Defining Patient Experience: Yes, it is about patient satisfaction, but it’s so much more

1 December, 2016

It’s time to clear the air.

“Patient experience” and “patient satisfaction” are getting thrown around willy nilly. Some are using the two terms synonymously. Others are using one or the other as a proxy for quality of care. And still others are misusing these terms so heavy-handedly that they obscure the role of health and clinical outcomes entirely. In addition to these misunderstandings, throw in health systems creating entire patient experience departments and hiring for positions like “Chief Experience Officer” and “Director of Patient Experience” at an exponential rate, and we have ourselves a quagmire.

Don’t get us wrong: we believe strongly that patient experience should be the top priority for health systems, but it is this dedication that causes concern when patient experience is misinterpreted and misused.

Patient satisfaction is an important brush stroke in the patient experience picture, but its shortcomings need to be understood so it can be put in its right place.

Patient satisfaction a good start, but an imperfect metric for quality and value of care

Ask any physician how they feel about patient satisfaction scores and you’ll see a lot of shrugging. Physicians are not calling for patient satisfaction to be wholly tossed out, but many are upset that it’s being extrapolated as a quality metric for physicians. This isn’t unwarranted.

For example, if a patient has his or her heart set on a particular prescription that doesn’t align with the physician’s diagnosis, that patient could make the doctor and health system suffer with a poor patient satisfaction rating. In a higher stakes example, if a patient needs an emergency kidney transplant, and the procedure is executed smoothly, does it matter that he or she spent two hours longer in the waiting room than desired, or if the nurse was terse in the explanation? “I’m alive!” would be the apt takeaway for that patient. In both cases, physicians may have performed their duties expertly, but patient perceptions may not accurately capture that high quality of care.

Some physicians feel duped by the federal government and payers for tying payment to patient perceptions. With Medicare reform relying on HCAHPS, oft-used Net Promoter Scores (NPS) treating a doctor’s appointment like a laptop purchase at Apple, and “find a doctor” websites like Zocdoc and Healthgrades averaging and publishing subjective consumer reviews, it’s clear that physicians’ and health systems’ bottom lines, from many different angles, are increasingly linked to patient satisfaction metrics.

Dr. Joshua J. Fenton presented a more dire perspective of patient satisfaction in 2012 with a national study. The authors of “The Cost of Satisfaction” concluded: “In a nationally representative sample, higher patient satisfaction was associated with less emergency department use but with greater inpatient use, higher overall healthcare and prescription drug expenditures, and increased mortality.” These conclusions have been found to be less than legitimate, but the premise should be taken seriously: due to market and federal pressures, physicians and health systems might pay more attention to satisfying patients than to treating them. If that were to happen, the health outcomes could be catastrophic.

Contrast Dr. Fenton’s findings with the literature published by the British Medical Journal in 2013 and one should be able to step back from the patient satisfaction abandonment ledge. The Journal found that patient experience was positively associated with patient safety and positive clinical outcomes in three out of every four cases. There was a negative association in only 1% of cases studied.

Patient satisfaction should not be neglected, nor should it be elevated to a holy-grail metric.

A place, where, mutually, patients are highly satisfied and health outcomes are positive, is typically going to be one where a physician and/or health system has struck the balance, and has viewed patient satisfaction in its right context within the larger patient experience picture.

What does that picture look like?

ImConnect recognizes The Beryl Institute’s definition of patient experience

A 2015 study by the Beryl Institute on “The State of Patient Experience” found that an understanding of patient experience was lagging behind passion for improving it. Eight out of ten U.S. hospitals, care centers, and practices were found to be formally addressing patient experience, but less than half of those organizations actually have a functional, formal definition of what patient experience is. The likelihood of misinterpretations and confusion between terms, metrics, and approaches isn’t that surprising.

At ImConnect, we recognize The Beryl Institute’s holistic definition of patient experience:

“Patient experience is the sum of all interactions, shaped by an organization's culture, that influence patient perceptions across the continuum of care.”

Notice that patient satisfaction is hinted at in the definition, but is classified as a symptom, not the root. Patient experience is made up of every interaction, which all influence how the experience is perceived. How does one know what the patient perceived? Depending on how they are utilized, patient satisfaction scores are a great way to give those patients a voice.

The President of The Beryl Institute, Dr. Jason A. Wolf, broke down the distinction:

“Patient experience is not just about satisfaction or even essential efforts such as patient engagement or approaches such as patient- and family-centeredness. Rather, experience is ALL someone has in their encounter with a healthcare organization.”

All encounters and interactions across the entire continuum of care typically goes beyond the time frame of patient satisfaction scoring, and it often begins much earlier than physicians and health systems typically account for. This is why ImConnect is passionate about its “Find a Doctor” online search and scheduling platform. In Deloitte’s groundbreaking study, “The Value of Patient Experience,” patients not only acknowledged the searching and scheduling process as part of their patient experience, they prioritized it, ranking it as the third and fourth important factors in their patient experience, right up there with their actual treatment. All interactions includes the first interaction. And as they say, you only have one chance to make a first impression.

It’s important to view patient satisfaction in its context, and as an important step in the right direction. The destination? Quality patient experience.

Stay tuned for more patient experience coverage, like designing organizational culture and understanding the continuum of care.