What’s the Difference Between Patient Satisfaction & Patient Experience?

October 7, 2016

When I heard Press Ganey Founder Irwin Press speak many years ago, he offered the perspective of an anthropologist, looking at healthcare as a culture and the factors that inform and define it.

Press hoped that focusing on patient satisfaction, where the patient was given a voice in understanding what happened during a hospitalization would be a valuable tool in improving care.

The question at that time was, “How are we doing?”  And, the patient satisfaction surveys asked this about issues that patients felt were important to them.

Now the focus is on the patient experience, a more in-depth look at the interactions between patients and those who care for them, the environment in which patients are cared for, and patients’ comfort in going home and taking care of themselves.

Still, there is confusion.

The Two Are Not the Same

So, what is the difference between patient satisfaction and the patient experience?  Although these terms may be interchangeable in conversation, they ask different questions and seek different answers.

Patient satisfaction surveys ask, “How did we do?”
Patient experience surveys ask, “What happened?

Patient satisfaction surveys ask, “Did your doctor spend enough time with you?”
Patient experience surveys ask, “How often did you get help when you wanted it?

They are both multiple-choice questionnaires. However, patient satisfaction questions offer answers that go from “very poor” to “very good.” Patient experience questions offer answers from “always” to “never.”

The patient satisfaction surveys are somewhat easier to respond to if only because they so simplify the issues and do not ask for any contextual information.   The HCAHPS questions on the patient experience are more challenging, as there is no obvious set of definitions for the terms used.

Still, without context, the answers to any survey offer limited insight.

Nonetheless, HCAHPS is looking to get actionable information that can lead to improvement and validation of the patient’s own perspective on what happened. And, the elusive nature of the HCAHPS scores, which are now reduced further to a 5-star rating, are indeed questionable.

What Means Something to One Person is Different for Another

Because the terms used in the HCAHPS survey are not defined, their meaning is left to those answering the questions.  For example, “being treated with respect” takes on an ambiguity when we look at cultural differences.

Making eye contact with female patients may be considered disrespectful in some cultures and desired/expected in others.  Physicians who don’t spend a lot of time with patients may not know what to do and what is needed for a particular patient to feel respected or experience respect directly from those who provide their care.

Nurses spend more time with patients and can learn what they need.  However, even nurses are pressed into task-oriented relationships.  Feeling that their nurse is too busy or does not spend the time they need may result in a bottom line of feeling disrespected.

No matter how we look at patient satisfaction or patient experience surveys, reducing patients’ stress, pain, and anxiety to multiple-choice questions makes it ever more difficult for clinicians to focus on humanistic care that addresses the personhood of the patient.

Essence of Nursing

The essence of nursing began with Florence Nightingale, who elevated nursing and prioritized the patient experience.  In Notes on Nursing, she wrote:

In watching diseases, both in private houses and in public hospitals, the thing which strikes the experienced observer most forcibly is this, that the symptoms or the sufferings generally considered to be inevitable and incident to the disease are very often not symptoms of the disease at all, but of something quite different–of the want of fresh air, or of light, or of warmth, or of quiet, or of cleanliness, or of punctuality and care in the administration of diet, of each or of all of these.

Therein lies the key to the patient experience — reducing suffering and personalizing care at the bedside.  Nightingale never spoke of satisfaction.  She only spoke of respect and compassion for the patient whose suffering should not be underestimated.

The patient satisfaction and patient experience surveys give us but a small hint of what a patient endures.  To actually engage and understand, we must be involved on a deeper level.

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