THE VIRGINIAN-PILOT
Copyright (c) 1997, Landmark Communications, Inc.
DATE: Thursday, February 13, 1997 TAG: 9702130300
SECTION: FRONT PAGE: A1 EDITION: FINAL
SOURCE: BY DEBRA GORDON, STAFF WRITER
LENGTH: 127 lines
Jill Teetor could receive free health care for herself and her 4-year-old daughter through the Navy's medical network, but she chooses to pay deductibles and co-pays so she can see doctors outside the military.
Not because she's personally had a bad experience with the Navy's medical system, but because she's heard stories of long waits, difficulty making appointments, and people who see a different doctor on every visit.
``In the Navy, you're a number and you're lucky to get an appointment,'' said the Virginia Beach nurse, whose husband is an active duty enlisted man based at Oceana Naval Air Station in Virginia Beach. ``I'm sure some of the doctors are as good as on the outside, but my personal opinion and professional opinion is that I'd rather go out to my own doctors.''
She's not alone.
Forty-two percent of active duty sailors believe Navy medical care is not as good as civilian health care, according to one of the most comprehensive customer service surveys ever conducted by Portsmouth Naval Medical Center.
About 425,000 people are eligible for care in Navy facilities throughout Hampton Roads. They have more choices and higher expectations than ever before, said Rear Adm. William R.
Rowley, commander of the Portsmouth medical center. So his staff designed the survey ``to ask the hard questions, to get the hard answers.''
More than 1,400 active duty service members answered questions this fall about their expectations and perceptions of the care they receive throughout the Navy's medical facilities.
The chief complaints: patients have to wait too long to see a specialist, it is too difficult to make an appointment, and provider/patient interaction is poor.
But the survey also pointed out areas where the Navy is doing well.
Eighty-seven percent said there was never a time in the past year when they needed medical care but didn't get it.
And 64 percent said the overall health care they received was good. Fourteen percent said the quality wasn't good and 22 percent had no opinion.
``I'm completely satisfied with Portsmouth Naval,'' said retired officer Roger Kilb of Virginia Beach. Kilb, who suffers from a gastrointestinal disorder called Crohn's disease, visits the Portsmouth facility several times a year.
``The quality of care is outstanding, which is better than excellent, and they have a tremendous understanding of people,'' Kilb said.
However, while 58 percent of respondents agreed with Kilb, saying that the medical staff at Navy clinics and hospitals is competent, only 43 percent said the staff was sensitive and caring to their patients.
The results both surprised and disappointed Rowley.
``Our doctors and nurses and corpsmen are probably more caring, more loving, than those in the civilian sector,'' he said.
But the bureaucratic culture in which they were trained and work sometimes hides that, Rowly said. The problem, he said, is that the non-medical conveniences patients expect these days - modern buildings, excellent customer service, continuity of care and easy access - have not been priorities at Portsmouth.
``We've focused so much on the right diagnosis and therapy that we have not, as a culture, put effort into those other amenities that people expect as part of the experience,'' he said.
``In the past, we were the only game in town,'' Rowley said. Active duty military and dependents had to use Navy facilities unless they got permission to use civilian services.
Now, through the Navy's health maintenance programs called Tricare, that permission isn't necessary for outpatient services like specialty care.
Because the Navy can often provide those services less expensively, said spokeswoman Lt. Merritt Allen, if customers go outside the system because they perceive they can get better care, ``that's a real concern.''
It's also a concern because the hospital is a teaching hospital, she said, and must maintain its patient load to continue as a place to train new doctors.
Rowley worries that if the naval health care system doesn't improve, Congress may decide to eliminate many military medical programs and use private providers.
The survey drew a warning from the Navy's top doctor, Surgeon General Vice Adm. Harold M. Koenig, who highlighted it in a memo sent throughout the Navy's medical corps last week.
``These numbers tell us that our customers don't like the way we're treating them and they expect more than we are providing,'' he said in the memo.
``The data Portsmouth collected tells us that our medical system is not user friendly; that we need to improve the access and convenience of specific health care services. . . and that we need to place greater emphasis on the importance of provider-patient interactions.''
Even before the survey pinpointed areas of concerns, Rowley said, Portsmouth Naval had already started making changes.
The hospital has hired consultants to revamp its appointment system and to train staff in customer service.
Volunteers have begun working in the pharmacy, which typically has long lines. They answer questions while people are waiting and ensure that the line moves quickly.
The hospital also changed the way it admits patients for same-day surgery. Now, patients go to one place to check in, complete paperwork, drop off lab results and get discharged.
Another key issue is doctor/patient communication, Rowley said. It's a problem throughout medicine - civilian and military. ``The old culture was, `I'm the doctor, I know the answers. You're the patient, let me tell you what to do and you do it.' The world has changed. Patients don't want that anymore.''
In fact, 33 percent of those surveyed said their health care provider ``talked down'' to them. Sixty-seven percent said that hadn't happened.
Part of the problem is time limits on doctors, Rowley said. Physicians are often pushed to see a new patient every 12-15 minutes, so theydon't have enough time to spend with patients. To help with this problem, he is getting nurse practitioners, corpsmen and physician assistants to spend more time educating patients and answering their questions.
Some problems result from working in an old hospital, Rowley said. For instance, in the orthopedic clinic, there are 17 exam rooms for 35 doctors. That resulted in a backlog of about 390 patients last year who had been waiting more than a month for an appointment.
The hospital's outdated phone system also slows down service, he said.
But a new hospital slated to open next to the old one in 1998 should solve those problems. The new hospital will have two exam rooms for every doctor, greatly improving patient flow and opening more appointment slots, Rowley said. ILLUSTRATION: Color photo by HUY NGUYEN/The Virginian-Pilot
Long lines outside the Portsmouth Naval Hospital pharmacy are not
unusual. The facility has posted volunteers to answer questions
while people are waiting and ensure that the lines move quickly.
Graphic
[Some of the results from survey]
KEYWORDS: MILITARY U.S. NAVY HEALTH CARE MEDICAL CARE
PORTSMOUTH NAVAL HOSPITAL CUSTOMER SERVICE SURVEY