Allina Health doctors unionize over health system’s objections

Dive Brief:

  • The National Labor Relations Board has certified the union election of more than 130 Allina Health doctors at Mercy and Unity Hospitals, nearly a year after they voted to join the Doctors Council Service Employees International Union (SEIU).
  • The certification follows objections from the Minneapolis-based nonprofit health system, which said that physicians active in the union drive held supervisor or managerial positions and may have unlawfully pressured colleagues into supporting the union. The NLRB rejected that claim.
  • It’s another victory for Doctors Council SEIU at Allina facilities. In October, more than 500 Allina doctors, physician assistants and nurse practitioners at over 60 facilities voted to join the union, according to NLRB documents.

Dive Insight:

Allina doctors and physician assistants said that chronic understaffing, high levels of burnout and compromised patient safety due to the corporatization of care motivated them to seek union representation.

“We have been seeing the shift of healthcare control going to corporations and further and further away from patient voices and patient advocacy. That really fell apart during the pandemic,” said Allina physician Liz Koffel during a press conference on Aug. 15 announcing primary care physicians’ unionization drive.

Koffel detailed workplace grievances that she said occurred due to Allina’s push for profits, including high productivity demands backed by few support staff and the health system’s now-abandoned policy of interrupting non-emergency medical care for patients with high levels of debt. 

In a statement to Healthcare Dive, an Allina spokesperson said the system had “committed to taking steps to make sure the National Labor Relations Board’s process was fair to all involved,” and that it would not take further procedural action against the union.

Across the country, physicians’ feelings of limited autonomy is driving similar interest in unionization, according to John August, director of healthcare labor relations at Cornell’s School of Industrial and Labor Relations. 

“Frankly, I’ve never seen anything like it in my whole career — where so many people are saying exactly the same thing at the same time, from a profession that heretofore has been essentially not unionized,” he said.

Although doctors have historically shown little interest in unionization — the physician unionization rate was under 6% nationwide in 2021 — the tide is beginning to turn. 

Doctors are increasingly working in consolidated hospitals owned by larger health systems or private equity firms. They report consolidation limits the influence they have on their day-to-day jobs, according to a December study from the Physician Advocacy Institute.

In addition, other options, such as physician-owned practices, are disappearing, with the percentage of owned practices falling 13% between 2012 and 2022, according to an analysis from the American Medical Association.

Elsewhere in the healthcare industry, unionization and strikes have led to gains for workers.

Last year, nurses at Robert Wood Johnson University Hospital successfully negotiated nurse-to-patient ratios by holding the picket line for nearly four months in New Jersey, and more than 75,000 healthcare workers secured a 20% raise over four years at Kaiser Permanente by staging the largest healthcare strike in recent history.

Medicare Advantage rate change bedevils UnitedHealth’s 2024 outlook

https://www.healthcaredive.com/news/unitedhealth-2024-pressure-medicare-advantage-rate-change/700945/

UnitedHealth is bracing for a struggle next year with the financial effects of shifting Medicare Advantage payment rates.

The health insurance giant released 2024 guidance on Tuesday that included a number of less favorable metrics than analysts expected.

During the company’s investor day in New York City on Wednesday, UnitedHealth executives blamed the outlook on an MA rate change issued by regulators earlier this year that insurers slam as a payment cut.

Pressured metrics include slower MA membership growth, lower margins at UnitedHealthcare and a higher medical loss ratio. UnitedHealth forecast a 2024 MLR of 84%, a full percentage point higher than analysts’ consensus expectation.

Despite the MA headwind, UnitedHealthcare’s financial targets overall still came in in-line or ahead of analyst expectations.

MA rates ‘ripple’ through UnitedHealth’s 2024

UnitedHealth is a behemoth in the U.S. healthcare industry, with one of the largest pharmacy benefits managers, an expanding healthcare IT arm and a growing presence in care delivery, including a network of tens of thousands of physicians.

UnitedHealth is also the dominant health insurer in many markets, including in MA. The Minnesota-based company is the largest provider of the privately-run Medicare plans.

Management has said they expect their share of the market to grow as more seniors age into the government insurance program and select MA over traditional Medicare.

However, UnitedHealth is now saying that MA growth could be depressed next year thanks to a rate notice from the CMS that’s deeply unpopular with insurers.

Earlier this year, the CMS finalized MA rates for 2024 that regulators said should result in a 3.3% increase in revenue for health insurers in the program. The changes also include a new approach to risk adjustment meant to curb upcoding, a practice where insurers inflate their members’ sicknesses to get higher payments from the government.

However, insurers have said the changes, which are being phased in over the next three years, will result in a net decrease to MA revenue overall.

“That rate notice has a material impact in terms of revenues associated with our Medicare Advantage portfolio, and as you can see that ripples through the metrics of the organization,” CEO Andrew Witty said during UnitedHealth’s investor day.

UnitedHealthcare, UnitedHealth’s health insurance division, now expects slower Medicare revenue and membership growth next year than analysts expected.

UnitedHealth expects to add between 325,000 and 375,000 Medicare Advantage members next year, representing almost 4% growth at the midpoint — “well below our model,” commented JP Morgan analyst Lisa Gill in a note.

That’s compared to 11% membership growth year to date in 2023, according to CMS data cited in a TD Cowen note. Previously, UnitedHealth leadership said they expected to grow above the overall MA industry growth rate in 2024, so “this appears to be a disappointment,” TD Cowen analyst Gary Taylor wrote.

However, “we are not materially surprised to see the slower growth rate in 2024 given the changes with the risk adjustment,” Gill said.

Some payers have said the rate changes could force them to cut benefits in MA. Yet, UnitedHealth has spent the last six months reconfiguring its plans in response to the rate notice, looking for ways to contain costs without curtailing benefits, Witty said.

UnitedHealthcare should bring in about $303 billion in revenue next year, mostly driven by Medicaid upside, the company said. TD Cowen’s Taylor noted he was unsure why UnitedHealth forecast the Medicaid improvement, given Medicaid payers are shedding members as states recheck eligibility for the safety-net insurance coming out of the COVID-19 pandemic.

UnitedHealth thinks its Medicaid enrollment will drop by up to 200,000 members next year due to redeterminations, the company said.

Eye on Optum Health

UnitedHealth leadership devoted half of their investor day to talking about the insurer’s plans to expand value-based care arrangements — a “core objective” for the next several years, Witty said.

A key actor in striving for that objective is Optum Health, UnitedHealth’s care delivery network that’s under the umbrella of its health services business Optum.

Optum released stronger 2024 guidance than analysts expected. Much of that growth is due to better-than-expected margins for Optum Health, analysts said.

Optum Health has been working to transition commercial lives into more lucrative value-based arrangements, management said in comments earlier this year.

Currently, Optum Health has about 4 million lives in fully accountable payment arrangements — a number that’s nearly doubled from 2021, said UnitedHealthcare CEO Brian Thompson during the investor day.

Optum Health expects to add another 750,000 lives by the end of next year.

”You should expect us to grow that number substantially each year,” Thompson said. “Our long-term ambition is to transition as many people as possible into value-based care.”

Overall, UnitedHealth expects 2024 adjusted profit of $27.50 to $28 a share, largely in line with what analysts expected.

Expected revenue is $400 billion to $403 billion, higher than Wall Street consensus.

New Jersey systems plan to combine for-profit, nonprofit hospitals

Jersey City, N.J.-based CarePoint Health and Hudson Regional Hospital in Secaucus, N.J., have signed a letter of intent to combine under a new management company, Hudson Health System, which will incorporate the acute care facilities of both organizations.

Hudson Health System would be a four-hospital system that includes both nonprofit and for-profit hospitals in an innovative new model and continue to be in-network with all major payers. 

The transaction is expected to strengthen CarePoint’s financial position and improve patient care and outcomes across the hospitals, according to John Rimmer, CarePoint’s chief medical officer, said in a Jan. 12 news release. 

“Hudson County is the most diverse and dynamic community in New Jersey, and its residents deserve nothing less than exceptional care, affordable access, the most advanced specialties and technology, and the highest caliber physicians to serve patients’ needs, especially the underserved communities that rely on our facilities,” said CarePoint President and CEO Achintya Moulick, MD, who will be president and CEO of Hudson Health System. “With adequate state support, I believe we can build a hospital system that will deliver on its core mission.”

The letter of intent is the precursor to a new organizational structure and operating plan that will require approval from the New Jersey State Department of Health. Hudson Health System would be a four-hospital system that includes Hudson Regional, Bayonne Medical Center, Hoboken University Medical Center and Christ Hospital in Jersey City.  

“This new system expands our mutual impact far beyond and far sooner than what we could ever have achieved separately,” Hudson Regional CEO Nizar Kifaieh, MD, said. “The possibilities are enormous and will energize the entire medical community to deliver that much more to the patients.”

More details about Hudson Health System are expected to be announced in the coming days.

How ‘quiet management’ cuts through the noise of healthcare

There is no one-size-fits-all when it comes to managing teams, and managers may take different approaches based on team size, organization size, organizational needs and other factors. However, one approach has risen to the surface recently: “quiet management.” 

Career coach Adam Broda posted about the topic on LinkedIn last year. He said quiet managers stop checking employee start and stop times, let people choose to work where they want, encourage guilt-free time off, remove unnecessary meetings and distractions, listen to team feedback about how the manager manages, and give workers what they need to be successful, then step away and trust them to deliver.

“Quiet managers operate with a high level of trust in their employers and don’t micromanage,” Mr. Broda wrote. “This way, the job becomes more of a support role and gives managers the time to get out in front and lead by example instead of leading by structure and administration.”

To gain insight into what quiet management may look like in healthcare, Becker’s discussed the topic with three leaders: Kevin Mahoney, CEO of the University of Pennsylvania Health System, part of Philadelphia-based Penn Medicine, which also includes the Perelman School of Medicine; Karen Frenier, BSN, RN, senior vice president of human resources and chief nurse executive at Orlando (Fla.) Health; and Mitch Cloward, president of Salt Lake City-based Intermountain Health’s Desert Region.

Mr. Mahoney leads health system operations, spanning six hospitals, 11 multispecialty centers and hundreds of outpatient facilities in Pennsylvania, Delaware and New Jersey. He said he demonstrates quiet management by emphasizing the “why” behind Penn Medicine’s business, rather than the “how.” 

“At Penn Medicine, we believe we were founded to create and disseminate knowledge, and that’s what we try to do,” he said. 

The organization has found success with this approach; the breakthrough messenger ribonucleic acid technology that enabled the COVID-19 vaccines from Moderna and Pfizer-BioNTech came from the organization.

“So when you’re doing your job, you’re not just doing your revenue cycle job,” Mr. Mahoney said. “You’re also creating a hospital margin that allows us to fund research.”

He said he also works to be visible and assumes positive intent.

“I think everybody comes to work to do their very best,” Mr. Mahoney added. “We give them guidelines, we set priorities, but we need to let them get the job done.” 

Ms. Frenier described her management style as authentic and transparent. This means clearly and frequently communicating with team members.

“With quiet management, I think, communicate once and get out of the way,” she said. “And my conflict a little bit [with that] is you can do quiet management and have visibility at the same time. And I think that is so important. What is important for us, Orlando Health, our culture, my leadership style is very clear expectations, what our goals are, what our priorities are.”

Ms. Frenier also subscribes to the lean management philosophy of leaders “going to the gemba” — a Japanese term for “actual place” — a principle that involves direct observation to improve work processes. 

“It doesn’t make any sense for me to say, ‘Here’s how to fix the problem.’ The problem needs to be answered by the team members who do the work,” she said. “Our role [as managers] is to remove obstacles, move things along sometimes. So to me, that’s part of quiet management. However, my conflict is that there’s nothing quiet about it.”

The approach is one Mr. Cloward said is woven throughout the healthcare workforce.

“Quiet leadership and quiet managers are frequently observed in healthcare,” he said. “This may be associated with our primary purpose and our mission of selflessly devoting ourselves to caring for our patients and the communities we serve. I also believe that most caregivers and leaders that choose a career in healthcare do so because they want to help others.”

Refining meeting strategy

Meetings are an important part of a manager’s responsibilities, but too many meetings could leave some employees overwhelmed and less clear on the task at hand. A 2022 report from Otter.ai and the University of North Carolina at Charlotte found nearly one-third of meetings are unnecessary and that organizations waste millions of dollars on them.  

From Mr. Mahoney’s perspective, the productivity of meetings can get lost in the virtual world and in Zoom meetings, so his focus is on getting back to productive meetings.

“You wouldn’t go into a conference room and put a brown bag on your head,” he said. “But people get on a Zoom meeting and they’ll turn the camera off, and we’re losing the engagement.”

To maximize engagement, his overall philosophy is that daily huddles on units are better than meetings to solve a problem, interact and move forward with a solution. He said video and online tools have also been helpful to disseminate his words to 50,000 employees.

Ms. Frenier also expressed support for huddles over formal sit-down meetings. She said 259 nurse leaders across the company attended a huddle Jan. 11. 

“That excites me,” she said. “That number is as good as when we started it a little over a year ago. And, when I start with my updates, if Hospital Consumer Assessment of Healthcare Providers and Systems, our customer experience and emergency department throughput is our top work, then I’m very consistent in giving us an update on how that work is. [Managers must] be clear with your expectations. You can’t talk about a new one every day. But you’ve got a follow-up [via huddles]. The best way for us to connect is to be visible, develop relationships.”

To help with that connection, Orlando Health recently rolled out new behavioral expectations for workers across all teams. The expectations center around communication, connection, commitment and curiosity. 

“We have written out what that means,” Ms. Frenier said. “The next step for that is to make our coaching plans easier for leaders to have that conversation [about those expectations].”

Facing conflict head-on

No matter the leadership style, managers at one time or another likely will have to handle challenging conversations or conflicts within their team. Mr. Mahoney’s approach: “Handle them straightforward first thing in the morning, get it resolved, get it behind us, and then don’t let it linger and carry forward.”

He said it is especially important to address the obstacle or problem rather than the individual.

“I do that with a lot of data, not just Penn data, but industry trends,” Mr. Mahoney said. “We all think we’re an island unto ourselves. [But no matter the organization], the issues are very similar. 

“We can’t control our external environment; we can just control our response to it. So a lot of the confrontational meetings that we have are because we have to change the way we’re doing business. Not because we’re doing it wrong, but because of the macroeconomic headwinds that we’re facing.”

Approaching challenging situations as a quiet manager often reflects the style of “servant leadership,” Mr. Cloward said. 

“I strive to understand what they hope to accomplish in their current job and what they hope to achieve over time with career goals and aspirations,” Mr. Cloward said. “I dedicate time to helping them remove barriers to reduce frustration and increase satisfaction as we serve. I establish clear direction so that expectations are fully understood and in doing so, I strive to inspire rather than force, coerce or incite fear.”

Being effective — quietly

There are other practices or habits that quiet managers use outside of handling challenging conversations or conflicts within their team. Mr. Mahoney, for example, stands at a connecting hallway between two buildings that is frequented by workers and answers people’s questions in between shifts. 

He is also in favor of asking workers more open-ended questions such as, “What can I do to make your job easier?” and “What obstacles did you face today that I could work to eliminate?” instead of a question like, “How many bills did we collect today?” 

“Because, again, people know their jobs,” Mr. Mahoney said. “They don’t need me to do their jobs.”

Ms. Frenier agreed.

“It is our role [as managers] to allow the team members to be the best they can be and get out of the way,” she said. “… Supporting them with the right tools and documentation that’s not so burdensome, and, if there’s technology that helps us do our job better, that’s the work we should be doing.”

However, being effective as a quiet manager does not begin only once someone is hired and part of a team. Rather, it can start as early as the hiring process, Mr. Cloward said, and approaching the process from this angle can improve workplace culture. 

“Quiet leaders are leaders who have been disciplined in the hiring process,” he said. “They hire the very best caregivers who not only have technical/clinical skills, but also human skills — caregivers who are altruistic, who devote themselves to serving our patients and our communities.” 

Jefferson hospital to close residency program

Jefferson Einstein Hospital in Philadelphia is implementing a two-year phased closure of its pediatric residency program, according to a Jan. 11 statement provided to Becker’s.

Residents currently enrolled will be able to complete the three-year program, but there will be no new class this year. 

Jefferson Health, the hospital’s operator, said the decision was made in response to “the changing medical needs of our communities.”

“We consistently examine all opportunities to continually improve health care delivery in the communities we serve,” the system said in the statement. “We remain committed to caring for the outpatient pediatric patients in our community and will continue to provide inpatient services in the perinatal newborn unit and neonatal intensive care unit at Jefferson Einstein Hospital.”

Jefferson Einstein Hospital came under Jefferson’s umbrella after the health system merged with Einstein Healthcare Network in October 2021.

Earlier this week, Upland, Pa.-based Crozer-Chester Medical Center’s surgical residency program’s lost its accreditation, with the program needing to close by Jan. 12. Accreditation for the program — which had 15 filled resident positions — was withdrawn “under special circumstances,” according to a note on the ACGME’s website. 

Economic Indigestion for U.S. Healthcare is Reality: Here’s What it Means in 2024

By the end of this week, we’ll know a lot more about the economic trajectory for U.S. healthcare in 2024: it may cause indigestion.

  • Digesting deal announcements and industry prognostics from last week’s 42nd JPM conference in San Francisco. Notably, with the exceptions of promising conditions for weight loss drugs, artificial intelligence and biotech IPOs, the outlook is cautionary for providers and inviting for insurers and retail health. Expanded conflicts in Ukraine and Gaza loom as threats. The U.S. trade relationship with China and its growing tension with Taiwan poses an immediate threat to the U.S. healthcare supply chain for raw materials in drugs, OTC products, disposables. U.S. public opinion about its institutions is arguably shaped in part in social media: TikTok is owned by Chinese internet tech company ByteDance and operates in 150 countries. The 16 not for profit health system presentations at JPM sounded a chorus in unison: ‘our core business—hospital care– is not sustainable. We need deals with private capital to stay afloat.’ By contrast, national insurers and retailers sang a different tune: ‘the market is receptive to our products and services that are cheaper, better and more easily accessed through digital platforms. The status quo is outdated’.
  • Digesting results from today’s Iowa GOP Caucus which serves as a gatekeeper for Presidential candidate wannabes. In the run-up to Campaign 2024, polls show voters interested in abortion rights and affordability. But specific health system reforms have not surfaced to date in this election cycle and understandably: per the November 2023 Keckley Poll, 76% of U.S. adults agree that “Most politicians avoid healthcare issues because solutions are complicated and they fear losing votes” vs. 6% who disagree. Thus, the Iowa results might narrow the President contestant pool, but it will do little to clarify U.S. health policies in 2025 and beyond.
  • Digesting takeaways from the World Economic Forum (WEF) in Davos. The annual confab draws world leaders and big-name consultancies and bankers who want to rub elbows with them. It’s notable that the WEF pre-conference Global Risk Survey indicated growing concern about a looming “global catastrophe” and its agenda includes sessions on women’s health, misinformation and artificial intelligence—all central to healthcare’s future. The world is small: 8 billion inhabitants in 195 countries. There’s growing global attention to healthcare and recognition that the integration of social services (nutrition, housing, transportation, et al) and elimination of structural barriers that limit access are necessary to the effectiveness of their systems. The U.S. lacks both though it’s the world’s most expensive system. Thus, U.S.-based solutions to enhance clinical efficacy for specialty care are accessible to global markets at prices significantly lower than what U.S. taxpayers pay because their government’s refuse to pay U.S. rates.
  • Digesting where Congress lands this week on the fiscal 2024 budget. A deal was reached tentatively yesterday on a short-term funding bill that would avert a partial government shutdown this Friday. The $1.6 trillion continuing resolution funds the government through March 1 and March 8 and includes $886B for defense and $704B for other total discretionary programs. While payments for social security and Medicare are not impacted, most other federal health programs are impacted and therefore caught in the Congressional crossfire between budget hawks wary of the ballooning federal deficit ($34 trillion) and progressives who think the federal government spends too much on the ‘have’s’ and not enough, including health and social services, on its ‘have not’s.’ And this deal is TENTATIVE!

My take:

The cumulative effect of these events in economic indigestion for the entire U.S. economy and especially for those of us who work in its healthcare industry. So, for the balance of 2024, the realities for U.S. healthcare are these:

  1. Public support for the health system is eroding. Trust and confidence in the U.S. health system is low. No sector in U.S. healthcare is immune though some (community hospitals, public health programs, independent physicians) are more favorably viewed than others. Confidence in government agencies (CDC, FDA, CMS) is fractured due to misinformation and disinformation. ‘Not-for-profit’ designation is a meaningful distinction to some but secondary to characteristics more readily understood and valued.
  2. Federal policies toward healthcare are increasingly antagonistic. They’re popular and in most cases, bipartisan. Federal policies that expand price transparency (drugs, hospitals, health insurance), constrain on consolidation (horizontal) and private equity investing, expose/reduce conflicts of interest, address workforce resilience (compensation, work-rules) and protect consumers will be prominent. Beyond these, court actions and budgetary negotiations will define/refine federal health policies. Notably, the rumored DOJ antitrust action against Apple will be a closely watched barometer as will the government’s attention toward Microsoft given its leading role in ChatGPT and AI platform Copilot et al.
  3. The big players enjoy advantages over smaller players. It’s a buyer’s market for them. The corporatization of U.S. healthcare has rewarded big operators in each sector and punished smaller, independent operators. More regulation, higher operating costs, escalating administrative complexity and shifting demand require capital that’s increasingly unaffordable/inaccessible to less credit-worthy players. In 2024, in every sector, bigger fish will eat the smaller as readily-accessible private capital is deployed to welcoming sellers. But mechanisms whereby ‘independents’ are protected and growing disparity in how care is financed and delivered will be a prominent concern to policymakers.

Regrettably, an off-the-shelf Pepto-Bismol is not available to the U.S. system. It is complex, fragmented, inequitable and expensive, but also profitable for many who benefit from the status quo.

So, the conclusion that can be deduced from the four events this week is this: economic indigestion in U.S. healthcare will persist this year and beyond because there is no political will nor industry appetite to fix it.  Darwinism aka ‘survival of the fittest’ is its destiny unless….???

Thought of the Day: Advice from an old Farmer

Your fences need to be horse-high, pig-tight and bull-strong.

Keep skunks and bankers at a distance.

Life is simpler when you plow around the stump.

A bumble bee is considerably faster than a John Deere tractor.

Words that soak into your ears are whispered… not yelled.

Meanness doesn’t just happen overnight.

Forgive your enemies; it messes up their heads.

Do not corner something that you know is meaner than you.

It doesn’t take a very big person to carry a grudge.

You cannot unsay a cruel word.

Every path has a few puddles.

When you wallow with pigs, expect to get dirty.

The best sermons are lived, not preached.

Most of the stuff people worry about ain’t never gonna happen anyway.

Don’t judge folks by their relatives.

Remember that silence is sometimes the best answer.

Live a good, honorable life… then when you get older and think back, you’ll enjoy it a second time.

Don’t interfere with somethin’ that ain’t bothering you none.

Timing has a lot to do with the outcome of a Rain dance.

If you find yourself in a hole, the first thing to do is stop digging.

Sometimes you get, and sometimes you get got.

The biggest troublemaker you’ll probably ever have to deal with watches you from the mirror every mornin’.

Always drink upstream from the herd.

Good judgment comes from experience and a lotta that comes from bad judgment.

Lettin’ the cat outta the bag is a whole lot easier than puttin’ it back in.

If you get to thinkin’ you’re a person of some influence, try orderin’ somebody else’s dog around..

Live simply. Love generously. Care deeply. Speak kindly. Leave the rest to God.

Don’t pick a fight with an old man. If he is too old to fight, he’ll just kill you.

Most times, it just gets down to common sense.

72 hospital patient experience benchmarks

Patient experience measures declined nationwide in 2022, though some hospitals are showing early signs of improvement.

Below are 72 hospital patient experience benchmarks based on national HCAHPS measures from CMS. Data was collected from hospitals in calendar year 2022 and published on CMS’ Provider Data Catalog Nov. 8. Learn more about the methodology here.

Communication with hospital staff

  1. Nurses always communicated well: 79% 
  2. Nurses sometimes or never communicated well: 5%
  3. Nurses usually communicated well: 16%
  4. Nurses always treated them with courtesy and respect: 85%
  5. Nurses sometimes or never treated them with courtesy and respect: 3%
  6. Nurses usually treated them with courtesy and respect: 12%
  7. Nurses always listened carefully: 76%
  8. Nurses sometimes or never listened carefully: 5%
  9. Nurses usually listened carefully: 19%
  10. Nurses always explained things so they could understand: 75%
  11. Nurses sometimes or never explained things so they could understand: 6%
  12. Nurses usually explained things so they could understand: 19%
  13. Physicians always communicated well: 79%
  14. Physicians sometimes or never communicated well: 5%
  15. Physicians usually communicated well: 16%
  16. Physicians always treated them with courtesy and respect: 85%
  17. Physicians sometimes or never treated them with courtesy and respect: 4%
  18. Physicians usually treated them with courtesy and respect: 11%
  19. Physicians always listened carefully: 78%
  20. Physicians sometimes or never listened carefully: 6%
  21. Physicians usually listened carefully: 16%
  22. Physicians always explained things so they could understand: 74%
  23. Physicians sometimes or never explained things so they could understand: 7%
  24. Physicians usually explained things so they could understand: 19%

Responsiveness of hospital staff

  1. Patients always received help as soon as they wanted: 65%
  2. Patients sometimes or never received help as soon as they wanted: 11%
  3. Patients usually received help as soon as they wanted: 24%
  4. Patients always received call button help as soon as they wanted: 64%
  5. Patients sometimes or never received call button help as soon as they wanted: 10%
  6. Patients usually received call button help as soon as they wanted: 26%
  7. Patients always received bathroom help as soon as they wanted: 66%
  8. Patients sometimes or never received bathroom help as soon as they wanted: 11%
  9. Patients usually received bathroom help as soon as they wanted: 23%

Communication about medicines

  1. Staff always explained medicines before giving it to them: 62%
  2. Staff sometimes or never explained: 20%
  3. Staff usually explained: 18%
  4. Staff always explained what new medications were for: 75%
  5. Staff sometimes or never explained new medications: 10%
  6. Staff usually explained new medications: 15%
  7. Staff always explained possible side effects: 48%
  8. Staff sometimes or never explained possible side effects: 31%
  9. Staff usually explained possible side effects: 21%

Discharge information

  1. Yes, staff did give patients information about what to do during their recovery at home: 86%
  2. No, staff did not give patients information: 14%
  3. No, staff did not give patients information about help after discharge: 16%
  4. Yes, staff did give patients information about help after discharge: 84%
  5. No, staff did not give patients information about possible symptoms: 13%
  6. Yes, staff did give patients information about possible symptoms: 87%
  7. Patients who agree they understood their care when they left the hospital: 43%
  8. Patients who disagree or strongly disagree they understood their care when they left the hospital: 6%
  9. Patients who strongly agree they understood their care when they left the hospital: 51%

Cleanliness of hospital environment

  1. Room was always clean: 72%
  2. Room was sometimes or never clean: 10%
  3. Room was usually clean: 18%

Quietness of hospital environment

  1. Always quiet at night: 62%
  2. Sometimes or never quiet at night: 10%
  3. Usually quiet at night: 28%

Transition of care

  1. Patients who agree that staff took their preferences into account: 47%
  2. Patients who disagree or strongly disagree that staff took their preferences into account: 8%
  3. Patients who strongly agree that staff took their preferences into account: 45%
  4. Patients who agree they understood their responsibilities when they left the hospital: 43%
  5. Patients who disagree or strongly disagree they understood their responsibilities when they left the hospital: 6%
  6. Patients who strongly agree they understood their responsibilities when they left the hospital: 51%
  7. Patients who agree they understood their medications when they left the hospital: 37%
  8. Patients who disagree or strongly disagree they understood their medications when they left the hospital: 5%
  9. Patients who strongly agree they understood their medications when they left the hospital: 58%

Overall hospital rating

  1. Patients who gave a rating of six or lower: 9%
  2. Patients who gave a rating of seven or eight : 21%
  3. Patients who gave a rating of nine or 10: 70%
  4. Patients probably would not or definitely would not recommend the hospital: 6%
  5. Yes, patients would definitely recommend the hospital: 69%
  6. Yes, patients would probably recommend the hospital: 25%