Dallas Smith's Blog

We Are All the Patient Experience

April, 2015

Dallas Texas Skyline
The Dallas, Texas skyline from our hotel room.

Inflated Prices for Rice and Healthcare

Rice is a staple of the Japanese diet. Japanese-grown rice costs twice as much in Japan as the same rice sold in other countries. This is because of a convoluted system of distribution and middlemen, which raises the price far beyond the actual and reasonably expected price of rice.

The price of healthcare in America is similarly inflated. Americans spend on a per-capita basis twice as much for healthcare service as the same healthcare services in other modern industrial nations. This would be okay if American healthcare were twice as good as that of other nations. Unfortunately, we do not receive the outstanding healthcare that its high price would imply. Indeed, in comparative measures, such as child mortality, hospital-born infections, re-admissions, and patient satisfaction, the US comes in the middle of comparative ratings, far behind nations who spend much less per capita for their healthcare delivery.

Like rice in Japan, Americans don't pay anything close to the actual cost of healthcare services received. A quick trip to the emergency room for a relatively simple injury, such as a broken bone, results in a bill for many thousands of dollars. Hopefully, the injured person has health insurance to cover the high cost (after the patient-obligated deductible has been paid). While the ACA, known colloquially as Obamacare, seeks to require all Americans to pay into a general insurance pool, at the present time, the US leads the world in medically-caused bankruptcies. (Such bankruptcies are non-existent in countries that have universal healthcare.)

The end of "fee for service"?

While a large cause of America's high healthcare cost can be attributed to the insurance industry's profits removing a large percentage of healthcare dollars to cover their operations, promotions, and profits, another important factor is the "fee for service" design in which doctors and hospitals are paid more when more procedures, tests, and treatments are prescribed, leading to ever-escalating costs. This basic flaw in our healthcare system is slowly being replaced by a new financial system called "outcome-based-reimbursement" (also called "value-based-purchasing"). Under this system, the hospital/doctor makes more profit when their treatments are successful, without complications or readmissions following the initial treatment. Personally, I think that a profit-based healthcare system is inherently wrong through and through, but this is a subject for another time.

Patient Experience

The Beryl Institute and the Patient Experience

In a refreshing contrast to the flawed system discussed above, I had the opportunity to attend a wonderful conference in Dallas, Texas, sponsored by The Beryl Institute, focusing on improving the "patient experience." The general theme of philosophy of the conference (and the Beryl Institute) is that every person working in the hospital contributes, either positively or negatively, to the experience of the patient who passes through the healthcare system. Certainly, a positive healthcare outcome is facilitated when the patient feels that they have been well treated, receiving the best care possible. This can be summed up in the phrase: How one feels affects how one heals.

Consideration of the patient experience is familiar territory for Susan and me, since our career in healthcare producing the CARE Channel has always been directed toward improving the patient experience. Indeed, at the conference, we met many attendees from our CARE Channel client hospitals. This was gratifying. I've always said that we work with the best, most sensitive humane individuals in healthcare. The people who are attracted to the CARE Channel are the ones most sensitive to the potential of beautiful music and nature images to improve the patient experience.

Spanning two and a half days, the Beryl Institute conference consisted of large general sessions, as well as smaller group "break-out" sessions, covering many single issues being addressed by different hospital representatives from the US and Canada.

The Beryl Institute defines the patient experience as: The sum of all interactions, shaped by an organization's culture, that influence patient perceptions across the continuum of care.

Healthcare horror stories

Several conference speakers prefaced their appeal for a better patient experience by recounting their healthcare horror stories, such as denial of coverage by insurance companies, distracted physicians who would not inform the patient of their condition and prognosis, delayed or undelivered treatments despite clear medical orders, uncoordinated staff leading to incomplete fragmented care, etc. Bureaucratic requirements reduce the amount of time that nurses are able to deliver care. Financial pressures leading to increased work loads result in overworked staff and low morale. Obviously, there is more than enough money being spent within the US healthcare system. Yet, the US system fails in comparison with other countries' universal systems that simply provide healthcare for all, just like education, water, electricity, roads, and other functions that have been recognized as being vital for the general welfare, and which suffer under competing companies seeking to maximize profits derived from delivering vital services only to those with enough money to afford them under the market-based model.

The grassroots response

Thus, we have a grass-roots movement to reform and improve patient care from the inside and from the bottom up, not through government regulations or financial incentives. Ultimately, groups such as The Beryl Institute (www.berylinstitute.org), Planetree (www.planetree.org), and the Center for Health Design (www.healthdesign.org) all seek a culture change in American healthcare, to humanize the environment of care for the benefit of patients and healthcare professionals, to lead with the values of caring, nurture, trust, and empowerment, separate from the politics and financial exploitation of the profit model that had given us our current system and its obvious flaws.

It is very uplifting to attend conferences such as this one in which the most progressive and enlightened individuals come together in the common purpose of improving our troubled healthcare system. Susan and I, together with our colleagues in Healing Healthcare Systems, are proud to participate in this work.

On the second day of the conference I played the morning invocation
On the second day of the conference I played the morning invocation.

This sentiment is embodied in another key Beryl Institute catchphrase describing the patient experience:

All voices matter.

Every interaction matters.

You matter.

We are all the patient experience.


I am the Patient Experience
I am the Patient Experience.
We are all the Patient Experience
We are all the Patient Experience.

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