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What goes into choosing a hospital?

May 19, 2009
by kate
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During an editorial meeting a few weeks ago, I was discussing an article I’m writing that will examine what hospitals are doing to reduce carbon footprint, and a very interesting point was raised as to whether “greening” a hospital can result in a soft ROI. That is, can environmentally-friendly initiatives attract more patients to an organization?

I was curious, so while researching the piece, I posed the question to a few of my sources, and I got some very thoughtful responses.

Some said they didn’t know if a hospital’s decision to reduce energy or construct a wing using earth-friendly materials would have any real impact on an individual’s choice of facility. One person said he would be much more likely to choose a “green” health system, and another said that although it was probably a plus for many patients, the environmental factor is just one of many that patients will consider when choosing a hospital.

This got me thinking — what are the key factors in selecting a health system? As a self-proclaimed tree hugger, I’d say that I would certainly give more consideration to a facility that uses renewable energy and recycles, but I’d definitely look at other aspects. With this in mind, I put together a list of possible considerations:

· Geography (although in populated areas, there might be several hospitals within a 15-mile radius)

· Recommendations from friends

· Rankings from media outlets like U.S. News and World Report

· Good reputation in a particular field (cardiology, maternity ward)

· Strong presence in the community

· Patient-friendly factors like private rooms, flatscreen TVs and edible food

· The technology factor (many sites now advertise things like Da Vinci robots on their websites, and well over 100 hospitals use social media sites like Twitter and Facebook)

I’ve heard people list all of these as reasons for choosing a facility; although it’s usually a combination of factors. But which reasons matter most to hospital executives, and how much of role does in play in shaping a strategy? For instance, if a particular initiative or implementation has the potential to get more patients in the door, does it get pushed to the front burner during these tough economic times?

What do you think?



Sometimes you don't get to choose. I wrote recently that I have more choice in deciding who cuts my hair than I got deciding who cuts your heart. You pick whichever hospital you're at when the siren stops.

Nowadays, I don't even need to worry about who cuts my hair. Bummer.

Mark -  Bingo on the Adlai Stevenson quote!

I agree that the information we'd all want is not published.  I suspect it's often not even recorded.

I went back and re-read a blog post on 'Virtue', titled: Practical Wisdom
Great organizations cultivate wisdom, in concert with rules and incentives
.  I think Barry nailed it.

To echo your point, Mark, transparency on performance measures and market forces are not the entire solution to improving healthcare quality and service.

And it's pretty well known, at least in the quality improvement world, that you can't test your way into compliance.  You've got to design your system with solid processes. That makes lots of folks nervous about CCHIT certification as a way to ensure we have better products.

I agree that the informed consumer (like Joe and Daphne) are likely to look at things like experience and quality indicators when picking a hospital for an elective procedure.

But my guess is that most consumers aren't all that informed.

(I've heard the story that during his presidential campaign in 1956 a lady called out to Adlai Stevenson, "Senator, you have the vote of every thinking person." He replied, "That's not enough, madam. We need a majority.")

Most people probably go to the place that has a nice, comfortable facility, where Uncle Fred went that time, where their family or friends work, or where their doctor tells them to go.

That disconnect between real and perceived quality is one reason I don't buy the credo that we can use market forces to fix our healthcare system.

Speaking of facility design, there's a very interesting article in today's NYTimes on-line that talks about "evidence based hospital design." Check it out.

One last point- don't forget that hospital choice is a luxury for many. A lot of us don't have four or five high tech tertiary care medical centers within a twenty mile drive.

In an ideal world, I'd like to know the hospital's volumes for the care process that I need.

If I needed a heart value repair re-do, there's less than five hospitals in the country that I'd consider.

If my local hospital had high process variation for something common, like community-acquired pneumonia, I would run the other way (probably in a wheel chair, so make that roll the other way.)

The kind of long process times that Anthony cited in his recent 'Adrift' article are very worrisome. If you or I took 2-3 weeks to return a phone call or email with no intervening communication, people would lose trust in us. And appropriately so. Keeping a patient waiting for an hour or more means a flow problem, and probably inadequate attention to buffering.

Tree hugging is important and ultimately more than nice-to-have. Care coordination including assured flow would be the most important factor for my decision. (The IHI and others have more than documented the poor current state; so has Anthony. Did I mention that I just had a great colonoscopy, at a high volume, well coordinated center with near zero process delays?)

I'm with Joe if it involves a real procedureI will choose the hospital that has the highest volume for that procedure because outcomes are always better. That means in NYC if I need a new hip I'm going to the Hospital for Special Surgery, if I need a new heart I'm going to New York Presbyterian. That's it. Otherwise, I'm not going to the hospital. I hope.