Everybody speaks now about “the patient experience” and probably it will become another buzz word like innovation, quality, etc. What is patient experience and what is the difference with patient satisfaction?
According the King’s Fund report on patient experience measures for the British National Health System (NHS), patient satisfaction is the way in which patient’s views on healthcare have been measured and “there is no consensus about exactly which domains should be included or which are most important”. The Report criticizes that Patient satisfaction is sometimes treated as an outcome measure (satisfaction with health status following treatment) and sometimes as a process measure (satisfaction with the way in which care was delivered).
Clearly patient satisfaction measurement is the application to healthcare of customer satisfaction, a concept coming both from quality management and marketing. It is an important evolution from industrialist metrics, focusing mainly on productivity and efficiency. In the 80s, with the upcoming of the so called service economy, customer satisfaction appeared to an important metric too. As healthcare was defined as a service, quality programs in clinics included also patient satisfaction.
Yet the value of measuring patient satisfaction has been limited. Mainly because, as in other industries and sectors, surveys have tended to focus on managers’ and clinician’s agendas; not on questions meaningful to patients, that can be translated into actions. This TED talk by Fred Lee explains very well the difference between a nurse’s work according to excellent service standards and the same work attending to the patient experience.
Patient experience vs. patient satisfaction in gynecology
In my experience in fertility clinics there is a clear difference between patient assistants acting according best quality standards and assistants working with empathy caring for the patient’s experience. In the first case, the assistant performs her work in an excellent manner, asks the polite questions when it is defined, smiles in a routine way, is also polite in a routine way and at the end it is difficult to distinguish her friendliness from the automated friendliness of a cash dispenser. Also, whenever a problem appears, doctors are interrupted, creating true bottlenecks.
To the contrary, assistants able to empathize with the patient, get into the storm of emotions highly hormone treated infertile women suffer and yet, not losing the clinical pint of view, will really look for solutions for patient problems, speak the patient’s language, challenge doctors and change their agendas if necessary, risking eventually an argument. They will start to think for themselves and try to learn as many easy clinical algorithms they can put in front of the doctors for decision making and they can explain to the patients. That way, patient assistants muted from administrative workforce to autonomous workers with enough knowledge to solve routine medical questions, such as “I forgot to take the medication yesterday, is this bad”, “I have a bleeding, and does it mean I will lose my child”. At the end, a physician will take the responsibility and the decision, but meanwhile the patient experience is that somebody listened, that somebody took care and that a preliminary information and solution was given.
Patients value this. Barbara from Switzerland, in a radio program on opening preimplantational genetic diagnosis in the Alpine Republic: “when we came here we felt immediately understood. The physician comforted us and acknowledged what a difficult journey we had.”
Comfort a patient is more than fulfilling patient satisfaction outcomes, as the example of obstetrics in an excellently rated Madrid private Hospital shows. A patient remembers: “when asking about amniocentesis, the doctor told me: “at this stage you will have to eat the child” (a rude expression in Spanish meaning that at this stage the test result had no relevance, since if the child had a disease, abortion was not permitted). Interesting enough, the hospital’s entrance proudly shows high scores in patient satisfaction.
The difference is: putting patients first
Both examples show, that measuring patient satisfaction or measuring patient experience leads to different employee attitudes. The problems with patient satisfaction have led to stress rather patient experience. As the King’s Fund report highlights: “Instead of asking patients to rate their care using general evaluation categories (e.g., excellent, very good, good, fair, poor), they are asked to report in detail about their experiences of a particular service, hospital episode, general practice, or clinician.”
For instance, knowing that 10% valuate their care as “poor” or the waiting times as “fair” does not help very much. Instead, knowing precise details about what went wrong during the care (communication, understanding of medication, etc.) makes a difference because here there is a call for action.
Thus, the difference between patient satisfaction and patient experience is what the values are prioritzed: the organization’s and management priorities or patient needs? Applying patient experience means: putting patients first.
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