The controversy over measuring patient experience

Measuring patient experience is a surprisingly controversial topic. 

Or, is it?

As physicians, we are trained to be experts in medical knowledge, treating illness, and outcomes. Not customer service. Yet, measures of patient satisfaction/experience have become commonplace and are now tied to payment through the CMS value-based purchasing program. Some providers disregard patient satisfaction/experience measurements as subjective and irrelevant, and even cite early literature suggesting that these measures may be negatively related to traditional clinical outcomes.

However, two articles published earlier this year, suggest otherwise. One, a BMJ article, positively correlates patient experience and clinical effectiveness and patient safety outcomes (BMJ Open 2013;3:e001570). The other, a New England Journal of Medicine perspective piece, notes that surveys such as the HCAHPS Survey include patient-experience questions tied to quality ("How often did hospital staff describe possible side effects?"), the patient’s health status, and his or her engagement in care. It explains that conflicting findings of the correlation between patient experience and outcomes may be related to several factors, including whether measurement is timely and focused on a specific visit (N. Engl. J. Med. 2013;368:201-3 [doi:10.1056/NEJMp1211775]).

Either way, patients and payors are increasingly expectant of high-value health care that includes good clinical outcomes, cost-effective care, and excellent patient experience.

Like other areas, motivation to improve patient experience can come through the transparency of publicly reported data. Yet, transparency can be limiting in impact when it is tied to the hospital level and not to individuals on the front lines who are providing the care. At University of Utah Health Care, Salt Lake City, we have made strides to improve the patient experience throughout the institution and to inform the public on how patients rate their experience with us. Our physicians’ public bio Web pages now include patient-experience ratings (on a scale of zero to 5 stars) and unedited comments—positive and negative – received from the survey. Here is a link to an example.

We are perhaps the first academic medical center to publish this information in a fully transparent way. While there has been a healthy amount of discussion within our organization, the majority of physicians are excited about our transparency and leverage their ratings to improve the way they interact and relate to patients.

For patients, having a doctor take an interest in their concern, respect their insight, and thoughtfully address the problem is indeed viewed as a measure of quality. After all, the robust information that hospitals can collect and report on far exceeds the limited ratings that patients can find on vendor web sites such as Health grades, Vitals, and others. In this way we are sharing credible and unbiased information to help our patients make informed decisions about their care.

What do you think?

Dr. Robert C. Pendleton is chief medical quality officer for the University of Utah Hospital and Clinics, Salt Lake City, and is a practicing hospitalist for University Hospital. He is on the advisory board of Hospitalist News. Follow him on Twitter @MDBobP

Dr. Thomas L. Miller is the chief medical officer for the University of Utah Hospitals and Clinics and also a practicing clinician in the division of general medicine, department of medicine for the University of Utah. Follow him on Twitter @TomMillerMD