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Academia and the Profession |

A Hospitalization from Hell: A Patient's Perspective on Quality

Paul D. Cleary, PhD*
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From Harvard Medical School, Boston, Massachusetts.

*This paper was prepared by Paul D. Cleary, PhD, for the Quality Grand Rounds series. Kaveh G. Shojania, MD, prepared the case for presentation.

Grant Support: Funding for the Quality Grand Rounds series is supported by the California HealthCare Foundation as part of its Quality Initiative.

Requests for Single Reprints: Paul D. Cleary, PhD, Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115-5899; e-mail, cleary@hcp.med.harvard.edu.

Ann Intern Med. 2003;138(1):33-39. doi:10.7326/0003-4819-138-1-200301070-00009
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Patients usually cannot assess the technical quality of their care; however, examining a hospitalization through the patients' eyes can reveal important information about the quality of care. Patients are the best source of information about a hospital system's communication, education, and pain-management processes, and they are the only source of information about whether they were treated with dignity and respect. Their experiences often reveal how well a hospital system is operating and can stimulate important insights into the kinds of changes that are needed to close the chasm between the care provided and the care that should be provided.This article examines the case of a patient admitted for ankle arthrodesis due to severe hemophilia-related arthritis. The surgery was successful, but the hospital stay was marked by inefficiency and inconveniences, as well as events that reveal fundamental problems with the hospital's organization and teamwork. These problems could seriously compromise the quality of clinical care. Unfortunately, most of these events occur regularly in U.S. hospitals. Relatively easy and inexpensive ways to avoid many of these problems are discussed, such as reducing variability in non-urgent procedures and routinely asking patients about their experiences and suggestions for improvement.





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