Can We Meaningfully Dissect the Patient Experience?

October 20, 2017

When value-based purchasing began, the patient experience was measured by the 31-question HCAHPS survey that sought to better understand what happened to patients from their point of view.

But since none of the questions are actionable or easily generalized, is the HCAHPS survey really all that valuable? What else do we need to know to meaningfully dissect the patient experience?

Patient-Environment Relationship

Nurse Theorist Martha Rogers builds her theory on Unitary Human Beings on the complex relationship of the patient to the patient environment. She says that as sentient human beings, we merge totally with our environment through not only our sensory system but also through our sensory responses, which are based on our perceptions.

In the 19th Century, Florence Nightingale had put forth her environmental theory based on the same assumptions.

More recently, environmental psychologists, such as Diane Pope and Roger Ulrich, have also studied this relationship and come to the same conclusion. They identify environmental stressors as being causal in physiological and psychological outcomes.

And, those in the healthcare design field continue to promote the idea that the design of the physical environment is also important to improving the patient experience because it can impact outcomes.

When you think about it, the patient-environment relationship should drive the patient experience because it is immediate, in the moment, and informs the minute-to-minute perceptions and condition of the patient.

Real-Time Feedback

Today we have moved far beyond surveys that provide feedback weeks after a hospitalization to the real-time lived experience that happens in the “now” and must be tended to in the “now.”

The discussion at the Beryl Institute Regional Roundtable at Stanford University Hospital in Palo Alto, Calif., a few weeks ago brought forth the frustration of HCAHPS for delivering results weeks after the surveys are taken.  Thus, many hospitals have opted for real-time feedback through companies like Truth Point.

The benefit of this is being able to respond almost immediately, while patients are still in the hospital or shortly thereafter. The results have been not only positive but offer a consistency in improvement and employee engagement.

Continuous improvement requires ongoing monitoring and feedback. A delay between an event, feedback, and resolution can undermine the immediacy of the patient experience.

Patients in the hospital, ED, or clinic right now have no interest in what the hospital is going to do next week, next month, or in years to come. In fact, patients or family members who are complaining about construction noise or poor response from housekeeping or the nursing staff could be insulted if what they are offered is an outcome in a future that may be irrelevant to them.

Everything Counts

So, can we meaningfully dissect the patient experience and learn “how it is?”

The answer is not only “no” but that the de-construction of an experience into small parts that do not relate to each other misses the point.

Everything that happens to the patient informs everything that will happen to the patient. Everyone who interacts with the patient creates an expectation for the next interaction.

Therefore, it is best to assume it all counts.  Because it does.

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