The surprising way to stay safe in the hospital

When Kathy Day, a retired nurse in Bangor, Maine, received a diagnosis of uterine cancer, she decided to focus not only on how her condition would be treated but also on the way she wanted to be treated by the doctors and nurses in the hospital. As a nurse, Day understood that busy hospital staffers aren't always as attentive as they should be.

She also had felt frustrated and condescended to in the fall of 2008, when her 83-year-old father was hospitalized elsewhere in Maine for an ankle fracture. He was discharged, then readmitted a few days later with what Day says was a MRSA (methicillin-­resistant staphylococcus aureus) infection, which he acquired during his first stay—and which ultimately killed him.

"MRSA wasn't diagnosed right away, but my family and I knew something was seriously wrong," she says. But when Day asked questions, the hospital staff behaved as though she was overreacting. "One nurse said, ‘Your dad is just tired. He's been through a lot,' " she recalled. "Even after MRSA was discovered, one of the doctors shrugged and said, ‘Well, these things happen. There isn't much we can do about it.' And though he was coherent throughout his illness, the doctors rarely spoke to him directly about his treatment; they came to my mother and me."

Determined not to repeat her father's experience, Day researched nearby hospitals before her surgery to check their infection rates and picked one with a good record. Equally important to her was that her medical team would involve her in decisions about her care and that they'd respect her capacity to make them. Hoping that a personal connection with her health care team would advance that goal, she wrote a short letter to the patient safety officer at the hospital, laying out her expectations in courteous detail.

"I trust you, as my healthcare team, with my life . . . Please be patient with my questions . . . Listen to my concerns and my husband's . . . Involve me in all discussions about my healthcare plan, even if something has gone wrong."

Day didn't know how her letter would be received, thinking that it might alienate everyone, but she knew how important assertiveness was. And when staffers came into her hospital room to thank her, she knew she'd done the right thing.

What Day was essentially asking for was to be treated like a person, not just as a patient. In the medical world, that is described as "patient respect and dignity." It isn't just a matter of common decency, although that's certainly part of it. In fact, a new national Consumer Reports' survey of 1,200 recently hospitalized people found a striking link between respectful treatment and patient safety.

Those who said they rarely received respect from the medical staff were two and a half times as likely to experience a medical error—such as a hospital-­acquired infection, a wrong diagnosis, an adverse drug reaction, or a prescribing mistake—as those who thought they were usually treated well. In fact, 29 percent of people in our survey said an error occurred.

Respectful treatment is when a doctor minimizes the use of medical jargon while talking to you, or at least takes the time to explain it. It's when the staffer who walks into your hospital room introduces herself before doing anything else. It's when you're seen as capable of making decisions about your own care—you're listened to without being interrupted, your questions are answered, your concerns are addressed, and your wishes honored whenever possible. It's when members of your medical team acknowledge mistakes and recognize you as something more than an appendicitis, a heart attack, or a hip replacement lying in Room 12.

"It's rare for a health care professional to be outright rude, but things like sitting when your patient is sitting, taking the time to explain things thoroughly, or making eye contact don't happen as often as they should," says Orly Avitzur, M.D., a Consumer Reports medical adviser.

Check our hospital Ratings and learn more about staying safe in the hospital.

In our survey, we measured perceptions of respect, such as the way hospital staff communicated and whether they acted with compassion, honored patients' wishes, and acknowledged mistakes. About one in four of those surveyed said that medical personnel did not consistently treat them as adults able to be involved in their own care or "like a person." One-third of the respondents said doctors or nurses didn't always listen to them without interrupting, and 34 percent felt that their wishes about treatment were not always honored. Worse, 21 percent of patients thought they weren't always treated fairly and without discrimination.

"People need to be in a healing environment—where they feel that they have a place and a voice. Where they are not just a body," says Thor Ringler, a therapist at the William S. Middleton Memorial Veterans Hospital in Madison, Wis. If they don't think they are being heard or their wishes are being considered, they hesitate to ask questions, point out mistakes, or communicate in other ways that could help them get better.

Every day almost 2,000 people on average pick up an infection in the hospital and about 1,100 preventable drug errors occur. Overall, hospital medical errors are linked to 440,000 deaths annually. A growing number of health experts think that lack of respect is an ingrained part of medicine that contributes greatly to those errors. In the journal Academic Medicine, a group of Harvard Medical School doctors and researchers wrote, "Creating a culture of respect in health care is part of the larger challenge of creating a culture of safety." The safest hospitals, the authors suggest, are those that "reveal certain common cultural characteristics: shared core values of transparency, accountability, and mutual respect."

Dismissive or poor treatment can also intimidate patients and make them more concerned about the staff's feelings than their own. In our survey, one in five respondents worried about being "a bother or a pest" to busy hospital staff and 13 percent were concerned that they would be labeled "difficult."

But the greater danger in the hospital is staying silent. Carolyn Thomas, a communications professional in British Columbia, learned the consequences of passive behavior the hard way. When an emergency room doctor diagnosed her chest pain as acid reflux, she wasn't convinced, and asked, "What about this pain down my left arm?" A nurse intervened to say, "You'll have to stop asking questions of the doctor. He is a very good doctor, and he does not like to be questioned."

"I left the hospital that morning embarrassed and humiliated for having made such a big fuss over nothing and wasting their very valuable time," Thomas says. But she was soon back in the emergency room, where she was admitted with the correct diagnosis—a heart attack.

Being persistent and making sure you understand everything you're told is an important part of minimizing the risk of suffering from a medical error and increasing your odds of recovering from illness or surgery. "The emerging evidence is that patients who are actively involved in their health care achieve better outcomes, and have lower health costs, than those who aren't," writes Susan Dentzer, former editor-in-chief of the journal Health Affairs, in a special issue devoted to the topic of "patient engagement." In fact, patient engagement is such a powerful tool that it has been nicknamed "the blockbuster drug of the century."

In our survey, those who felt very uncomfortable asking questions about their care and the steps being taken to keep them safe were 50 percent more likely to experience at least one medical error, compared with those who felt very comfortable. Those factors include letting a nurse know how much pain they were in, finding out what tests or procedures were being recommended, and asking about drug side effects.

In an ideal world, respectful treatment from health care providers would be the norm. In the real world, you may have to insist on it. "Most health care professionals come to work with the best interests of the patient in mind," Avitzur says. "But we're only human. It's no excuse, but we succeed more on some days than others." You can increase the odds of a good hospital experience and set the stage for positive interactions with these strategies:

Do some research

Choosing the right hospital is important. A study published in the New England Journal of Medicine linked low patient satisfaction with less-than-stellar hospital performance in areas such as pain control, discharge instructions, and communicating about medication. And research in the American Journal of Managed Care showed that people who were satisfied with their care after a heart attack, heart failure, or pneumonia were less likely to be readmitted to the hospital within 30 days. An analysis of data from Consumer Reports' Ratings of almost 2,600 hospitals supports the idea that patient experience and patient safety are connected. (See "Top- and Bottom-Scoring Hospitals for Safety and Respect.")

Help providers see you as a person

Having an ongoing relationship with your doctor can improve care and reduce hospitalizations, according to a review of published research in the Annals of Family Medicine. But once you get to the hospital, chances are you won't know many of the folks taking care of you. That might explain why about 40 percent of the patients in our survey did not feel that staff always took a personal interest in them.

Reminding people that you are more than a diagnosis can change that. Bring in pictures, maybe one showing you playing golf or tennis. Tell your nurse about your family. Add a personal detail when you describe your medical problems to a doctor. "That takes you out of the roles of patient and doctor or patient and nurse into person and person," says Eileen Ahearn, M.D., a psychiatrist at the William S. Middleton Memorial Veterans Hospital.

"Unfortunately, when patients say they aren't being heard, they're often right. The increased use of technology and its role in data collection are having a real impact on doctor-patient communication," Avitzur says. "More and more, doc­-tors are using smart-phone and tablet apps to get information, so they're constantly looking at their devices. Nurses are entering numbers into bedside computers. All this means it takes a greater effort to look people in the eye."

In a recent study, Norwegian researchers created simulations in a hospital setting, using real doctors and actors as patients and comparing electronic devices with paper medical records. According to the doctors, the devices became a "disturbing third party." The patient actors thought the doctors were so busy with their devices that they shouldn't interrupt to ask questions. If you experience that dynamic, you can change it and make it easier to communicate by inviting your doctor to sit down and have a conversation.

Use our tips for choosing a doctor.

Have "your people" with you

In the Consumer Reports survey, people who had a family member or friend to act as an advocate were 16 percent more likely to say they had been treated with respect and 12 percent more likely to recommend their hospital to others. An advocate can help in a number of ways—for instance, making sure you are comfortable, getting information from the doctor or nurse, helping you make decisions about treatment, and speaking for you if you aren't able to speak for yourself.

Know when errors tend to occur

In our survey, patients who thought there weren't enough nurses available were twice as likely to experience some kind of a medical error and 14 percent less likely to think they were always treated with dignity and respect. Shift changes can also create safety hazards, as can care trans­itions, such as moving from an intensive care unit to a hospital floor. If you know when and where errors are most likely to occur, you can make a special effort to have your advocate be present then.

Find a "troubleshooter"

Navigating the hospital is much easier with an "insider" ally. You or a family member should introduce yourself to the head nurse on duty or seek out the nursing supervisor, attending physician, or even a physical therapist or aide you feel comfortable with. Then, if something goes wrong, you will have already established a personal connection with someone who knows the system and can help.

One often-untapped resource is the hospital ombudsman, an intermediary between patients and staff available at many facilities. Fewer than half of CR's surveyed patients knew such a person was available, and almost no one—just about 4 percent—asked to see one. Their responsibilities and even their titles differ from one hospital to the next, but an ombudsman can investigate complaints and address concerns you have about quality of care or any of the hospital's employees or policies.

Be assertive and prepared, but always be courteous

"In a high-stakes situation, like a job interview, you have a short time to make an impact, so you practice," says Leana Wen, M.D., a director of patient-centered care at George Washington University. "You should do the same thing in the hospital." Think about what you want to ask your doctors when they rush in for that early-morning visit, and say it out loud a few times so that you get what you want from the encounter.

"Challenge your doctor, but don't alienate him or her," Avitzur says. "Say, ‘I know my body, and these symptoms aren't normal for me. I'd like to work together to figure out what's wrong.' "

For example, Joanna Kaufman, a program information specialist at the Institute for Patient- and Family-Centered Care, based in Bethesda, Md., knew her father had never suffered dementia symptoms. So when he was confused about where he was after having hip replacement surgery, Kaufman asked hospital staff whether his medication could be at fault. She evoked a spirit of teamwork, letting them know she was sharing observations and asking questions, not making accusations. Once her father's medication was changed, the confusion disappeared.

Write things down

With doctors, nurses, technicians, medical students, and social workers in and out of your hospital room, it can be very difficult to keep track of what is being done, especially when you are ill. Listen to what they have to say, ask questions, and take notes. Keep a journal and a pen, or an e-device if you prefer, ready at your bedside.

Medicine is complicated stuff, and sometimes doctors forget you haven't studied it. "This is so much a part of their lives and their vocabulary. Sometimes they rush through an explanation without realizing that the person in front of them has no clue how to interpret what they just said," says communications specialist Carolyn Thomas. "I simply raise a hand in the ‘stop' position, and politely remind them that I haven't been to medical school, so please slow down and translate."

Patients' perception of their care in the hospital and the safety of the hospital are two of the categories scored in our hospital Ratings. An analysis of our data found that higher patient-experience scores are linked to higher hospital-safety scores and vice versa. (Many of the elements of respectful treatment are reflected in patient experience measures.) Below you'll find a list of the 32 U.S. hospitals (out of 2,591) that received a safety score higher than 60 (on a scale of 1 to 100) and did well in our measures of patient experience. We also list the hospitals with safety scores lower than 50 and low scores in patient experience.

Safety scores are based on factors such as mortality rates, infection rates, and hospital readmissions. Patient-experience scores include doctor- and nurse-patient communication, clarity of discharge instructions, and patients' overall impression of the hospital. The higher-scoring hospitals received a safety score higher than 60, earned the two highest ratings in at least eight of nine patient-experience measures, and did not get a low score in any of them. The lower-scoring hospitals had a safety score lower than 50, received the two lowest ratings in eight of nine patient-experience measures, and did not score high in any of them. Scores are based on January 2014 data from the Center for Medicare & Medicaid Services and are updated periodically.

Higher-scoring hospitals

Lower-scoring hospitals