Perception is Patient Reality: Experience vs. Satisfaction
By Jennifer Kennedy, Vice President Quality & Standards
The “patient experience” is a top issue in most healthcare provider quality programs, and quarterly patient satisfaction scores are closely analyzed to identify gaps. But is patient satisfaction and the patient experience the same?
The Agency for Healthcare Research and Quality (AHRQ) describes the patient experience as encompassing “the range of interactions that patients have with the healthcare system, including their care from health plans, and from doctors, nurses, and staff in hospitals, physician practices, and other healthcare facilities. As an integral component of healthcare quality, patient experience includes several aspects of healthcare delivery that patients value highly when they seek and receive care, such as getting timely appointments, easy access to information, and good communication with healthcare providers”. AHRQ states that patient satisfaction is about a patient’s expectations for his or her care encounter, and in essence, is a subjective healthcare measure.
Patient satisfaction and patient experience may be used reciprocally, but they are not equal. For example, Mrs. Ross was scheduled to receive oxygen from her home health provider’s contracted durable medical equipment (DME) vendor on August 28th. The patient experience assessment for the home health provider in this scenario identifies whether the oxygen was delivered on time and that education about oxygen use was provided to Mrs. Ross by the DME vendor. Mrs. Ross’s satisfaction is about whether her expectations were met.
Patient experience and satisfaction are different, but both drive person-centered care and have implications related to healthcare quality. Therefore, providers must understand the difference between the two, how to apply them appropriately to daily operations, and how to measure the data each one produces.
Perception and expectation
An individual’s perception is their reality. Two patients can receive the same care and provide different satisfaction ratings due to individualized expectations for how that care is supposed to be delivered.
A patient’s perception is individualized and shaped by personal beliefs, values, cultural background, age, education level, socioeconomic status, health literacy, and previous health care experiences. Healthcare providers implement consistent processes and apply standards of practice for their entire patient population to achieve a positive perception of the care experience. However, based on a patient’s individual characteristics, the perception of the care experience cannot be consistently ensured.
It is critical for all healthcare providers to determine patient and family expectations at the start of the provider-patient relationship. Asking key questions such as:
- what is important to them
- what they expect from the provider
- their hopes for health outcomes
- how to achieve those outcomes
How and when communication takes place will reveal information for the provider to develop an individualized, person-centered experience that meets those expectations within reason. Determining what the patient values also ties to their expectations for care.
Studies indicate that patients have increased satisfaction with their care when it meets their expectations. They equally value quality clinical care and the interpersonal aspects of care delivery. In fact, several studies show that patient-provider interaction, shared decision-making, and interpersonal qualities are among the highest ranked aspects of a quality care experience. Not discussing patient and family expectations can be a path to less than positive patient care experience and lower satisfaction ratings. In the case of hospice care, providers have one opportunity to meet expectations for a terminally ill patient and their family, and a less-than-positive experience will have a lasting emotional impact on the patient’s family. A significant part of the quality improvement process is to continuously assess and monitor the processes and care provision that impact the patient experience; it is never once and done.
CAHPS Surveys and Patient Experience
The Centers for Medicare and Medicaid Services (CMS) utilizes the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) and its specific provider-type surveys to measure patient experience with healthcare. The CAHPS surveys are focused on patient experience measurement and include topics that center on aspects of quality that patients value, such as the communication skills of providers and ease of access to healthcare services. All CAHPS surveys focus on the following areas:
- Communication with healthcare professionals
- Access to care and information
- Customer service
- Coordination of care
Survey questions are structured to assess the patient’s perspective in these designated areas. In hospice, the patient’s primary caregiver completes the survey, so hospice providers must pay attention to the patient and family experience equally.
Providers should review all CAHPS questions carefully to help them build the optimal patient experience. For instance, if an aggregate score is lower than the national average for hospice CAHPS measure “Communication with Family”, the provider should drill down to the individual questions that feed that measure and then drill down again to organizational and clinical practice to identify gaps. But providers should not forget to begin by asking what is important to the patient, so their care experience can be individualized right from the first contact. Dedicating resources to improving CAHPS scores is a commitment to enhancing the care experience and quality of care for every patient and family. While scores are important for a variety of reasons in today’s healthcare landscape, ensuring an optimal patient experience is the priority outcome. It is all about the patient’s perspective, and perspective is their reality.
Hirpa, M., Woreta, T., Addis, H., & Kebede, S. (2020). What matters to patients? A timely question for value-based care. PLoS One, 15(7), e0227845.