Patient experience is about the people behind the statistics

Improving patient experience is all the rage these days. Hospital administrators across the land are talking about it. This can only be good for our patients and for the health care system at large. Satisfied customers are what every industry strives for. It is a bit sad however that it has taken the threat of looming financial penalties to make this happen.

Now that hospital reimbursements are directly tied to HCAHPS scores (Hospital Consumer Assessment of Healthcare Providers and Systems), every hospital has been forced to tackle the issue head on. For anyone who isn’t familiar with how the surveys work, patients will typically be given a questionnaire within the few weeks after their hospitalization, and will evaluate their hospital stay. A rating of “always” is needed to make the top grade. It’s a far from perfect method, but is what we are judged by.

As we try to improve in this area, many health care institutions appear to have gone astray. Having hospital committees sitting around in meeting rooms and talking about it is not enough. Neither does having a “Director of Patient Experience” or “Patient Experience Coordinator” automatically mean that you are on the right path.

I’ve met a lot of people, from health care leaders to entrepreneurs, who are banding around the terms “patient satisfaction” and “improving the patient experience” as if it was a fashion statement. I’m sure they are fine people with good intentions, but I can’t help but wonder if some of them truly comprehend what patient satisfaction is actually about. The same goes for all those Silicon Valley whizzkids and information technology professionals who talk about “revolutionizing patient experience.”

Do they really understand what they are saying? The drive to improve satisfaction is not just an opportunity to make money through new electronic systems. This is one problem that cannot be solved with a funky new app.

Patient experience is about the people behind the statistics on hospital spreadsheets. It’s about real people and their experiences. It’s about the emotional roller coaster of illness and how it affects human beings and their families. It’s about the story behind every disease. Those of us who practice medicine at the frontline get to see and feel our patients’ health care experiences each and every day. Ask any patient what they want out of a hospital stay, and what they will ask for really isn’t too much. Their answers will simply be along the lines of caring doctors and nurses, good medicine, and a quick cure.

So what will work?

First, let’s make sure that we teach doctors and nurses good communication skills. Techniques such as asking open-ended questions, maintaining eye contact, and sitting down, can all be taught — although they can easily be forgotten during a typical busy day. If there are any recurring problems with communication, we ought to deal with them promptly and attempt to rectify them. This should start all the way back in medical and nursing school.

Then, let’s have leaders who are really committed to the cause of patient-centered care. They should work closely with their frontline staff to improve the system in every way possible, while getting feedback from the very people who care for the patients. Doctors and nurses will know exactly where the system doesn’t work, what makes patients unhappy, and where we can do better.

Most of all, promote a system where clinicians have maximum time with patients. Put the doctor-patient relationship front and center of all health care. Cut the bureaucracy and computer time (which some studies suggest is almost now half of a doctor’s workday). Those are some of your straightforward answers.

When we get these fundamental issues right, everything else will fall into place. A colleague of mine put it well a few years ago when he remarked to me that when he treated elderly patients, he noticed that all most of them wanted was for the doctor to “sit down for five or so minutes and just talk to them.” All diagnoses and complex explanations aside, that’s what would make their day. And if that’s what makes patients feel better, then we should do it more often. Let’s exercise some common sense in other basic areas of comfort too, from how a hospital floor is designed, to just making sure every patient has a chance to get tasty (but healthy) food and a good nights’ sleep.

Think of the last time you had a great customer service experience. It wasn’t about gimmicks or keeping on being asked “how’s the service?” It was probably a time when you felt truly connected to those serving you. There’s often a fine line between customer service and tackiness. I remember an experience I had with a national bakery cafe chain several months ago. I visited the restaurant twice in the space of a week, and both times had a host come up to the table and ask me abruptly if I needed anything else. This doesn’t usually happen, and I was a bit mystified. Then as I was leaving each time, the same host came back and asked me to remember their name and fill out a satisfaction form. How tacky and fake! I hope health care isn’t going down this route. We have to be real.

Furthermore, even before the days of HCAHPS scores and patient satisfaction, was the care we provided really that terrible? Most of our parents and grandparents have wonderful memories of their personal physicians, house visits, and the doctor who would take care of the whole family. Was everything so bad when we didn’t wear the badge of “patient satisfaction”?

No — because back then we practiced the basic fundamentals correctly. We may have moved on in terms of sophisticated treatments and cures, but there’s a lesson here. Many current hospital initiatives are well intentioned, but as with lots of things in complex organizations, we tend lose the forest for the trees.

There’s no magic bullet. Hire the best doctors and nurses with a commitment to excellent patient care. Avoid gimmicks that an 8-year old can see through. Realize what really matters and take everything to the next level. Let’s not get too hung up on all the surveys, the apps, the customer service agents. Delivering excellent health care is simply about practicing thorough and competent medicine, good communication with our patients and their families, having adequate time with them, and being compassionate. No patient would ask anything more.

Truly understand and feel what the patient is going through at a low point in their lives when they have entrusted their care into your healing hands. What’s the most important thing to your patient today? It might be their pet cat, missing their grandchild’s birthday, or the fact that they got something they couldn’t eat for lunch. Learn about them as well as their illness.

As Hippocrates advised, “Cure sometimes, treat often, comfort always.” Patient experience is no bumper sticker.

Suneel Dhand is an internal medicine physician and author of Thomas Jefferson: Lessons from a Secret Buddha and High Percentage Wellness Steps: Natural, Proven, Everyday Steps to Improve Your Health & Well-being.  He blogs at his self-titled site, Suneel Dhand.


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  • Peter Elias

    I agree with much of what you say here, with one HUGE exception. you suggest that the first step is to teach clinicians better communication skills. I have no doubt that this is important and that doing so would be a very good thing. But first?

    Patient experience is about patients. If they are not at the table for discussions of how to improve their experience, then they are on the menu. The first thing to do is to put patients into positions where they can help control the things that impact their experience.

    Let’s do away with ‘in loco patientis’ approaches.

    Peter Elias, MD

  • rbthe4th2

    That is because they’re laying off nurses in the hospital and giving them way too many patients to take care of. I got in the hospital and I asked how to run the IV machine … give me extra cloths and towels … and I’ll do it. I rarely call them. If I know I’m going in I bake a ton of goodies for the whole staff. 8 months ago I had a nurse who I asked what was wrong, and she said she had a headache. She had a candy bar on her rolling station. I asked and she hadn’t a chance to eat it. I told her if she wanted I would keep the door closed and she could eat in my room and I wouldn’t say anything. I’d say that she was helping me out if needed.
    The other is I think doctors and nurses should take time with family so they know what it means to be human, to connect. Medical school appears to have its first maxim as beat that out of people.