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Providers and Patient Experience

By Lindsay Jubelt Moderator Emeritus | 02 Dec, 2014

In the recent Journal of General Internal Medicine (JGIM), Rebecca Anhang Price and colleagues address common critiques of patient experience measures. Here are the seven criticisms they identify:

1. Consumers do not have the expertise needed to evaluate the quality of care
2. Patient “satisfaction” is subjective and thus not valid or actionable
3. Emphasis on patient experiences encourages providers to fulfill patient desires, leading to care that is inappropriate, ineffective, and/or inefficient
4. There is a trade-off between providing good patient experiences and providing high-quality clinical care
5. Patient scores cannot be fairly compared across health care providers due to factors beyond providers’ control
6. Response rates to patient experience surveys are low, or responses reflect only patients with extreme experiences
7. There are faster, cheaper, and more customized ways to survey patients than the standardized approaches mandated by federal accountability initiatives.

I am a big supporter of patient experience. Despite this, I can still relate to a number of these criticisms, and I hear many of them echoed by friends and colleagues. If we are to embrace patient experience measures as providers and health systems, how do we get past these concerns?

What are readers’ reactions to these criticisms of patient experience? Do you agree or disagree?
I encourage you to read Price’s piece in JGIM and see if your reactions change.

Attached resources:



Mighty Casey Replied at 12:59 PM, 3 Dec 2014

I think both "experience" and "engagement" have been reduced to buzzword status in the overall healthcare discussion, largely due to overuse by the marketing department. Measuring either one is almost laughable, since both are so subjective for both sides of the transaction. Add to that the fact that most Press-Ganey/HCACHPS surveys are given to the patient up to 60 days post-discharge, which means the data collected is at least suspect, at worst utterly useless.

I bang on constantly, everywhere, about the need for health LITERACY before anyone can talk about patient-side "experience" or "engagement" - working on that should be Job 1. Without real literacy-building initiatives, it's going to remain too easy to say "patients are too dumb to understand [whatever]" and we'll be stuck on square one forever.

Emilia TAI Replied at 1:15 PM, 3 Dec 2014

I absolutely agree with you, Mighty. The "medical" shield has been too often used and abused by some professionals (no offense to doctors) - one significant part of patient experience is the relationship and dialogue with care givers - patient centered care is about engaging the patients in being actors of their care and studies already shown that this increases their adherence to treatment, hence improving outcomes.

Tom Catron Replied at 1:43 PM, 3 Dec 2014

Patient surveys are fine if we use them for what they actually measure: stale memories of the care experience using poorly worded questionnaires. Unfortunately, surveys are used as markers for reimbursement and QI actions - and sometimes physician compensation/performance review- despite the lack of data supporting the relationship of surveys with medical outcomes or other quality indicators. Consequently, we waste substantial resources trying to raise our survey scores rather than addressing personal performance and systems issues that actually make a difference.

The burden appears to be on medicine and healthcare to produce and promote the science and policies that make more sense to our industry. We utilize unsolicited patient dissatisfaction reports (not satisfaction surveys) and staff observations for risk management and quality purposes because our research (and others) support the connection and positive outcomes. Unfortunately, our healthcare enterprise also chases patient satisfaction scores because our credentialing and payor systems require it.

Mighty Casey Replied at 2:47 PM, 3 Dec 2014

Tom, I'd invite you, and any other clinician/system-side human to find a robust patient-side community to engage with. Some recommendations would be the Society for Participatory Medicine and/or MedX (both linked).

I'd also recommend joining in on the Patient & Family Engagement work emerging from a project (full disclosure: I worked on this) funded by the Gordon & Betty Moore Foundation (also linked).

When it comes to easily deployed literacy tools, Emmi Solutions (linked) has 'em. They're a company, not a charitable org, but that's not a negative. I have no financial interest in them, but I know some of their team personally.

I myself came to the healthcare policy game as a journalist and family caregiver. The patient side has MUCHO resources, if only the professional side would recognize that the lack of letters after one's name doesn't mean "clueless" ...

Attached resources:

Thomas Tsai Moderator Emeritus Replied at 2:28 PM, 5 Dec 2014

To play devil's advocate here, there's actually more robust empirical evidence that patient satisfaction/experience is related to measures of hospital and health care quality. Even if there were NO evidence, would it matter? Shouldn't we intrinsically care about including our patient's experience? Most of us went into health care because we wanted to help patients and be responsive to their needs. Factoing patient satisfaction is not only good health policy, it's also good medicine.

Attached resources:

William Martinez Moderator Replied at 10:03 PM, 11 Dec 2014

I agree with many of the criticisms outlined in the JGIM article. I will add that I find the general term "patient satisfaction" to be somewhat meaningless. Satisfied with what? I think it needs to be very specific. How satisfied were you with the way your doctor ...explained your medical condition? ...listened to your concerns? ...answered your questions? etc.

I agree with Mighty Casey that health literacy is of critical importance. Patient Satisfaction With "X" = Patient Experience / Patient Expectation/Estimation for Satisfactory Experience with "X". If the experience matched or exceeds your conception of what a satisfactory experience would be, you are by definition satisfied. Of course if your expectations are low and uninformed then satisfaction is meaningless. Perhaps measuring and accounting for expectations in the measurement of satisfaction is one way to improve it? Health literacy is a prerequisite for appropriate expectations in many areas. On the flip side, even patients with low health literacy can provide very important information about their satisfaction with certain aspects of the their experience (eg, how satisfied were you with the way your doctor listened to your concerns?)

Patient satisfaction data about certain aspects of patient experience (particularly areas where the patient is the expert) can be very valuable and important if captured and measured appropriately. General satisfaction and the measures of satisfaction I have seen thus far fall short in many ways as outlined in the article and noted by many of you in this thread. I agree with Tom above (full disclosure I work with him on related projects) that patient dissatisfaction (or complaints) if properly collected and analyzed are a powerful tool for improvement.

I hope "patient satisfaction" will not be abandoned but improved in how we measure it, talk about it, and promote it.

This Community is Archived.

This community is no longer active as of December 2018. Thanks to those who posted here and made this information available to others visiting the site.