Hospital Quality: A Different View

Paul Farmer (of Partners in Health fame) has an easy-to-apply formula for quickly assessing the quality of hospitals or clinics anywhere in the world. He says that given the resources of the country, he looks at the quality of the hospital/clinic bathrooms and the gardens surrounding it. Based on just those two items, he claims he can accurately assess overall hospital/clinic quality—and afterwards correlate it with more ‘objective’ measures of quality and safety. Try out his quality assessment at your own hospital/clinic work-site, and maybe as a New Year’s resolution try to influence improvements.

My office at work is in the world’s largest university building: the Warren G. Magnuson Health Sciences Building at the University of Washington. The building has close to 6,000, 000 square feet of space and is composed of over twenty wings whose hallways are connected, but in a haphazard, disorienting way. The building is an Escher-esque sort of place, with faceless people wandering the hallways and strange concrete staircases going everywhere and nowhere. Ten thousand or so people work (or are hospital patients) in this building. At any given time at least half of the people are lost. I am usually one of them. The building includes a hospital and four health science schools—medicine, nursing, public health and dentistry. The fifth health science school—social work—was lucky and is far across campus in its own (very small) building.

The Health Sciences Building is sandwiched between three busy streets and one busy ship canal. Many of its courtyards are completely covered in concrete, with only a few stalwart and scraggly rhododendrons popping up in places. The bathrooms are tiled and painted a sickly yellow-beige that reminds me of public high school gym locker rooms.

My office is in the ugliest wing of the world’s largest university building. My office has a fault line running through it. There is a 6-inch wide grey rubber seam that bisects my office in two—it runs up one wall, across the ceiling, down the other wall, and across the floor. This rubber seam is the building’s earthquake shock absorbers. I often wonder what it would be like to stand on the fault line during an earthquake. Would I be safer there than ducking under my fake-wood desk? My office also has a door that goes nowhere. Supposedly it allows access to various pipes and electrical wires in the concrete-encased outer phalanges of the building. This door is perpetually locked and I have hung a silk scarf over it to make it seem less weird. I tell students it’s where old faculty members go to die. I often want to crawl in there and take a nap.

The particular part of the Health Sciences building I work in, the T-wing, was built in the late 1960’s and is a prime example of Brutalism. It is also a prime example of why Brutalism is not an architectural style suited either for Seattle weather or for being attached to a hospital. Outside and inside it appears to be made of crumbling, damp and moldy concrete. In one staircase I use there are arm-sized stalactites forming on the ceiling and liquid is perpetually dripping from their pointed ends into a black and green puddle in one corner of a stair landing. It has a bizarre beauty. Over Winter Break the stalactites were removed and the ceiling painted over. I find that I miss them.

University of Washington Medical Center does fairly well on most quality measures included in Medicare’s Hospital Compare. Under ‘patient satisfaction survey’ they include an item on cleanliness of bathrooms. (Gardens aren’t included). If you haven’t used this website before, I encourage you to do a search of hospitals in your area. They have recently added a section on hospital readmission rates.