Consumer-Focused Innovations

By Jon B. Christianson, Michael D. Finch, Christine Goertz Choate and Barbara Findlay

A study looks at hospitals that have incorporated consumer-focused innovations--patient-friendly design, nurses trained in reducing patient stress, complementary therapies and spiritual support--and finds them feasible and cost-effective.


Jon B. Christianson	Michael D. Finch	Christine Goertz Choate	Barbara Findlay

While the financial health of the hospital industry appears to be improving, new challenges are emerging for leaders. Foremost among these is the movement of the U.S. health care system toward what University of California, Berkeley, School of Public Health professor J.C. Robinson has labeled “managed consumerism.” Consumers are being provided with information on cost, quality and patient satisfaction at hospitals, and health insurers are introducing “tiered” benefit designs that reward consumers and their physicians for choosing some hospitals over others.

Ahead of the Curve

A small number of hospitals seem positioned to prosper in a consumer-driven health care environment. Over the past decade, they have implemented innovative, multidimensional strategies that go beyond the efforts of many hospitals to become more “consumer friendly.”

In our forthcoming book, Reinventing the Hospital Experience, we report the findings from a project that analyzed consumer-focused innovation strategies in eight early adopting hospitals:

- Abbott Northwestern Hospital, Minneapolis
- Celebration (Fla.) Health--Florida Hospital
- Highline Medical Center, Burien, Wash.
- North Hawaii Community Hospital, Kamuela, Hawaii
- St. Charles Medical Center--Bend (Ore.)
- St. Rose Dominican Hospital--Siena Campus, Henderson, Nev.
- The Valley Hospital, Ridgewood, N.J.
- Windber (Pa.) Medical Center

These early innovators have redesigned the physical environment for patients and families, changed nurse-patient relationships at the bedside, given inpatients access to complementary therapies, and addressed the spiritual and emotional needs of hospitalized patients and their families.

The hospitals do not yet employ a common language in describing their strategies, although some speak of creating a “healing environment” within the hospital, while others talk about a “mind/body/spirit” approach to the care of hospitalized patients.

The hospitals do not cite favorable financial projections or marketing considerations. Instead, they use phrases such as “It’s the right thing to do,” “It’s what our patients want” and “It’s the experience we would want for our family members or friends if they were hospitalized.”

There is substantial variation in the characteristics of the eight hospitals selected for the study. Half belong to multihospital systems, with two of these systems having a religious affiliation or sponsorship. Six hospitals are in markets with a large number of diverse competitors, while two are in relatively protected markets. Four hospitals are in the Western United States, two in the East, and one each in the South and Midwest.

The study hospitals vary in size from 40 beds to more than 600 beds, and from 60 medical staff members to about 1,600. There is similar wide variation in hospital dependence on Medicare for inpatient revenues.

Implementation Strategies

The strategies pursued by the study hospitals varied: they depended on each hospital’s capabilities, culture and leadership. But we were able to group programs into four general areas: physical environment, nursing practices, spiritual support and complementary therapies.

Physical environment. All but one of the study hospitals sought to create a more consumer-friendly physical environment in new facilities or additions. This helped fund-raising and resulted in a better work environment for staff and physicians.

The North Hawaii Community Hospital went the furthest in designing inpatient spaces that reflected the culture, climate and natural features of the area: It employed feng shui principles relating to color, textures and spatial relationships within the hospital. Each patient room was built with windows that open, as well as a door that opens to the outside.

Nursing practices. A new approach to nursing care received particular emphasis at three hospitals, especially at the Valley Hospital. There, chief nursing officer Linda Cuoco instituted a shared governance approach under which, she says, professional staff “share all responsibilities for the evolution of patient care practices within a holistic framework.” Nurses are trained, on a voluntary basis, in therapeutic methods to help patients manage pain and relieve anxiety.

Study hospitals reported that nurses generally received the new therapeutic role well, although some nurses believed that it competed with time for other quality improvement initiatives such as electronic medical records systems. Those who were uncomfortable with the approach usually resigned, and study hospitals were able to replace them with supportive nurses.

Spiritual support. The spiritual aspects of patient care received attention in all the study hospitals. For instance, where there was new construction, it was common to include carefully designed spaces for family and patient meditation and spiritual renewal. At North Hawaii Community Hospital, spiritual icons representing 14 different religions were displayed throughout the facility, and a specific code was used to alert hospital staff to send a prayer or “healing intention” to a patient room.

Two of the hospitals placed even greater emphasis on the spiritual support of the patient.

- At the Siena Campus of St. Rose Dominican Hospital (a Catholic Healthcare West affiliate), a spiritual care team was charged with helping patients “integrate their spiritual values and beliefs to promote healing,” spiritual interventions were documented in the patient’s record and a member of the spiritual team responded to each emergency in the facility.

- At Florida Health--Celebration (owned by the Adventist Health System--Florida Division), each department identified one person, the spiritual ambassador, who received training on how to minister to the spiritual needs of patients and co-workers.

Complementary therapies. Of the four program areas, hospital administrators expressed the most concern about making complementary therapies available to inpatients, primarily because they feared a negative reaction on the part of medical staff. To address this concern, some study hospitals required a physician’s order for inpatients to receive complementary therapies.

At Abbott Northwestern, however, a “consultative model” was employed, facilitated by the hospital’s Institute for Health and Healing. Institute consultations may be ordered by any member of the patient’s health care team, including the patient or family member. (Only a physician can order acupuncture consultations.) These services include massage therapy, acupuncture, aromatherapy, bio-feedback-guided imagery and music therapy. An institute practitioner assesses the patient’s condition, explains the services that are available and, working with the patient and health care team, develops a plan for incorporating specific services (primarily massage therapy or acupuncture) into the patient’s treatment.

Addressing Obstacles

Concerns about how a consumer-based innovation strategy would be received shaped the implementation approaches adopted by virtually all study hospitals. Most hospitals proceeded cautiously, educating groups within the hospital about the innovations early in the implementation process. For instance, at Highline Medical Center, off-site training for 1,250 hospital staff members was carried out in 25-person groups.

In addition, a significant amount of experiential learning occurred at the hospitals. Practitioners provided stress management therapy to nursing staff so they could experience the potential benefits for patients. And, in many study hospitals, physicians who initially resisted nontraditional therapies became supporters after observing the positive impact of a therapy--often pain reduction in cancer or minimizing anxiety prior to surgery--on a patient.

Along with educating nurses and physicians, hospital administrators chose innovations or implementation approaches that were not likely to provoke physician opposition. Several of the study hospitals placed less emphasis on complementary therapies, while others introduced them gradually, focusing first on the least controversial.

Perhaps the most important step taken by hospital leaders was conveying a clear message that their hospitals would not sacrifice “high tech” for “high touch” in patient care. Maintaining the latest high-tech treatments helped the study hospitals fend off any concerns that consumer-focused innovations would be unable to compete in the delivery of specialized services.

Sustainability

For hospital employees and clinical staff, the biggest threat to their hospital’s commitment to consumer-focused innovation was a change in CEO. But the consumer-focused innovation strategy survived (sometimes multiple) CEO changes in several study hospitals, suggesting that hospital boards selected new CEOs based in part on their support for these strategies.

With respect to finances, hospital leaders typically held the opinion that consumer-focused innovations likely “paid for themselves” or that fund-raising could cover program shortfalls or startup costs. Several financial officers observed that the cost of the hospital’s consumer-focused strategy was relatively minor. Some administrators also believed that their innovative strategies decreased length of stay for some patients, reduced the use of narcotics, lowered cancellation rates and reduced infection rates. However, these perceptions were based largely on anecdotal evidence.

More significantly, the hospitals that emphasized nursing practice strategies--and, to a lesser extent, the hospitals that revamped their physical environments--found that the financial case for sustainability was clear: They documented reductions in staffing costs due to a dramatic reduction in turnover. Given the costs of recruiting and training new nurses, hospital administrators saw this as convincing evidence that their nursing practice approach was cost-effective.

The Future

Our study findings suggest that broad-based, consumer-focused innovation strategies are feasible for a variety of hospitals and under a wide range of circumstances. Implementation did not depend on public policy initiatives, nor did it require substantial additional financial resources.

In deciding to pursue consumer-focused innovations, hospital leaders placed greatest weight on their belief that this approach was consistent with the hospital’s vision and culture and/or the culture of the parent system. Above all, when mobilizing support for the strategy within the hospital, and sometimes with their external constituencies, hospital administrators emphasized that it was the right thing to do for patients.

Later-adopting hospitals may demand a stronger business case for consumer-focused innovations before they embark on implementation. Tracking internal cost savings from consumer-focused innovations is likely to be easier than establishing their marginal contributions to hospital revenues. At present, the clearest source of cost savings, and the most straightforward to quantify, appears to be reductions in hospital staffing costs for nurses.

Jon B. Christianson, Ph.D., is a health economist and the James A. Hamilton Chair in Health Policy and Management at the University of Minnesota, Minneapolis. Michael D. Finch, Ph.D., is an adjunct associate professor in health policy and management at the University of Minnesota and a senior fellow of the Samueli Institute in Alexandria, Va. Christine Goertz Choate, D.C., Ph.D., is director for the Palmer Center for Chiropractic Research in Washington, D.C. Barbara Findlay, R.N., B.S.N., is a vice president at the Samueli Institute, where she heads the Optimal Healing Environments Program.

A presentation on this report will be given at Health Forum's 2007 Integrative Medicine for Healthcare Organizations conference, April 12-14 in San Diego. For more information, please visit www.healthforum.com and click on “Conferences.”

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This article 1st appeared on March 27, 2007 in HHN Magazine online site.

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