Patients’ definition of their own experience is quite divergent. We ask patients for feedback, and the results are fascinating. We’ve found that patients often use the word experience in their comments: “I can’t believe how the experience in this hospital was.” “This place is amazing— everyone is so friendly and caring.” A patient remarked to our CEO on one of his leadership rounds, “Where do you find all of these angels to take care of patients?” Occasionally, patient comments are less complimentary:
“My experience was terrible!” Patients tend to define their experience based on an “in-the-moment” encounter or a specific significant occurrence. Regardless of the quality of the entire journey, it will be the one or two great — or bad — events that will define a particular patient’s experience.
Patients’ perceptions, and, therefore, their patient experience definitions, are also influenced by the people around them. Once, when he was chairman of the department of thoracic and cardiovascular surgery before becoming CEO, Cosgrove was summoned urgently to a patient’s room after surgery. The operation had gone well, and he believed the patient to be recovering without incident. Concerned, he ran to the room, finding the patient visiting with family and doing fine. A family member implored Cosgrove to look under the bed, where she pointed out dust bunnies. She asked the world-renowned surgeon, “How can this hospital provide top care if you can’t even clean the floors?” Cosgrove was stunned. Why were the family members evaluating the organization’s quality on dust bunnies when their loved one had a successful outcome from a difficult operation? He was getting firsthand insight into how patients judge our overall effectiveness based upon seemingly minor things that they readily understand.
I once rounded on one of my patients, and in the room were several family members. They knew of my role in patient experience and immediately wanted to relay a terrible experience they had had in our hospital cafeteria. They went on to describe, “We waited at the counter and the employees just ignored us. People down there were not helping us. The cashier person was rude. She was too busy talking to her partner.” The patient, who had not even been in the cafeteria with his family members, piled on, “Yeah, that is no way for a hospital cafeteria to function.”
I thought this patient’s experience so far had been very positive. He had a good medical outcome, the nurses and I were attentive, and he was happy with our interactions. Does the bad experience of a family member in the cafeteria impact the patient’s perception of his experience while in the hospital? I am not sure anyone knows the answer for certain. However, to ignore the possibility would be to diminish the impact of family dynamics on perceptions and opinions. We must assume that occasionally the patient’s personal and family experience in the hospital environment outside of the patient’s room will impact survey results. There may also be a disconnect between patients’ perceptions and how care was delivered. One patient wrote to our organization, “Your hospital is really bad. They hurt me.” Those are tough words for a health care professional to hear.
Yet often, when we review a dissatisfied patient’s medical record and discuss the experience with the team that took care of him or her, we discover that, in fact, the outcome was very good, it met our standards of medical care, and all the members of the team thought that they were going above and beyond what was required to ensure that the patient and family experience was exceptional. When I asked this particular patient what he meant by “hurt,” he expressed disappointment at having to undergo treatment in the first place. We were not being judged on the care or the caring; we were being evaluated on the patient having the disease — a battle we could never win, but a very important illustration of how some patients think. Often patients’ definition of “quality” is not our definition of quality. Patients relate to things they understand, and that drives their perceptions.
Patients frequently use their experience with service quality to define their perception of the health care they received. If you ask patients to tell you “What is it about your stay that made the experience great,” they often zero in on a specific item such as “The doctors explained things well and were very nice,” “The nurses were very attentive,” or “The building is new and clean.”
This global grab bag of comments demonstrates the challenge: If the patient experience can mean anything, then how do you define it as an organization and, more important, how do you fix it? Patients have widely varying perspectives, and it is unreasonable to hold patients to a single definition of how they think about the patient experience. The patient experience can mean anything, can differ from patient to patient, and is highly perspective — and experience-based. A patient will define the experience from his or her unique vantage point, which is often determined by a single good or bad event. This is what patients remember.
James Merlino is chief experience officer, Cleveland Clinic and author of Service Fanatics: How to Build Superior Patient Experience the Cleveland Clinic Way