L.A. Hospitals Are Not What They Used To Be.

THE SURVEYS

APPA began surveying its members regarding quality of care at hospitals in 1999 and has conducted yearly surveys since then. Physician members of APPA practice primarily in the Santa Monica-West LA and Beverly Hills communities. Hospitals surveyed over the years include: St. John's Health Center, Santa Monica-UCLA Medical Center, Cedars-Sinai Medical Center, Century City Hospital and Midway Hospital.

Yearly surveys ask over one hundred questions regarding bedside nursing performance, specific hospital department performance, hospital administration and policy issues. Physicians are asked to compare performance to that of one year ago. Letter grades are given for various departments and overall quality of care. Additional written comments are submitted and are usually numerous, adding perspective to the opinions rendered.

Overall the surveys have concluded that the quality of healthcare deteriorated remarkably over a ten year period beginning in the early 1990's. Whereas many hospitals and their services would previously be given an A, hospitals overall quality is now at a B minus.

SURVEY CONCLUSIONS
1. Each hospital's overall performance deteriorated yearly until 2002, falling from A to B minus. Some hospitals and departments were felt to have changed more than others.
2. Specific problem areas exist for each institution. One had problems with its operating room, radiology and cardiovascular services. Another was seen to have difficulty with its emergency room, radiology and surgery scheduling.
3. Compassionate bedside nursing care is harder to find at every hospital. Physicians are aware that the number of patients assigned to each nurse has increased as the number of nurses per unit has dropped. Non-nursing personnel now perform bedside services. Overworked personnel are less attentive and less compassionate.
4. Patients complain to their doctors more every year about their hospital stay. Patients are aware that recent hospital care is nothing like a stay of a few years ago. Some wish to go elsewhere in the future. But where to go if all are worse?
5. Physicians are becoming patient advocates when hospital performance breaks down. Complaints from patients and families to hospital personnel seem to fall on deaf ears. Patients turn to their doctors to help with hospital issues over which physicians have little control.
6. Physicians find hospital administrators less responsive to their complaints and needs. Administration is seen as disingenuous when promising change which never comes to pass.
7. HMO contracts have had a specific negative effect on performance. The ownership of one large HMO group by one hospital is viewed as causing a steady deterioration of performance.
8. Hospital business deals are not seen as improving patient care. One hospital with a large oncology contract is seen as too crowded with contract patients to meet the needs of the physician community. The purchase of another hospital and physician practices by the University of California system is viewed as disrupting physician relationships and worsening care at the hospital.
9. Loss of a hospital's reputation damages the reputation of its staff physicians. The prior reputation of a hospital was seen as an advantage to a doctor's practice. A tainted reputation is a disadvantage, potentially turning away patients.
10. With all hospitals seen as problematic, physicians and their patients have little advantage to switch institutions. They must address their complaints to hospitals directly.

APPA ACTION FOR BETTER PATIENT CARE
The American Private Physicians Association views the 2003 survey as another call to action. The organization's founding motto has been "Our Patients Come First". The following actions have been undertaken to address specific problems.

Hospital survey results have been shared yearly with the CEOs of the hospitals reviewed. Meetings were held with CEOs, board members, medical staff officers, and directors of hospital departments to communicate specific problems and initiate action. These surveys and meetings represent the only organized outside critique of hospital performance by the physicians who staff these institutions. By and large, the medical staff organizations and their officers do not represent an objective view of the hospital and its problems.
At one hospital, APPA initiated a hospital employee recognition program to reward employees demonstrating unusual compassion and attention to patients. This program has become ongoing and has yielded gratifying results.
APPA will continue its yearly surveys and plans to work more closely with hospital employees to help them understand the physicians' concern about changes in hospital policy and performance which adversely effect patient care.