Jarrod Shapiro, DPM
Practice Perfect Editor
Assistant Professor,
Dept. of Podiatric Medicine,
Surgery & Biomechanics
College of Podiatric Medicine
Western University of
Health Sciences,
St. Pomona, CA

What Makes a Great Hospital?

Through my almost seven years of clinical practice since graduating residency, I've worked in 3 states and been on staff at 9 hospitals, 2 surgery centers, 1 wound clinic, 2 private practices, 1 multispecialty practice, and one university clinic. Moving around has its disadvantages, but the one advantage I've found is the education I've received through each of these practice situations. I've learned so much from all of the different people and each environment. One of the obvious conclusions is in each facility, a unique character existed that greatly affected the overall function of the hospital. Each location had its own flavor, a distinctive feel and personality. There were also certain quirks and inefficiencies that made each place far from perfect.

What Makes a Great Hospital Let me ask you this question: If you were going to work at the "perfect" hospital, what would it be like? We often learn about the "ideal" wound care product or "ideal" surgical instrument. What would your ideal hospital be? Indulge me with some wishful thinking and think about your ideal hospital.

The Operating Room

For me, a great hospital must start with a stellar surgical experience. First, from a scheduling perspective, I'd have surgical block time at least weekly with certain OR rooms kept free for add-on surgeries. The hospital would never hassle the surgeon about what instruments or devices they were going to use. The start time would always indicate incision time and, of course, they would always start on time or early. I have almost never had this at hospitals, but I've seen it much more commonly with surgery centers. The change-over time between cases would be 10 minutes, and, while we're at it, they'd have a second room ready to start my next case (remember, I did say wishful thinking, right?). Personally, I don't care exactly how large the OR rooms would be; I've never been comfortable in huge rooms. It's Goldilocks for me – not too large, not too small.

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James DeJesus, DPM

The Floors

Now, of course the medical-surgical floor would be on the same floor as the operating rooms to make them easy to get to. The charts would be on the walls right outside the patients' rooms and the most recent vitals would always be present just outside the room. I don't know why so many hospitals at which I've worked seem to enjoy hiding the vitals. Of course, with the advent of EMR systems, all patient health information is easily and rapidly accessible (now we're really on wishful thinking). Patients would have individual rooms, and this hospital would have given up contact precautions for MRSA patients. Gowning and then having to leave is such a pain in the butt. A small supply stock cubby would be available in the rooms for dressing supplies.

The People

Everything else is nice, but a hospital sinks or swims by the people that work there. I've worked in hospitals with staff of all kinds, and the one thing that really makes a hospital great is a friendly, caring, hard-working staff that actually wants to be there. From the janitor to the CEO, if the vibe isn't there, neither is the hospital. I was once in an OR where I actually watched two nurses get into a verbal fight in the middle of one of my cases. I couldn't believe it. Besides the completely unprofessional attitude of these two people, they put my patient at risk by destroying the team environment I worked so hard to create. On the other hand, I recently took care of a pediatric patient overnight after surgery, and the nurses on the floor were fantastic. They were so helpful, knowledgeable, and caring, that I was very impressed. It's people that make the hospital a place of healing, and if I could pick one parameter to make all hospitals great, it would be the people.

To this day, I find his statement to be a profound commentary on modern medical education. Much of medicine may be learned via books, but the transition from student to clinician requires practical experience. The logical conclusion to this line of reasoning is the more time spent training, the more likely the trainee is to have experiences, and the better the overall education. What this means for resident education as it relates to duty hours and patient safety is anyone's guess. Keep that in mind the next time your resident calls you in the middle of the night. Sleep tight.

What does your perfect hospital look like? Write in with your thoughts.