What is Patient Experience, How do You Measure it, & is There Anything Wrong with this Picture?

FollowFollow on FacebookFollow on Google+Tweet about this on TwitterFollow on LinkedInFollow on TumblrPin on Pinterest

Health Leaders Media surveyed healthcare leaders in 2010, 2011 and 2012 on patient experience issues, with a focus on HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems).  Pronounced “H-Caps,” this measurement syste, in the words of its creator, the Centers for Medicare and Medicaid Services of the U.S. Department of Health and Human Services, is “the first national, standardized, publicly reported survey of patients’ perspectives of hospital care. . . . While many hospitals have collected information on patient satisfaction for their own internal use, until HCAHPS there was no national standard for collecting and publicly reporting information about patient experience of care that allowed valid comparisons to be made across hospitals locally, regionally and nationally.”

A “massive” 84 percent of those surveyed in the 2012 HLM report said that patient experience (sometimes known as “PE”) is one of their three top priorities, with 24 percent denoting it as priority number one. Other surveys and the healthcare blogosphere substantiate this importance, and patient experience has been linked to customer service and employee engagement.

Inasmuch as patient experience ratings are now affecting individuals’ choices of hospitals and hospital federal reimbursement rates, attention to this factor can only be expected to increase.  The HLM survey said that 85 percent reported having put more time and resources in the past year on efforts intended to raise patient experience scores, with training and use of consultants being frequently cited.

“Patient experience” seems to be replacing “patient satisfaction” as a new buzzword, though some seem to see a distinction favoring them former.  Certainly we can all hope that patients are satisfied and that they have a good (or at least optimal) experience.  But what does that mean and how can it be measured?

A majority (56 percent) of those surveyed in the HLM report actually maintained that HCAHPS is not a valid indicator of patient satisfaction. Indeed, only 75 percent said they actually use this data. Outside services for measuring or benchmarking patient experience were used by 62 percent of these organizations, with 59 percent also citing follow up phone calls to discharged patients. In addition, 41 percent said they track anecdotal sources such as letters from patients and social media and 18 percent claimed to sponsor community opinions surveys.

Some respondents even maintained that patients’ subjective opinions don’t really correlate with whether their care was good or not. Of course that’s like saying that students can’t tell whether they were well educated or that restaurant diners don’t really know what good food is: whatever truth there may be in such assertions, institutions get paid and survive according to what people think of them.

So health care providers must address these issues, if only because the government, insurers and consumers are forcing them to do so.  Some hospitals even have a Chief Patient Experience Officer and other staff for this purpose.  Just as consultants can claim to help schools improve educations testing scores, so raising patient experience ratings will no doubt have a practice of its own.

CMS and HLM also want hospitals to make more use of Internet portals to measure patient satisfaction.  As part of the drive toward electronic records, CMS has mandated “meaningful use” of patient Internet portals, with a standard of 5 percent of patients using them.  Practices complying will receive an economic incentive. But the HLM survey shows that only 19 percent indicating that their portals have the advance features needed, with 61 percent saying that they are working on it and 21 percent having no plans to do so.

All very well and good – maybe.

If one takes a system view, however, a feeling arises of “What’s wrong with this picture?” In the first place, as in the case of patient advocates, is establishing another set of actors, adding to the already overly bureaucratic healthcare environment, really going to help?

After all, isn’t it already the job of all healthcare employees (doctors, nurses, attendants, administrators) to ensure that patients have a good experience? So why it is necessary to add more personnel and resources instead of putting the emphasis of seeing that the existing ones are doing what they are supposed to do? If a restaurant is getting bad review, do you improve the quality of the food and service or do you hire people to circulate among patrons to see that they are having a good experience?

The HLM report notes that “every patient/staff interaction is a patient experience opportunity”. Why not put the emphasis on motivating and training those involved in such interactions to provide a good patient experience in the first place?

As to web portals, the five percent target if achieved would mean that ninety-five percent of patients are not being counted.  Moreover, one might ask why patients have to go onto the Internet to report what they feel.  Why couldn’t that information be collected while they are at the hospital? And in so many situations, it seems that trendiness causes promotion of on-line and social media methods when simpler and more direct methods might actually work better and cheaper.  If those responsible for actually providing the patient experience were involved in collecting the data, won’t they more likely to take it serious that it comes around in a circle from outside sources?


Print Friendly, PDF & Email
This entry was posted in Communication in Healthcare, Complexity in nursing, Nurse Leadership, Patient Advocacy, Patient Safety and tagged , , , , , , , , , , , , , , , , , , , , , , . Bookmark the permalink.

9 Responses to What is Patient Experience, How do You Measure it, & is There Anything Wrong with this Picture?

  1. Pingback: A Strong and Convincing Piece on Patient Satisfaction: In the News with Jim Murphy

  2. Pingback: Sleep Deprivation as a Social, Organizational and Healthcare Issue (Book Review)

  3. Pingback: Seven Questions About Seven Ways to Increase Patient Satisfaction

  4. Pingback: Let’s Make Patients Happy! (It May Be Easier Than Making Them Well)

  5. Pingback: Supplementing HCAHPS? Ten Quality Improvement Questions for Everyone in Healthcar

  6. Pingback: The Future of Medicine – Are Terms Like “Health” & “Care” Becoming Obsolete?

  7. Hi Jim and Lori,
    Very interesting dialogue. I think it speaks to challenges in defining, respecting, and validating patient experience. Yet, we must also do this in the context of nursing and medical expertise, budgetary incentives and limits, and a million variables that human beings have including but not limited to: religious beliefs, cultural differences, financial wealth, social support, height, medical history, weight, jello preferences, family dynamics, allergies, age…..

    Sometimes, I think we need to define basic healthcare in the USA. Even this seems complicated, but possible.


  8. Jim Murphy says:

    Thanks, Lori, for a very amusing – and significant – anecdote!

    I don’t think anyone would maintain that patients don’t have opinions about their treatment. So what the person quoted means is that these opinions don’t count because patients don’t know enough about treatments.

    Now imagine a hospital where morale among nurses is bad. You are called in as a consultant and suggest that the nurses be surveyed as to what’s wrong. But management disagrees because “they don’t know how a hospital should be run”.

    Just a patient – just a nurse – just a voter – just a customer – who cares what they think? If this person were the owner of a bookstore that was losing money, would her explanation be that patrons just don’t what kind of books they should buy?

    Moreover, as to patient knowledge, isn’t it the job of hospital staff to enlighten the patient? If you are treating someone, aren’t they supposed to be informed about their condition and treatment – simply as a part of good healthcare practice, never mind HCAHPS? And if something might negatively impact them once they go home, isn’t it good medical practice to give them what they need to know so that does not happen?

    Restaurants exist to meet the needs of and satisfy diners. Schools exist to meet the needs of and satisfy students. Hospitals exist to meet the needs of and satisfy patients.

  9. Hi Beth,

    Great post. I once met a woman in an airport who said she collated the HCAHPS surveys. So I asked if they’ve ever considered asking patients (via survey) if they had experienced any complications while in the hospital or after they got home. Or if they would consider asking if anything went wrong and if so, simply asking “what can we do better?”

    Her response was that patients don’t really know what a complication is (!) “They would report anything from a little wound drainage that could be completely normal to things that might be out of our control that happened after they get home.”

    It reminded me of when I was still in nursing school and some doctors used to ask “why would a dad want to be in the delivery room for the birth? what would they do???”

    Patient engagement can’t happen without PATIENTS at every level; in the design, policy-setting, and delivery of care.

    Thanks for bringing attention to this issue,


What are your thoughts?