An Expert’s Take on an Award-Winning Philadelphia Hospital’s Patient Family Experience: 3 out of 10.

Patient experience is about doing the right things right. I’d like to describe a real-life experience where it was evident many components of an engagement strategy were in place, but they fell far short of providing a pleasant experience. 

Early May of this year I took my cousin to Pennsylvania Hospital in the Society Hill section of Philadelphia for a same-day surgical procedure. The first hospital in the nation, Pennsylvania Hospital is now part of the world-renowned University of Pennsylvania Health system and was awarded the prestigious Magnet Status for Nursing in 2015.

With all these accolades I expected to be wowed by our experience visiting this hospital. I was not.

Pre-Op

We left his home in Delaware with plenty of time to make a 2 pm appointment. On arrival however, we had trouble locating parking. We drove around the block several times searching for signage to direct us. No signage to be found. We did see an elderly fellow in what appeared to be a uniform, and my cousin got out of the car to ask him how we accessed parking. He walked over to my car that was double parked in the street to give me a ticket and take my car. No further instructions given. 

We found our way to the Spruce Street facility, which is across the street from the main hospital entrance. We entered the wrong door as again signage was not clear. Another yellow shirt was sitting inside the door on his cell phone. Reception asked me to supply ID and sign in for my visitor’s pass; then we made our way to the outpatient waiting area. We were told to have a seat and we would be called. Many of the seats were clearly dirty, and the magazines were at least one year old, so again it was clear they didn’t really care about our experience.

My cousin was called by name, out loud in the waiting room with plenty of other visitors present. No HIPAA compliance here! 

HIPAA Privacy regulations require health care providers and organizations, as well as their business associates, develop and follow procedures that ensure the confidentiality and security of protected health information (PHI) when it is transferred, received, handled, or shared. This applies to all forms of PHI, including paper, oral, and electronic, etc. Furthermore, only the minimum health information necessary to conduct business is to be used or shared. Throughout our experience, it was clear that basic concepts of adhering to HIPAA protections were in place, but in actuality our experience was just the opposite of compliance.

Oops, it turned out we had been guided to the wrong place. “They must have changed the location of where your procedure is going to be done.” We needed to check in at the main hospital, which meant leaving the facility and crossing the street to another building. 

Across the street we were referred to the registration area, where a standing sign asked us to wait in front of it. Problem was the admission clerk couldn’t see us behind the sign. My cousin waved his arms and finally got his attention. By the time all of this had occurred the clock read 2 pm, so we were late for the appointment. 

While this was going on, I sat in reception. Imagine a “V” shape with very noisy hallways on the 2 sides of the “V”. Did you know that “Danny” is getting a new job with no weekends or holidays and “Sally” had a great weekend? In an office behind the registration desk, I could see an employee enjoying a snack and drink.

My cousin returned to sit with me after registration in order to wait for someone to escort us to the procedure. I noticed he had a folder with his admitting papers. I asked what took so long to get registered since he was just here a week ago and was already in the system. He didn’t know, but the clerk verified everything and had him sign everything again. This was all on paper.

From my cousin’s description, the clerk was very friendly and did an outstanding job. He was a super user for the EPIC registration process; my cousin trains clinical staff at another hospital to use EPIC. He knew that over the weekend there were some upgrades to the EPIC system that caused some difficulties across the enterprise, so the hangup made sense from his perspective.

We waited….

And waited….

Corporate Certification Patient Experience

Eventually, we were brought back across the street to the original facility! Yes! Back outside and across the street. It was 3 pm. 

The pre-op holding area was very small and cramped. Old TV’s on the wall. The place was very noisy and there was no possible way to ensure patient privacy or HIPAA compliance. For instance, I knew that “Mr. Del Toro” (name has been changed) has high blood pressure and is 5 lbs overweight. I am thirsty, so I take a sip of water, feeling a pang of guilt. My cousin tells me his mouth is dry. He did not have anything to eat since dinner the previous night and nothing to drink since 12 noon in anticipation of his procedure. 

We remained like that for 2 more hours. 

During that time 4 different nurses attended to my cousin. All four asked the same questions. The anesthesiologist came and did the “pre-anesthesia assessment,” but it did not include the normal information required to make an assessment. He just asked a few questions. He did not make eye contact with my cousin, but he did shake my hand as he looked away. 

My cousin did explain that for the previous procedure a resident intubated him for his anesthesia. They had to try three times, leaving him with a sore throat and neck. The anesthesiologist assured my cousin he would not need to be intubated for this procedure. 

If that were the case, I wondered, did they really need to intubate him last time? My cousin believed that they were practicing on him for an unnecessary procedure. Not a good feeling to have.

The surgeon stopped by. My cousin gave him the list of medications he is on and the one he needs to have refilled. He asked to have them called in to the pharmacy or e-scripted. The surgeon assured that this would be done. His surgeon also did not make eye contact with him, and he completely ignored my presence in the cubicle. Patient-family care is not yet practiced at Pennsylvania hospital.

I overheard the nurses stating they were going to need coverage at 4pm. I wondered what that would mean for my cousin.

We asked several times, but no one could give us a time for his procedure. We did find out that he was an add-on and not on the schedule even though he was scheduled last week. We were down to 2 patients in the pre-op area, and it was 4:30 pm. The CRNA came to insert an IV, which she did in a very skillful and friendly manner. 

A new nurse arrived (she must be the coverage at 4pm) and again asked the same questions. I wondered why these nurses don’t do a hand off. Finally, the OR nurse came in. She was the only one to look at my cousin’s armband to verify name and birthdate. She informed us that it would take about 2 hours to do the procedure and prepare my cousin to go home. 

Where is my car?

The CRNA came and walked my cousin to the OR. No need for wheelchairs here! The 4pm coverage nurse said I would need to wait back in the main building, which meant heading outside again. 

By 5:30pm I was getting very familiar walking back and forth across the street to the main building. Yellow shirt valet guy was still on his phone.

I grabbed something to eat at the coffee shop, and when I returned, the receptionist broke someone else’s confidentiality: “Who is here for ‘Tom Harris?’” (name changed).

Around 7pm, I got a call from the nurse working with my cousin and she told me my cousin was doing great. All he needed to do was urinate before he could go home. I crossed my fingers and waited some more.

At 7:40pm the receptionist called out my cousin’s name and asked for his family member to come to the desk. Yeah! I said to myself: my cousin was able to produce! The receptionist told me to go get my car and then call this number, and the nurse would bring my cousin down. I asked, “Where is my car?” 

“Give your ticket to the valet outside.” She said.

Outside I went. I didn’t see any yellow shirts, and I certainly didn’t see my car. The office appeared dark, I only knew it was the office because earlier I saw a yellow shirt walk in. 

When I asked a different receptionist, I was informed that the Valet service ended at 6pm. I asked, “Where is my car?” Across the street diagonally. An employee that is leaving said I could follow her. Great! 

No wonder why we didn’t see a parking garage across the street. There was a very small sign on the side of the building, which I noticed. 

I went in to pay, and the parking attendant instructed me to go down 1 flight in the elevator. My car is on the floor, a few spots down, so it took me some time to find.

I got in the car and called the number to the nurse who said she would be right down. I left the garage, but through all the one-way streets. I couldn’t find my way back easily by car. I eventually got there, but no signs told me I was in the right place. Eventually, my cousin and his nurse found my vehicle.

We needed to stop at the CVS near his home for medications. The prescriptions were not called in, nor was e-script used, so we were told it would be a 45-minute wait, after which time they told us to come back the next day. 

Just when I thought nothing else could go wrong, we looked at the discharge instructions. They were completely wrong and for another patient! I just shook my head and wished my cousin well. 

Would you return to this hospital?

On my way home, I thought about the Icarus paradox which is a neologism coined by Danny Miller in his 1990 book by the same name. The term refers to the phenomenon of businesses failing abruptly after a period of apparent success. The paradox is that the failure is brought about by the very elements that led to initial success. It alludes to Icarus of Greek mythology, who melted after flying too close to the Sun. 

I wondered if Pennsylvania Hospital had been blinded by their success. Maybe a smile was enough when this hospital achieved such prominence, but is that enough now? Inefficiencies, patient confidentiality, and a myriad of inconveniences ensure that patients who can choose will take their business elsewhere. 

We need to remember that for all the checkboxes that are becoming standard for hospitals, implementing the right systems is not enough. A small sign for a parking garage means very little if most patients don’t see it.

The end goal is the experience itself. We need to ensure that we understand and empathize with our patients and their families, so that everyone leaves knowing they were the focus of their stay, not the checkboxes.

Corporate Certification Patient Experience