Altru Health System: Measures of care

• Patients who would recommend the hospital

For more data from the U.S. Department of Health and Human Services, click on the PDF below.

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• Altru defends recent move to protect against competition
• Measures of care

When it comes to patient care and satisfaction, Altru Health System lags behind when compared to other providers in North Dakota and across the country, according to a survey from the Department of Health and Human Services.

Altru CEO Dave Molmen said the organization is working to improve its scores by focusing on patient interaction, adding doctors and expanding its facilities. In fact, Altru officials say they have already made big strides.

“We’ve done a lot of work recently to make sure we have a high compliance to best practices,” Molmen said. “We’re really working very hard on our scores.”

But in light of Altru’s recent moves that have protected status as Grand Forks only hospital, there is a the question: How does the lack of competition in the health care market affect the quality of patient care and services?

Supporters of an effort to open a second hospital have said competition would improve care. Direct competition between similar hospitals could push facilities to improve their service to draw patients.

And while experts say that is a valid argument, whether or not there is truly a connection between patient satisfaction and a more competitive health care market is up for debate.

Profile by data

Compared to hospitals in other North Dakota cities, Altru fares worse in patient satisfaction and care, according to data from April 2010 to March 2011, the most recent Health and Human Services data that has been published.

In Grand Forks, 54 percent of Altru patients said they would recommend the hospital to others, compared to an average score of 68 percent for all North Dakota hospitals and 70 percent for hospitals nationwide, the survey data show. Additionally, 55 percent of respondents gave Altru a nine or a 10 on a scale where 10 is the highest score.

The statewide average is 65 percent and the national figure 68 percent.

In Fargo, Sanford Medical Center had 72 percent of its patients say they would recommend the hospital and 70 percent gave it a score of nine or 10. Fargo’s Essentia Health had 78 percent of patients say they would recommend it and 69 percent gave it a rating of nine or 10.

In Bismarck, Medcenter One, which is entering a merger with Sanford Health, scored 75 percent on the patient recommendation measure and 68 percent gave it ratings of nine or 10. St. Alexius Medical Center scored 81 percent and 74 percent, respectively, on the two measures.

Minot’s Trinity Hospitals posted lower scores than Altru, with 50 percent of patients willing to recommend the facility and 47 percent rating it a nine or 10.

Among Altru’s lowest scores: 44 percent of patients saying their rooms were always quiet at night, 56 percent saying staff always explained medicine and 57 percent saying they always received the help as soon as they wanted it.

Among its highest scores: 84 percent of patients saying they were given information on their home recoveries, 72 percent saying doctors always communicated well and 71 percent saying nurses always communicated well.

In another recent report, this one by the Joint Commission — a national organization that provides accreditation to hospitals and reports on providers’ quality of care and safety — Altru exceeded its standards according to some measures, but fell behind in others.

Altru scored above the commission’s goals in heart attack care, getting high marks for smoking cessation work and use of aspirin during admissions and use of beta blockers at discharge. It also met the commission’s standards for infection prevention in surgery and for pneumonia care. Altru also met commission standards for heart failure care, showing improvement over 2011. However, Altru rated low in pneumonia care, gaining poor marks for vaccinations, timely use of antibiotics and blood cultures.

Effect of competition

Some consumers in the Grand Forks market have called for more choice in health care providers, saying it would improve overall care and satisfaction. There are several independent practices in Grand Forks, as well as the Sanford Clinic in East Grand Forks — all of which compete for local and regional health care dollars — but Altru is the only comprehensive health care system in Grand Forks.

Doctors Hospital would have brought more choice to Grand Forks consumers and would have attracted many people who travel to other markets for health care, its supporters argued.

“It’s a very simple, true business axiom that choice benefits the customer,” said Albert Pilkington III, who was hired as CEO of Doctors Hospital and is now working as a health care consultant in West Virginia, according to his website. “We would’ve provided a significantly better level of service.”

Dr. Jerry Smith, who along with others hired by Doctors Hospital, lost his job when Altru purchased the Aurora facilities, said the competition could have pressured Altru to improve its care.

“They needed someone to hold their feet to the fire a little bit,” he said.

According to Dan Zismer, a professor with the University of Minnesota’s School of Public Health and a former health system executive, it may not be that simple.

The way competition affects patient satisfaction or quality of care is difficult to say, Zismer said.

“I can make an argument that Fargo is better off because there’s two (hospitals) that are roughly the same,” he said. “There’s a great argument for service and there may be an argument for price.”

But there are also single-hospital markets that score well in patient satisfaction and care measures, Zismer said, citing St. Cloud Hospital in St. Cloud, Minn.

One problem hospitals that dominate their markets could face is patients linking a lack of choice with dissatisfaction with their hospital.

“I think that’s a common reaction,” he said. “Any problem I run into is because they’re so big and don’t care.”

Altru has a 296-bed hospital, provides more than 100 services and employs 3,888 people, including more than 190 physicians. Doctors Hospital would have had 65 beds with plans to eventually employ 500.

A smaller hospital would only be able to compete with a large hospital on the services they both provide and have little or no effect on other areas of care, Zismer said, noting that another new hospital would not be full-service like Altru.

“A hospital is not a hospital is not a hospital,” he said.

Improving care

As for the patient satisfaction numbers, Altru officials say they take them seriously and are striving for improvement, with or without competition in the market.

They say the most recent data in the Health and Human Services survey present a worse picture than Altru’s latest measures.

New numbers provided by Altru, reflecting March results only, show improvements in patient satisfaction, with 67 percent giving it the highest overall ratings and saying they would recommend the hospital to others.

The newer data, which has not yet been published, also shows improvements for heart attack care in four out of six areas. Measures of heart failure care show improvements in all areas. Pneumonia care measures were up in two areas, while other measures had been dropped from the survey. Surgical care improvement measures also improved in several areas.

Heather Strandell, manager of Altru’s managed care, said the data is no longer correct and that the measures ignored recognition that Altru has received for its care, including distinguished hospital awards three years in a row and statewide first-place rankings for cardiac services, cardiac surgery, orthopedic services, vascular surgery and pulmonary services. All awards came from HealthGrades, a company that awards quality ratings.

Altru Chief Operating Officer Brad Wehe said the system’s adoption of an electronic hospital record system in 2010 also meant some data was not included in the surveys.

“The numbers haven’t caught up with the most recent numbers available,” he said.

Margaret Reed, Altru’s chief nurse executive, said the organization is trying to update its care procedures, adding new services such as aromatherapy and spa treatments and increasing the frequency of nurses’ rounds with patients.

“We’re really trying to look at not just traditional medicine but how to meet today’s needs and expectations,” she said. “We’re really trying to humanize it.”

Altru will be able to improve some of its scores through its $200 million expansion plan, managers said, with the addition of new space and the hiring of more than 50 new physicians in 2011 and 2012.

Molmen cited one measure on patient surveys, in which only 44 percent said their rooms were always quiet at night. He said the construction of new facilities will improve space shortages that can make hospital stays less comfortable. He also said Altru management is trying to improve the way staff interact with patients to take some of the confusion and stress out of medical experiences that are by nature unpleasant.

“It starts with things as simple as smiling and greeting a patient,” he said.

Other goals include improvements in the time it takes for test results to become available and making sure patients know who their caregivers are and understand the steps of their care.

Altru-provided numbers:

Altru Health System provided more recent numbers than are available on Health and Human Services’ website comparing hospital data. The newer figures show improvements in patients’ experiences but do not provide comparisons with other facilities.

- Nurses always communicated well: 80%

- Doctors always communicated well: 77%

- Patients received help as soon as they wanted it: 74%

- Rooms were always clean: 77%

- Patients gave a rating of 9 or 10 on a scale in which 10 is highest: 67%

- Patients who would recommend the hospital: 67%

Online: Survey data is collected by the federal Department of Health and Human Services and is available at www.hospitalcompare.hhs.gov and also on Altru’s website, along with other data on its service and performance.

Reach Bjorke at (701) 780-1117; (800) 477-6572, ext. 117; or send e-mail to cbjorke@gfherald.com.

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