At a time when healthcare organizations are supposed to be improving quality of care and engaging patients and families, my recent visit to Kaiser’s Oakland hospital was surprisingly because the hospital staff was careless and indifferent.

These are the things in the overall operation of the hospital that raised red flags and made me question the quality of care. My father went to Kaiser’s Oakland ER last Friday afternoon. He’s 97 and it turns out he had the early stages of the flu and possibly pneumonia. He went in with a high fever by ambulance around 2 pm and was still waiting for a bed at 8 pm. That seems to be the standard number of hours to wait before getting a bed at this hospital.

He stayed three nights and I visited twice during that time. Here are things that I found made the hospital encounter poor quality for the patient and family:

  • Not knowing where your patients are. I called the main hospital number at 8:30 am, tackled the numerous voice prompts, waited on hold, then an operator comes on the line. I ask him to please connect with the nursing station for my dad. He immediately says he is not in the hospital. (Turns out that his fast reply was because my mother had just called and asked for his room.) I asked him to look again and spelled the name. No, he said, he’s not in the hospital. I explained that he came to the ER yesterday and was waiting for a bed. He said emphatically, “NO! He’s not in the system so he’s not here.” I get a little panicked because I wonder if that means my dad died and no one told us. He was in the hospital, but not in the system. Here’s a huge communications gap that is being ignored. Aren’t the ER staff busy enough without having to act as receptionist as well?
  • Apathy for safeguards. He is in isolation in a regular room, but there is no sign indicating that. The hospital room door is open and there is a speech therapist wearing a mask, gown and gloves in the room. I walk in, greet them both and stand to observe the swallowing tests.  His nurse comes to the door, stands outside and calls into the room asking for the therapist. She sees me, doesn’t acknowledge me and walks back to the nursing station. Neither the nurse nor therapist told me that I was supposed to put on protective gear – mask, gown, gloves. I did not see a sign on the door that said visitors need to put on protective coverings when I walked into the room. This was hospital protocol for patients who possibly had the flu (a test confirmed this). Why didn’t these professionals exercise a best practice of insuring a safe environment for the patient and visitors by calling a visitor’s attention to the safeguards? What good are safeguards if they are not used? In this case, the professionals put both the patient and visitor at risk. It appears that everyone decided, “That’s not my job.” It is not a big leap to conclude that this lax care easily translates to how personnel cause high rates of  iatrogenic incidents.
  • Physician attitude. I manage the care for my parents. I usually speak with the doctor in the hospital by phone since it is impossible to schedule a time to meet. I asked the doctor, “Can you please tell me the condition of my father?” The first thing out of the doctor’s mouth was, “I already talked to your mother. I updated her and she said it was ok to talk to you. Are you the single point of contact? I need to have one contact and you take care of everyone else.” I said I was the person to whom she could give information and I would update my mother and family. She gave me  a few short sentences on his condition and reiterated that she could only have one person to talk to. She said she needed to call my mother again the next morning before talking to me. I asked if there was a problem because I had never had any issue with doctors needing to check each time before talking to me. Then she repeated herself again! I came away with the impression that she was more concerned about her own business than her patient. Is this an example of HIPAA poorly understood and enacted?

Who is looking after the overall quality of the hospital experience for both the patient and family?