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Watch your language and mind your manners, please!

Patient Ward

A patient ward at Lancaster General Hospital, in the early 1900s.

When the Perelman School of Medicine celebrated its 250th birthday in 2015, we took the opportunity to take a look back at some of the major milestones and advancements in the practice of medicine, which has evolved alongside our nation itself.

In 250 years, we saw the first transfusion of human blood (1795), the world’s first x-ray image (1890), the opening of the nation’s first Coronary Care Unit (1963), and so much more.

Just as the practice of medicine has evolved, so too has the patient experience.

This year, as Penn Medicine Lancaster General Hospital  celebrates its 125th anniversary, we’re taking a look back at how far the patient experience – which in the early days wasn’t much of an experience at all – has come, and how it’s playing a vital role in the future of health care.

Take note of these rules for “Conduct and Duties of Patients” as they were posted at LGH in 1893:

  1. The patients shall conduct themselves with decorum toward each other, the officers of the hospital, the nurses and servants; they shall not use profane or indecent language, become intoxicated, or behave rudely or indecently; they shall not smoke tobacco or play at any game of chance in the hospital.
  2. No liquors, provisions or medicines of any kind shall be furnished to patients by their friends, and no patients shall be permitted the use of any diet other than that which may be ordered by the proper officers.
  3. No patient shall be permitted to leave the hospital while under treatment, except by special permission of the Superintendent.
  4. Such charity patients as are able shall give assistance in nursing or otherwise when required to do so by a physician, nurse or superintendent.
  5. No reading in bed at night, either by patients or any other person connected with the institution, shall be allowed.
  6. Visiting hours are 2 to 4 p.m. daily.

Stacey C. Peeples, curator-lead archivist at Pennsylvania Hospital, explained that these rules, while strict by today’s standards, were well within the norm for that time period.

“During the 1800s and early 1900s, hospitals were institutions for the poor, working class in our society. Rules like these were established to maintain order and control while the doctors and staff worked to help the patients get better,” she said.

Like Pennsylvania Hospital, Lancaster General Hospital was founded as a charitable organization. Most patients received free care, and it was understood that if asked to pitch in by distributing food to other patients or changing a dressing, they were expected to comply.

“The people running hospitals in this century existed in a social circle well above the people who were coming in for treatment,” Peeples said. “There was an accepted hierarchy that placed administrators at the top, followed by doctors, staff and patients. The expectation that patients would behave, follow orders, and refrain from vices was not viewed as unfair, but as part of the culture in polite society.”

LGH on Queen

Lancaster General Hospital’s first location at 322 N. Queen St., in 1893.

The rules of conduct were also established in order to control the environment and allow the physicians to do their jobs without distraction. Visitation was limited to a two-hour window. Smoking was prohibited; not because of health risks, but because a simmering pipe in the hands of a drowsy patient posed a real fire hazard. Patients were housed together in shared spaces, and when night fell, the lights were extinguished so everyone could sleep. Administrators would have frowned upon the expense of additional kerosene to allow a handful of patients to read.

Changing Times: The Patient Experience

Attitudes toward patients began shifting during the 1940s and ‘50s, when wealthier, paying patients began staying at hospitals with greater regularity. In the late ‘60s and early ‘70s, this shift became more pronounced. “Women were empowered to ask for more control during childbirth, and became better informed as patients than women of previous generations,” Peeples said.

The “rules of conduct” from yesteryear have been replaced by a more balanced patient bill of rights. While rules still exist to ensure a safe and healing environment for all, there are now entire teams dedicated to providing an optimal experience for individuals and families.

“We’ve made a big shift, just in the last ten years, from paying attention to patient satisfaction to focusing on the patient experience,” said Craig J. Loundas, Ph.D., associate vice president, Penn Medicine Experience.

The model of patient satisfaction used to be very transactional, Loundas said. Today, providers look at every touch point on the continuum of patient care to ensure that from the moment a patient calls to schedule an appointment, until the patient leaves the hospital with a post-discharge care plan, the experience matches the high level of clinical quality.

Better Options for Patients

One reason for the change is that individuals today are much more engaged in their own health care decisions. That approach, research demonstrates, benefits patients and providers alike.

“Back then (in 1893), a patient would never have asked questions about their doctor’s orders,” said Kate Newcomb, RN, a clinical liaison dedicated to the Pavilion, the innovative 17-story facility under construction across from the Hospital of the University of Pennsylvania. “Patients and their families need to play a part in their care, and be involved by asking questions and getting answers.”

Due to open in 2021, the Pavilion will provide 500 private patient rooms large enough to accommodate a private bath and a comfortable area for family members and caregivers to stay close by. It’s a far cry from the open patient wards of the early 1900s.

Kathryn Gallagher, RN, another clinical liaison, noted that the Pavilion’s project team is learning valuable lessons from colleagues at other Penn Medicine facilities that underwent significant facility expansions, including Penn Medicine Chester County Hospital, Penn Medicine Princeton Health and LGH. The counsel on past room design, interior décor, and patient and clinical technology selections help drive future efforts aimed at making the health care experience more comfortable and convenient at the Pavilion.

Technology upgrades offered within the Lancaster hospital’s $65 million Frederick Building expansion – which opened its first patient floor in April - include an interactive patient education and communication system. Christopher T. Addis, MD, chair of the LGH Department of Medicine, said the new in-room system – now being deployed throughout the 505-bed hospital, enables physicians to display a patient’s x-ray or lab results on a large screen, which will enhance engagement and shared decision-making.

“This is a very tangible way for patients to participate in their care, which helps them to feel more empowered,” Addis said. “It will lead to further questions and conversation, which to me is very energizing. It also breeds trust.”

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Views expressed are those of the author or other attributed individual and do not necessarily represent the official opinion of the related Department(s), University of Pennsylvania Health System (Penn Medicine), or the University of Pennsylvania, unless explicitly stated with the authority to do so.

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