Hospitals find patients feel neglected.

• Position: Government Guidelines

Hospitals that adopt strategies to reduce errors and meet government requirements face an initial trade-off between improved clinical quality and a decline in the quality of individual patients' experiences, indicates research at Ohio State University, Columbus. Quality process management, a practice associated with the private sector, is becoming more common in hospitals as they set up operating systems in response to Federal and state mandates to reduce medical errors and improve safety.

In a move toward standardization, the Centers for Medicare and Medicaid Services (CMS) in 2003 issued hospital care guidelines related to four health conditions: heart attack, heart failure, pneumonia, and surgical care. CMS requires hospitals to report their care practices with these types of cases, and has provided financial incentives to hospitals that are best at adhering to the standards of care outlined in these guidelines.

The researchers were not surprised to find that the implementation of these techniques led to improved clinical outcomes, but discovering that these improvements sometimes came at the expense of the quality of the patient experience was unexpected. Also referred to as experiential quality, the quality of the patient experience is gauged by how patients perceive their personal interactions with health care providers.

"Clinical quality is about doing things correctly--strict guidelines, standardization, and checklists, for example-so, when you consider experiential quality is about customizing health care delivery to an individual patient's needs, there is a tension there, maintains Aravind Chandrasekaran, assistant...