrasekaran noted that CMS is scheduled to begin offering financial incentives to hospitals that score well on patients’ experiential quality scores in October. The research appears online and is scheduled for future print publication in the journal Manufacturing & Service Operations Management.

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