UI Hospitals has 'healthy appetite' for improving low marks from patients

Government survey 'shows that we have room for improvement' CEO says

University of Iowa Health Care complex, which houses University of Iowa Hospitals and Clinics, is seen in this photo tak
University of Iowa Health Care complex, which houses University of Iowa Hospitals and Clinics, is seen in this photo taken on Friday, April 18, 2014, in Iowa City, Iowa. (Justin Wan/The Gazette)

IOWA CITY — Fewer than half the University of Iowa Hospitals and Clinics patients who responded to questions about their satisfaction there said the areas around their hospital rooms were always quiet at night — earning UIHC just one star out of a possible five in a survey.

The national average for that question was 62 percent who said yes, it was always quiet. Across Iowa’s other hospitals, the average was 67 percent — 22 points higher than UIHC, according to the Hospital Consumer Assessment of Health Care Providers and Systems survey, which the Centers for Medicare & Medicaid Services has required since 2007 at thousands of hospitals across the nation to participate in Medicare.

UIHC fell below the state average on all but one of 10 patient satisfaction measures in the most recent survey, submitted in September 2018. It fell below the national averages in all but three categories.

But despite low scores elsewhere, UIHC ranked above the state and national averages in the percentage of patients who said they’d recommends it to family and friends. UIHC earned four stars in that.

Still, the low satisfaction scores contributed to UIHC’s most recent two-out-of-five stars rating in a broader overall ranking — putting it among just 18 percent of the more than 4,500 hospitals considered. The largest rating group was three stars, encompassing 28 percent of the surveyed hospitals.

“We don’t have any concerns with the reporting,” UIHC Chief Executive Officer Suresh Gunasekaran told The Gazette in an interview this week, after recently flagging the low scores to the Board of Regents and promising to do better. “Absolutely we take it seriously.”

The government survey is the same for every hospital — from rural community facilities, like many across Iowa, to major academic medical centers, like UIHC.


The survey doesn’t take into account how sick the patients are or how many a hospital treats every day.

“The denominator isn’t the same — their 100 patients aren’t our 100 patients,” Gunasekaran said, noting the survey “is not a perfect instrument.”

“That being said, it shows that we have room for improvement,” he said. “And we have a healthy appetite for improving.”

‘Another level’

The UIHC administration recently deployed measures aimed at energizing faculty and staff around the mission of developing a patient-centered culture and creating an excellent customer experience, Gunasekaran said.

Where the hospital for years pushed an “excellence every time” ideology that was modeled, to some degree, on the Disney customer-service doctrine, Gunasekaran said, “We’ve taken it to another level now.”

Among the efforts, the hospital has assigned managers — like nursing unit managers and medical directors — to make specific quality-assurance rounds.

“It’s very similar to a restaurant, where a manager rounds to make sure the wait staff is doing well,” Gunasekaran said. “In a hospital environment it’s a little bit different. What’s happening at each table in a restaurant is relatively the same. People are eating. And they’re getting something off the menu. Well, in our hospitals, everyone’s getting something somewhat different — working with a different doctor, working with a different care team, working with different therapists — so there’s a great opportunity for things to fall through the cracks.”

For example, according to the survey, about 60 percent of UIHC responding patients reported staff “always” explain medicines before providing them — below the averages.

The hospital also has instigated “physician communication training” in hopes of providing more tools for faculty in their communication with other care providers and with patients.


The survey showed 77 percent of UIHC respondents felt nurses always communicated well and 78 percent reported their doctors always communicated well. But both measures fell below state and national averages.

Among the reasons for a reignited push toward patient satisfaction is the surging demand for services — especially from the state and region’s sickest patients.

“It’s not the same environment it was a year or two ago,” Gunasekaran said. “Now we’re full even in the summer. That’s a highly unusual thing.”

A packed hospital stretches physicians and resources, drives up wait times and taxes facilities and technology.

“As you become more full and you are a larger place with a lot more diversity and care, you want to encourage your staff to be empowered to work across departments to get it done for the patients,” Gunasekaran said, referencing another recent initiative.

“What we’re really asking folks to do is be empowered to solve a patient’s problem on the spot,” he said. “Pick up the phone. Find out what’s going on with radiology. Find out what’s going on with discharge planning. Really own that patient’s situation.”

High cost of care

Although UIHC is hiring more faculty and staff, Gunasekaran said, retirements and attrition have impeded its ability to keep pace with its demand for services.

Although Gunasekaran couldn’t say definitively why UIHC is seeing more demand and why the patients who come there in a broad sense are sicker, he said it has to do with the aging population and the high cost of providing health care — in an age of rapidly advancing technology and research.

“There’s tens of millions of dollars worth of technology that we keep here,” he said. “And we see a lot more hospitals around the state that are unable to keep this kind of technology and keep the kinds of physicians available that are qualified to use this technology.”

Aging facilities

Among UIHC’s weakest performances on the survey were patient responses for room and bathroom cleanliness.


Where Iowa hospitals reported an average 80 percent of patients saying their rooms and bathrooms were always clean, just 66 percent of UIHC patients did so.

That, Gunasekaran said, could reflect that facilities are aging and rooms are packed.

“Once you get to facilities that are a certain level old — tile, paint, furniture, discoloration just from excessive use — it gives patients an impression that it is dirty,” he said. “When you have two patients’ families worth of stuff in a given room, people have a perception that everyone is not being cleaned as well as it is.”

In that case, he said, “renovating is the solution, not cleaning.”

The university previously has considered the idea of another main hospital tower, though that’s been on the back burner for years. And Gunasekaran said that’s where it will stay — for now.

“We don’t have an active plan for a new tower,” he said. “But we have to continue to look at how do we add capacity in the face of this much patient demand.”

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