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The Problem with Patient Experience

  • Patients are most satisfied when a trusting relationship is developed with their physician and caregiver team.
  • Elements like parking, food quality, and billing are rarely relevant in terms of how a consumer perceives overall quality or likelihood to recommend.
  • Given connection between excellent patient experience and clinical outcomes and safety, incentives and rewards should be in alignment.

By William Maples, MD, Executive Director for The Institute for Healthcare Excellence and Candace A. Quinn, COO, Professional Research Consultants, Inc.

As a result of an article that we saw recently in The Atlantic that attempted to describe the quest for creating an excellent patient experience as one that has nurses and caregivers pursuing some holy grail of happiness, good food, and smiles, we reflected on the importance and impact of patient experience on the overall care and eventual health of each and every patient, and, we have reaffirmed our conviction that our industry must first develop an understanding of what are the key drivers that determine excellence in patient experience and engagement.  So often this definition is assumed to equate to many of the characteristics outlined in the Atlantic article, including giving the patient what he/she is asking for, an exceptional “hotel” experience, and “the patient is always right”.

However, if one reviews the longstanding literature on this subject, (or takes the time to speak to over two million patients each year) one finds that excellence in the eyes of the patient has very little to do with these factors and rather has to do with the ability of the physician and caregivers to be present, listen to the patients and each other, demonstrate respect and compassion, and convey to the patient that he/she understands the concerns raised by the patient. When completing statistical analysis of key drivers leading to excellent patient experience within the Professional Research Consultants (PRC) (one of healthcare’s premier patient experience measurement companies) data base, the top factors include teamwork and understanding and connecting with the patient. In addition, these findings were nicely summarized in a Harris study of 2,267 patients in 2004. Patients are most satisfied when a trusting relationship is developed with their physician and caregiver team.  Just as with parenting, this does not equate to one party always being right or “getting what they want.”  Rather this trust develops with honest, intelligible, compassionate and engaged dialogue resulting in a common understanding of the situation at hand.

Achieving and sustaining significant improvement in patient experience metrics has been elusive and often times frustrating for healthcare organizations.  Frequently this is due to organizations attempting to create this experience by focusing on false assumptions of what will contribute to this exceptional experience rather than focusing on the key drivers.  This often results in an unsuccessful journey to improve patient experience while simultaneously losing focus on the opportunity to create a culture of teamwork and respect where safety and outcomes will flourish. While healthcare organizations may measure elements like parking, food quality, and billing, at the end of the day, none of these elements when considered against how a consumer perceives overall quality or likelihood to recommend are rarely relevant.  It comes back to teamwork, understanding and connecting with their physician and the creation of that trusting relationship.

There are many articles highlighting the connection between patient experience and clinical outcomes and safety.  A summary of 55 articles on this topic is presented in the work from Doyle in the British Medical Journal Open (BMJ open) 2013;3.  A positive association between achieving excellence in patient experience and outcomes was demonstrated in this comprehensive analysis.

So how does the industry approach patient experience and close the gaps in what patients want during a medical visit and what they experience?  The answer begins with investing in communication skills training for physicians and all caregivers.   These skills can be learned/reinforced and help physicians and caregivers reconnect to the purpose that they originally chose medicine for their career.   Through this focused training, a culture of teamwork and safety results; as well as strong relationships/connections between patients, physicians and the caregiver team. Multiple institutions participating in this skills based work have demonstrated significant sustained improvement in patient experience including one institution reaching top national performance for two consecutive years.  Simultaneously, improvement in the culture of safety and clinical outcomes, similar to what has been described in the literature as referenced above, has also been witnessed.

By focusing on the key drivers of an excellent patient experience, performance on the HCAHPS metrics will follow without the need to focus on each individual element in the HCAHPS bundle. For instance, prompt answering of a call bell becomes the responsibility of the team instead of any available soul…and if the appropriate relationship building conversations with the patient/family occur up front, it is then when the opportunities to meet the needs or educate the patient/family are seized.  This type of connection will lead to less frequent use of the call bells as the needs of the patient are heard and addressed in a timely fashion, resulting in more time to devote to the needs that develop moment to moment in the hospital setting.

Given the connection between excellent patient experience and clinical outcomes and safety, it appears most appropriate that these metrics be tied to incentives and rewards as this is a win for the patient, a win for the physician and caregiver team, and a win for the institution.  The return on investment from improving quality has been estimated in the range of 5 to 1.  With physicians and caregivers working on the true key drivers of patient experience, there is no difficulty justifying the connection to rewards.  However, this justification is more difficult to make when the focus of the work is on initiatives arising from false assumptions of contributing factors to an excellent patient experience.

In conclusion, readers and the authors of the Atlantic article are encouraged to pause and reflect upon the true definition of an exceptional experience from the patient’s perspective and then reframe the question of the importance of patient experience in achieving safe, efficient, effective, and compassionate care.  The question becomes clear…as an industry do we really have a choice not to focus on this journey?

—contributing authors William Maples, MD, Executive Director for The Institute for Healthcare Excellence and Candace A. Quinn, COO, Professional Research Consultants, Inc.

Maples is a board certified Medical Oncologist and also serves as Chief Medical Officer for PRC.

Quinn has her MBA from Kellogg Graduate School of Management at Northwestern University and prior to her role at PRC had served as CMO for multiple health care organizations and brand consultant to dozens more.