Patient (and Provider) Experience Are Underrated

The Challenge of "Satisfaction"

The national dialogue around patient satisfaction surveys increasingly paints a grim picture of patients and doctors pitted against each other, with patients wishing to be pleased to the nth degree and doctors feeling that they are being asked to provide inappropriate medical care or work harder to satisfy irrelevant measures imposed from above. Mainstream healthcare opinion pieces tout eye-catching titles such as "Patient Satisfaction Is Overrated"^[1] and "Why Rating Your Doctor is Bad for your Health."^[2] One author describes "How Doctoring Has Become the Most Miserable Profession."^[3] All claim that measuring the patient's experience is to blame for worsening the quality and value of care as well as career satisfaction. As physicians, leaders, and teachers in healthcare, it is important to ask: Is this the story we really want to be telling ourselves?

The Relevance of Patient Surveys as Measures

The Centers for Medicare & Medicaid Services' (CMS) Hospital Value-Based Purchasing (VBP) program and the Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys have brought attention to the patient's perspective on healthcare. While the inpatient VBP pie adds new outcomes and quality measures yearly, the patient voice is the only piece that retains its generous 30% of dollars at stake for care provided to Medicare patients. This highlights an important message: Patients have something important to tell us about the care we provide, and we can do better. Although the financial cost to poorly performing hospitals may be painful in the short term, the purpose is to get us all to a better place in the long term. Just because it is hard to move the needle does not mean that the needle is not worth moving.

Letting doctors off the hook is probably not the right answer for us or our patients. Consider the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, which asks 3 questions about physician communication in the inpatient setting:

• How often do doctors treat you with courtesy and respect?

• How often do doctors listen carefully to you?

• How often do doctors explain things in a way you can understand?

To say that these are unreasonable expectations of physicians on the part of patients and families is like a grocery store saying of their customers, "Why do they want food when they come here?" These are the fabric of what we do in healthcare. The more time and energy spent refuting and resisting these measures, the longer it is taking us to collectively improve. That is bad for both the healthcare team and patients.

Improvement in patient experience elements like communication has the potential to reap great rewards, not the least of which is reconnecting ourselves to the human and healing part of medicine. That reconnection reminds us that what we do as clinicians matters to people in a very profound way, every minute of every day. When we become better listeners to patients, not only can we diagnose and treat better, but tensions increasingly morph into authentic gratitude, a powerful antidote to the burnout that so many of us experience in the current healthcare environment. To this end, I propose that our investment in "experience" is not, as we fear, the nail in our coffin, but rather the blue sky after a tumultuous storm.

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