Some rural community hospitals, the backbone of the US healthcare delivery model, suffer from the myth that they are not held to the same standard of professionalism and customer service that is front and center for many large regional referral centers. It is not that they do not believe in the importance of service, quality and patient satisfaction, it is just that they have subconsciously lowered the bar based on a false equivalency.
I want to pause here to reaffirm that this is not a broad brush criticism of all rural and community hospital. Many do a terrific job and they have excellent quality/safety and patient satisfaction scores to prove it, but they are not in the majority.
To understand this issue, you must first begin with a common illusion; in small towns everyone knows everyone else. That is not exactly the case. They may recognize fellow residents, but they do not know them all off them. While it is true that the normal rules of personal connectivity — also commonly referred to as six degrees of separation — do not apply in small towns, it is rare to find the soul who literally knows “everyone in town.” There is certainly familiarity, and with that familiarity comes a degree of informality — we all know each other so we do not have to “put on airs.” Therein lies a problem when it comes to customer service and patient satisfaction. That familiarity impacts the staff’s interactions with the patients and I believe this is an important reason why many of these rural and small community hospitals struggle with their HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) patient satisfaction scores when, compared with the complexity of their regional referral center counterparts, they should be knocking the ball out of the park. But far too many are not.
Further, many rural and community hospital employees — based on my more than 30 years in this market segment — have come to believe that because they “know everyone in town” then they are not held to the same standards for service and professionalism as their larger referral center counterparts. But here is the reality and the great irony: in fact, small town residents actually hold their local caregivers and the leadership to a higher standard of care BECAUSE of the familiarity factor. Patients and their families do not expect less — they expect and want MORE — and this striking gap contributes to the lower HCAHPS scores and significant outmigration.
Rural and community hospital employees in fact must “do it better” than the big-town tertiary care facilities.
It all begins with the hospital chief executive officer. She or he must model behaviors that create the expectation of five-star care, service and safety. They must work with the clinical teams to set high standards for quality of care, safety and service. This includes the nurses, ancillary clinicians, dietary and housekeeping personnel. In this area, no silos can be permitted. To survive, rural and community hospitals must have patient satisfaction scores that are in the top 95 percent and they should strive for a 5-star CMS rating and settle for nothing less than a 4-star designation. They should also set standards to limit outmigration of patients they should be caring for based on the medical staff profile, to less than 25 – 30 percent. Today many rural and community hospitals are losing more than 40 to 50 percent of their market. That is not sustainable.
So, too, must the medical staff engage in this effort. While hospital nurses, ancillary and other personnel can control a significant portion of the HCAHPS calculus, the medical staff must commit to a high level of participation to achieve market sustainability. Without a local hospital, outmigration will explode and local physicians will eventually see a decline in their business.
The key to survival for rural and community hospitals is a forceful partnership with the hospital leadership and employees and physicians, to quality, safety and satisfaction as well as to dominate the primary care in their service area. You may not realize that goal but not setting bodacious goals and really trying to achieve them is just selling your community short.
The take away: If you work in healthcare in a small town, the spotlight is always on you. For you it may be just a job, an endeavor to pay the bills and support your family, but for your fellow residents, you are a lifeline. They want you to be a professional, trusted resource they can depend on and they want a hospital about which they can be enormously proud.
© 2019 John Gregory Self