How Hospital Parking Kills Patients, Pt. 2
So I got curious: I asked my patients, in a kind, patient, and empathic way, “Why are you late for surgery?”
Almost every family had the same answer: parking.
What does hospital parking have to do with bias in healthcare? And what does solving for parking have to do with making healthcare more financially sustainable, and improving outcomes overall?
As I discussed in my last piece, uncovering and addressing unconscious bias is a complicated undertaking. It’s one thing to have understanding and compassion for those who are like you, but expanding beyond that viewpoint to give everyone the benefit of the doubt is a powerful step. It comes from engaging with people and seeking to comprehend their circumstances out of genuine curiosity and empathy. It’s especially important for those of us in positions of relative privilege and influence, who hold the keys to desperately needed resources — like medical treatment — to foster our own curiosity and empathy.
Almost all hospitals have garages where people can park their cars while they or a loved one are being treated. Say the cost of parking is $12 for two hours, and $40 for eight. That’s before validation, which knocks it down to $10 for an entire day. This probably sounds reasonable, but for those already struggling to pay for healthcare, it can present a significant barrier. The validation process can be unclear — prohibitively so for those learning English — and the amount shelled out for parking may represent a substantial chunk of a person’s discretionary income.
When I finally asked why so many of my patients had been late for surgery, I learned that their parents had been circling the hospital in ever-widening loops for minutes or hours in search of street parking — in a neighborhood, I’ll add, that also included the notoriously packed Fenway Park. Add to that the time it takes to walk from whatever parking they did find to the hospital, with a child who’s already tired, under duress, and in need of a surgical intervention, and you can see how our fine-tuned schedules were impossible for parents and patients.
Far from being lazy or disinterested, as some of my colleagues had seemed to assume, these caretakers were doing just about everything they could to get their kids the care they needed. They took time off work, took their kids out of school, and sometimes walked a mile or more. These people weren’t indolent. They just couldn’t afford to add parking costs to that list.
In Massachusetts where nearly 16% of households face food insecurity, paying for parking is not a priority.
Once I knew what the problem was, it was easy enough to solve: I asked my patients if parking was a challenge for them and offered those who wanted help free vouchers for the garage on the day of the operation. Just like that, they stopped missing or showing up late to their procedures. All it took to uncover the root issue behind late patients and delayed surgeries was the simple curiosity and compassion to ask my patients about their experiences. All it took to address the problem was a basic fix that cost us $10 per patient — far less than a rescheduled surgery.
I was elated. I had solved a problem that had been plaguing the hospital, and made it possible for the patients I was dedicated to serving to get the help they needed, without the potentially disastrous delays. Excited by the development, I shared it with hospital management. We could put an end to the wasted time and unused resources that had been throwing our operating rooms into chaos. We could make more care more accessible to more patients.
The hospital’s response stunned me: I was ordered to stop. Legal counsel had explained to management that paying for a patient’s parking could be seen as a monetary incentive coercing them into care. While the concrete, positive effects were clear, the potential liability placed the hospital in legal jeopardy. I would have to stop covering patient parking, lest I put the hospital at risk for a lawsuit or federal fines.
And it’s not that the hospital was especially cautious or overreacting. The truth is this problem is built into our legal system and affects every hospital at every level.
I have deep respect and admiration for every hospital where I’ve worked, including the institution that saved my life when I was a small boy, and the one I am proud to be part of as a surgeon today. From the top down, we are doing the hard work of reflecting, consulting and taking action against bias. This story is not meant to denigrate this institution, or any other hospital. Rather, I want to show that even at the best hospital, hypothetical legal risk and cultural bias can block attempts to alleviate structural issues.
Fortunately, there has been a trend within healthcare toward cultivating and prioritizing empathy. Healthcare institutions and organizations beyond are waking up to the idea that living up to the promise of addressing wellness in patients goes beyond prescriptions and blood work.
But it’s not clear who will pay for these programs. Is it the onus of doctors or hospitals to help children get enough to eat? Is it an administrative issue? And once programs have been set up, how does the healthcare system connect people to those resources? How do we make it an efficient, sustainable program that can be adopted at scale? This is an area where public-private partnerships, a mix of philanthropy, institutional, technological and venture support, may be able to pave the way. In addition to vital organizations and nonprofits doing this work, I predict that companies will begin to emerge that will work with hospitals to address food insecurity, and offer options like microfinancing to pay for healthcare expenditures.
The startup community is already making crucial efforts. Companies like Violet are working to benchmark and publicly recognize medical professionals around cultural competence, and offering training to help them increase their knowledge and skills. I am eagerly waiting to see the emergence of startups addressing other social needs that so often fall through the cracks — things like food insecurity.
The reality is that our healthcare and insurance systems as they are now are broken. Research has shown that even people with private insurance through their employers are dissatisfied with their coverage, skip routine preventative care due to cost, and are more likely to experience medical debt. And yet it’s “those people” — the ones without private insurance — who face negative bias and deliberate deprioritization within the healthcare system.
Of course, I don’t have a simple answer for how to fix the healthcare system’s current problems. No one does. There are no simple answers to questions like these. The hospital parking garage is one example of how small-scale, individual intervention — as small as asking a simple question — can have a major impact along the entire care and revenue chain of a much larger health system.
It also showed me that small-scale intervention is not nearly enough. We must combine the compassionate urge to address problems on an individual basis with the big-picture reckoning it takes to face the greater problem. Those who measure legal risk must remember what that liability is, at its core, meant to represent: human safety and wellbeing. Meaningful change must begin with empathy, and the firm belief that everyone is from the same human family. Through this lens, we can start to deconstruct, and forge a new path forward.
We have to keep asking patients, “Why?” with love and kindness when we seek to understand a problem. And when the obvious solution is deemed too risky, we also have to keep asking ourselves, and the institutions we work within, “Why not?”