Hospital improves its public image

Hilo Medical Center once again showed strong improvements in an annual report rating patient satisfaction.


Hilo Medical Center once again showed strong improvements in an annual report rating patient satisfaction.

However, the hospital might see cuts of up to $60,000 this year from its Medicare reimbursements, as its scores continue to fall below other hospitals in the state and around the country.

Recently posted data at shows HMC has improved upon its performance on nine out of 10 survey questions posed to in-patients during 2012, compared to the previous year. The standardized questions, totaling 32 in all, are asked of patients at thousands of hospitals around the country and focus on the experience the facility and staff provide to patients who make overnight stays.

The patients are asked about their opinion of areas such as hospital cleanliness, staff communication with patients, pain management and noise level. Hospitals that underperform on patient satisfaction compared to other hospitals can be hit with reductions in reimbursements through the Affordable Care Act. That makes patient satisfaction a metric that can directly affect a hospital’s bottom line.

While HMC has shown steady improvement since 2009 on its customer satisfaction, it might see reductions in reimbursements this year of between $30,000 and $60,000, said Dan Brinkman, Hawaii Health Systems Corp.’s East Hawaii Regional Chief Nurse.

“The way the system is set up, there are winners and losers. The winners get to keep the money the losers don’t get. It’s set up to be cost-neutral for Medicare,” he said.

How an individual hospital fares in reimbursements is tied not only to its own performance, but also with the performance of other local and national hospitals, similar to students being graded on a curve, Brinkman said.

“Unfortunately, even if some hospitals are getting the desired results, if others are doing better, they can be penalized,” he said.

The most important questions among the 10 questions displayed at are the two related to patients’ overall impressions of a hospital, Brinkman said, and in those areas, HMC continues to lag.

Last year, 56 percent of those patients surveyed said they would rate HMC a 9 or 10 on a scale of 0 to 10. That compares to a state average of 70 percent, and a national average of 70 percent. Meanwhile, 57 percent said they would “definitely recommend” the hospital, compared to 71 percent at hospitals statewide, and 71 percent nationally.

Despite performing below state and national averages, the hospital improved on both metrics by leaps and bounds. In 2009, 46 percent of patients at HMC rated the hospital a 9 or 10, and 45 percent said they would definitely recommend the hospital.

The newest data shows HMC improved on both questions by 22 percent and 27 percent, respectively, during the last four years.

Brinkman explained while the other questions on the survey show customer service at the hospital has seen improvement in the last four years, patients continue to factor in experiences they had and experiences friends and family had, going back years, when deciding on the hospital’s reputation.

“Those two metrics are the hardest to change. It means we still have our work cut out for us. We have to keep it up, we have to stay consistent. … It’s just going to take time to change people’s minds,” Brinkman said.

The other questions in the survey show HMC to be consistently improving its scores, and in some cases meeting and exceeding state and national averages.

When asked whether their pain was “always” well controlled, 70 percent of HMC respondents said yes, compared to 70 percent in the state, and 71 percent in hospitals across the country.

Meanwhile, 68 percent of patients in Hilo said they “always” received help as soon as they wanted it, compared with 70 percent statewide and 67 percent nationwide. That particular question showed HMC’s largest improvement of 2012, increasing from 58 percent in 2011.

One area which HMC has worked to improve but continues to remain low concerns noise levels near patient rooms. Forty-one percent of respondents said the area around their rooms was quiet at night at HMC in 2012, the same score as was achieved in 2009.

Brinkman said that is a metric that is largely hard to control because of the age of the building and the fact it was built solidly to protect it from earthquakes, and therefore it has little ability to dampen sound. However, this year, the hospital spent $137,000 to purchase and install white noise generators in each patient room, so he expects the hospital’s scores to improve somewhat with time.

“These sound-masking generators create a sub-audible hum which has been shown to help reduce ambient noise,” he said.

The hospital has also undertaken a campaign to promote quiet near patient rooms, including posters in hallways and near elevators reminding staff and visitors to keep their voices low. And managers can access remote decibel-level monitors on their computers to compile data showing which areas, on average, are the loudest, allowing them to address noise on a unit-by-unit basis.

Additionally, patients have access to a “noise hotline,” a number they can call and complain if noise gets too loud.

“Each of these issues requires multiple strategies,” Brinkman said.

As a result of such efforts, Brinkman said he and the rest of the staff and administration at the hospital are encouraged by the improvements made on customer satisfaction.


“I think we’re getting there,” he said. “This year, we saw a multitude of steady improvements. … We want to get where we have steady, across the board customer satisfaction.”

Email Colin M. Stewart at

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