Outlines six steps to creating a successful patient experience program
Provides answers to commonly asked questions
Provides tools and resources to use during and after program implementation
Provides examples from other practices describing how they have implemented patient experience programs and their impact
Enhancing the experience of patients and their loved ones is crucial in today's health care environment. Competition in the health care market has led patients and insurers to become more informed consumers who expect higher quality, more value and better outcomes. Patient satisfaction is viewed as an important indicator of quality of care and assists in understanding patients' perceptions of their care.
That being said, building a better patient experience goes well beyond patient satisfaction scores.
Patients make choices based on how you make them feel, not just the quality of clinical care you are providing. Therefore, a comprehensive strategy relies on team engagement to create a culture of empathy in the practice that is palpable to patients. Successful patient experience efforts are grounded by creating a burning platform for change, leveraging transparent feedback and providing effective training. Building a patient experience program is not only important for improving patient satisfaction, but can also be a rewarding activity for your practice.
What is patient satisfaction and how does it differ from patient experience?
Patient satisfaction is the term used to describe the extent to which a patient is content with the health care provided to them and is often measured by their responses in surveys. Patient experience considers a patient's end-to-end journey through the continuum of care. Individual experiences can be influenced by interactions with practice clinicians and staff as well as how their physical, emotional and spiritual needs are addressed in various health care settings. We encourage practices to think bigger and more holistically about the entire care experience beyond what can be shared on a survey. Physicians are often meeting patients when they're at a challenging time in their life, so the goal can't always be to make them happy, but rather to improve their experience with how care is delivered.
What factors affect a patient's experience?
Quiz Ref IDA variety of things influence a patient's experience, but the factor with the greatest impact is how you and your team make the patient feel. Every moment in the continuum of care matters. Communication between the patient, staff and physician are among key determinants of the experience. Clinical factors also have an impact. Comorbidities such as depression are correlated with lower patient satisfaction scores. In hospital settings, as length of stay increases, patient satisfaction scores decrease. The severity of a patient's illness as well as whether their problem is medical or surgical also influence the patient's perception of their experience. Anecdotally, patients just having had surgery tend to feel that they are being “fixed” and this is reflected in their feedback.
Why should I develop programming that enhances the patient's experience?
Quiz Ref IDA patient experience program can be utilized by practices of all sizes and is an effective way to:
Improve patient engagement and patient-physician relationshipsIdentify areas for improvementImprove patient outcomesIdentify and celebrate what you do wellDifferentiate your practice or organizationCo-create new programs with patientsIncrease practice reputation and patient loyaltySupport service recovery3, which can drive brand loyalty to your clinic
Improve patient engagement and patient-physician relationships
Identify areas for improvement
Improve patient outcomes
Identify and celebrate what you do well
Differentiate your practice or organization
Co-create new programs with patients
Increase practice reputation and patient loyalty
Support service recovery3, which can drive brand loyalty to your clinic
It can also improve your patient satisfaction scores, but beyond that, it is the right thing to do for your practice, staff and patients. Building more effective relationships with patients benefits physicians and their staff and supports other programs designed to bring joy back to practice.
Assess the current state of patient satisfaction
Define your “North Star”
Engage key stakeholders in experience design
Develop and implement your patient experience strategy
Analyze feedback and determine impact
Recognize accomplishments and improve over time
Start by gaining an understanding of the current state of patient satisfaction in your practice. There are several options for collecting patient feedback in a timely and cost-effective manner. One way is to provide patients with a patient satisfaction survey. Surveys give patients the opportunity to provide anonymous feedback that can be used to make improvements. This is a popular and simple approach that can also be used to continually evaluate the patient experience over time.
You could also enlist members of your team to have brief, casual conversations with patients during their clinic visit. Anyone in the practice can get a pulse on patient experiences by simply asking patients, “How was your visit today?” or, “Do you have any feedback you'd like to provide to us?” These questions can be asked by staff at check-out, by a medical assistant as they escort the patient out of the exam room at the completion of the visit or by anyone in the practice that finds themselves sharing an elevator with a patient. Any pertinent positive or negative feedback can then be relayed to the practice manager. If accessible, reviewing patient complaints and grievances can also offer perspective.
Review the results of the current state assessment to identify themes and trends you can highlight when discussing the program direction with other practice stakeholders. The feedback collected could help create guiding principles for the program and serve as a catalyst for change.
What should be included on the patient satisfaction survey?
Practices can utilize existing surveys or create and customize surveys based on their practice needs. Some common themes on patient satisfaction surveys include access, teamwork, communication, front desk friendliness, office cleanliness and billing. You could also consider asking, “Would you recommend the practice to a friend?” This question establishes “likelihood to recommend,” which is a loyalty indicator and an indirect measure of patient experience. Many surveys aim to understand how patients feel about specific components of the practice and then how likely they are to return and refer others to the practice.
How should I go about surveying my patient population?
After a visit, consider handing the survey to the patient at check out, mailing the survey or sending it via email. Set a limit to the number of surveys or designate a period where you'll hand out surveys to every patient who comes to the clinic. This will prevent survey fatigue, especially if the patient sees multiple physicians in the same practice or organization. For example, make a rule that a patient can only be surveyed once every three months. To get unbiased feedback, you should also make sure patients are surveyed randomly. If you only survey patients from one day of the week, you may not get a realistic perception of the practice or clinician.
Any survey you use should be short and simple. This module contains a template that you can adapt to fit your needs. You may also consider using the free, six-page long Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG CAHPS) outpatient satisfaction survey developed by the Agency for Healthcare Research and Quality. If you choose to send the survey out via mail or email, consider creating a quick cover letter to introduce the survey and its importance in improving patient experience in your practice.
Do patients provide honest feedback during face-to-face interactions?
There is some evidence that patients are hesitant to give honest negative feedback for fear of retribution that might affect their care. However, some practices have found that patients are honest and respectful when giving feedback during face-to-face encounters. The patients were pleasantly surprised to be asked about their visit or experience in the practice. If you are uncomfortable with this approach, some other tactics include surveys or a comment box.
What are some other ways to appreciate the patient perception of the practice?
Consider using the gemba or “go and see” methods of Lean to observe the frontline staff in their daily roles. This can be extremely helpful for administrative leadership to understand the interactions that occur between staff and patients during daily operations. You could also put together a “mystery shopper” style approach where hired and/or outside colleagues can provide you with valuable feedback related to their experience as a patient in your practice. If you choose this approach, be sensitive to your staff's reaction, so they don't feel they are being targeted or deceived. Informing them that they may be observed during a certain time period can set appropriate expectations and eliminate surprise.
Your North Star is what your practice will strive towards and guides your program's purpose and structure. When defining your North Star, make sure you gather and discuss different team member, patient and caregiver perspectives. Take time as a team to characterize the ideal patient experience and outline goals for the program. Consider how you'll engage other physicians, staff, patients, families and loved ones.
What are some examples of North Stars?
Your North Star will unite your practice around a common goal and support the development of your patient experience program. Your North Star may be defined by your organization's mission or vision statement. Some examples of guiding principles include:
“Patients First” at the Cleveland Clinic
“Healthcare that Cares” and the pineapple image, a symbol of warmth and hospitality that all patients can expect, at Baptist Health
“Advancing Health Together” at Duke Health
“Humankindness heals. Mind, body and spirit.” at Dignity Health
Culture is critical in creating a sustainable patient experience program. To build a relationship-centered program, you need to have a culture that encompasses teamwork, integration, good communication and an environment supportive of continuous learning.
Quiz Ref IDInvolve all clinical care team members, administrative leadership, front desk and scheduling staff, physicians and, perhaps most importantly, your patients in program creation. Share the results of your assessment of the current state of the patient experience and discuss reactions and trends. Hold a brainstorming session to come up with ideas for your patient experience platform. Take the opportunity to ask employees about the challenges they face in daily operations to identify areas where additional training could be useful. You can also include patients in the design process by holding a focus group to evaluate ideas.
Why is it so important to include stakeholders at all levels in experience design?
There is not one ideal patient experience program, as different practices and patients will have varying preferences and expectations. Including stakeholders from all levels and areas in your practice can help you uncover valuable and sometimes surprising insights. For example, team members who work in the front desk area may notice that there is inadequate seating on busy clinic days or that the waiting area music is too loud. These are things that care team members may notice in passing without recognizing the impact that they are having on a patient's experience. Patients can offer the customer perspective that staff can often forget when they are focused on their work. That is why it is important to include personnel at all levels of your organization and partner with your patients to create a program that best fits your environment and patient population.
Should we consider including other types of clinicians or services in the planning stages?
This will depend on your practice type, location and size, but it can be an important consideration. For example, if you are a surgical practice, you encounter your patients not only in the clinic but also in the operating room. Patients look at their experience in its entirety so they often don't distinguish between the two distinct care environments and staff. In this scenario, you may decide to include pre-operative testing staff, surgical waiting room staff and nurses and the patient transport team in your experience design process because their feedback may cover both environments.
Patients often have complaints about billing processes, so including leadership from this group in experience design can also be beneficial.
Should we benchmark against other practices or organizations in our area to help set strategy?
While you may choose to look at what your competitors are doing well and emulate best practices, this should not be the major driver for creating a patient experience program. Vendors exist that enable benchmarking, but if your efforts are grounded in your local culture and patient needs, you are on the right track.
Work with your patient experience program team to determine which processes or changes to implement first. To ensure success, start small and pick an option that is sustainable and scalable for your practice. Here are some ideas:
A PFAC is a partnership between patients, families, caregivers and members of the care team that encourages honest feedback and constructive criticism to make the practice better. A PFAC ensures the voice of the consumer is integrated into prioritization of decisions your practice makes related to changes that will affect the patient community. Strengthening the partnership between the practice and its patients can help you achieve goals and provide better care to patients.
Rounding enables the clinic leadership to connect with patients in real time to gain a deeper understanding of tactics to strengthen care. This approach also provides opportunities for immediate service recovery and feedback for staff and physicians. You could assign a team of leaders to specific clinics or request that the manager, administrator or lead physician engage with patients in their own clinic. Leadership rounding can occur on a weekly, bi-weekly or monthly basis.
Employee engagement is imperative to a successful patient experience program. It is important to understand what drives employees and why they come to work each day. Consider conducting an employee engagement survey to better understand how staff members feel about their work environment. Communication, teamwork, safety, confidence in management and the ability to provide quality care are key topics to cover in an employee engagement survey. You can also personally check in with your staff through leadership rounding to get a better understanding of what is working and what needs further attention. Listening with empathy to your employees is just as important as listening to your patients. Studies show that less than half of the U.S. healthcare workforce is highly engaged in the work they do.11 It is important to make positive changes to the work environment based on the employee feedback received so that staff feels that they are being listened to, which itself can make them more engaged. More engaged employees make for more satisfied patients.
Service excellence is more than a friendly face. It requires a core set of standards that yield a framework for treating patients with courtesy and respect while offering the highest quality of care. Such training teaches staff how to effectively handle patient concerns in real time as well as how to respond in a way that demonstrates empathy to the patient's concerns. Acknowledge, Introduce, Duration, Explanation and Thank You (AIDET®)18 and Communicate with H.E.A.R.T.® are examples of common service excellence training tools that help teams establish powerful communication frameworks for staff to use with patients, families and each other.
Service excellence training will not prevent all service breakdowns, so it is also important to have a strong service recovery strategy. Service recovery can turn a disgruntled patient into someone who is happy and loyal to your practice. In the event that service recovery is needed, staff should be prepared to apologize and acknowledge the breakdown in service, listen to the patient's concerns and act quickly to fix the service issue. While all practice staff should be prepared to handle these types of situations, it is helpful to identify an individual, often a supervisor or practice manager, to lead service recovery efforts.
The strength of the relationship between a patient and their physician and other care providers significantly impacts the patient experience. A strong relationship is founded on effective communication. Initiate conversations with clinicians to understand how they are currently introducing the computer, working with patients on agenda setting and other aspects of the patient encounter to understand any challenges they are facing in effectively communicating with their patients. Find avenues to maximize communication and peer training. Practice listening with empathy, teach-back and other methods to foster strong communication. Consider applying evidence-based models such as the REDE Model of communication, which stands for Relationship, Establishment, Development and Engagement19, or the Four Habit Model17. REDE emphasizes creating a safe and supportive atmosphere as you establish the tone for the conversation with the patient.
What is the expense associated with building a patient experience program?
Staff time is needed to collate and analyze survey data, although for many practices the time needed is minimal. If service excellence training is new to your practice, there will be some cost associated with staff time and training; however, consider incorporating the program into your new employee orientation to reduce future expense. Many of the other patient experience program strategies, such as leadership rounding or a PFAC, tend to be inexpensive and can also offer valuable insight into ways to improve the practice, maintain an engaged patient population and build a referral base without a lot of data analysis.
What are some common practice challenges and where do I start?
Use your patient experience survey and/or feedback as a guide. Here are some examples of initiatives to improve patient care:
Improve lab results reporting: Consider using your patient portal to automatically send a note about results being available to view along with your nurse's contact information in case the patient has questions. This provides patients with access to information as well as to the care team.
Reduce patient frustration with wait time: Communicate delays to patients in a timely manner. Identify internal solutions to chronic bottlenecks and work with your team to address them. Some practices have a manager come out with coffee or vouchers when wait times are abnormally long.
Reduce patient dissatisfaction with billing and insurance-related issues: It is unlikely that you will be able to eliminate all billing and insurance-related complaints, but training staff on basic insurance information and office billing practices can help them answer questions from patients. If you are consistently receiving patient feedback that their bills are hard to read or understand, consider putting together a team to reconfigure the bill layout to be more patient-friendly.
Implement pre-registration: Collecting important demographic and insurance information ahead of the patient's appointment can significantly expedite the check-in process and eliminate delays.
Maximize in-basket management: Come up with a strategy to effectively manage patient messages coming through the in-basket and online patient portal to provide more timely responses to patients.
You may choose to repeat patient satisfaction surveys as a part of your ongoing program strategy. Many surveys use similar measures that you can trend over time. If you are working with a vendor such as Press Ganey to distribute and analyze your survey or using the free CG CAHPS outpatient satisfaction survey, you can submit your practice data to a database for benchmarking.
It is likely that you won't be able to quantify all parts of your patient experience program. Qualitative input can be just as valuable. Look for trends in the comments section of your patient survey. If you started a PFAC, ask how it's going. Is meeting attendance strong? Are patients engaged and happy to be participating? Are physicians and staff deriving value from the PFAC?
If your practice has recently undergone a change or initiated a project aimed at solving a particular problem, look at patient visit statistics, complaint data and referral patterns to assess impact. For example, patients may have been particularly dissatisfied with the communication about wait times in your practice, so you recently put a process in place where the care team updates the front desk when the physician starts to run behind. That has allowed your front desk staff to let patients know about a delay at the time of check-in, which not only updates them immediately upon arrival, but also provides them with the opportunity to reschedule if they are not able to wait. You can track patient complaints and survey comments or complete leadership rounding to gauge the impact of this new communication strategy from the patient perspective.
Should I give group feedback to care team members other than the physician?
Yes. It is surprising how many practices do not share feedback with their clinicians or teams. By sharing information, you create an environment of continuous quality improvement to keep employees engaged. During team meetings, you can use the results and patient comments to identify opportunities for improvement and highlight practice and staff strengths. Other ways to share this feedback include emails, daily huddles or displays/visual management boards in a common area.
What are some tips for approaching difficult conversations about satisfaction scores with clinicians?
Reflecting patient comments back to individual clinicians can be a sensitive topic. Be sure to share positive as well as negative comments. When addressing negative feedback, it is important to give clinicians the tools they need to improve and to communicate efforts that are being made back to their patients. For example, if patients are frustrated and unable to find a parking space, be sure clinicians know that appropriate administrators are addressing this. This allows clinicians to respond to patients' concerns. If patient feedback indicates their physician seems to be rushed and distracted, relay this feedback to the physician and explore what might be leading to this response.
If you are comfortable facilitating education to enhance communication skills, great. If not, there is tremendous value in simply exploring what clinicians think is the gold standard of communication in their practice. Ask them how they open and close visits. Collating the responses can benefit everyone in the group. Providing feedback generates discussion and helps identify strategies to improve the patient experience.
Building a patient experience program can be a challenging process. Your team will continue to stay engaged if they feel the program has value. Make the program a key discussion topic in team meetings. Continue to ask for employee feedback and suggestions on ways to improve and enhance the program. Regularly share any results and positive affirmations gleaned from surveys. Share patient suggestions and stories from the PFAC or leadership rounding. Physicians and management should lead by example by participating in the various patient experience initiatives within the practice.
Celebrate the team members who are shining in this effort. Share uplifting or positive patient narratives, invite a patient to speak and present the highlights of mystery shopping to raise awareness of how the practice is moving towards its North Star.
“I have had and continue to have excellent service from Dr. Smith's staff and excellent, professional and caring medical care from Dr. Smith herself. I am retired from the U.S. Army and I have had myriad experiences with medical doctors, civilian and military, national and international. Dr. Smith is by far, one of the most knowledgeable, professional and personally caring physicians I have encountered. She is never hurried. She listens and hears my questions and concerns with compassion. Most important to me, she gives me the best professional instructions and guidance, and leaves me with the confidence I need to take better and better care of my health. Dr. Smith is a stellar example of what physicians should be; she is pragmatic about her decisions to affect my healthcare courses of actions. I have and will continue to recommend her to professional and community associates, and friends.”Anonymous patient comment about their experience
“I have had and continue to have excellent service from Dr. Smith's staff and excellent, professional and caring medical care from Dr. Smith herself. I am retired from the U.S. Army and I have had myriad experiences with medical doctors, civilian and military, national and international. Dr. Smith is by far, one of the most knowledgeable, professional and personally caring physicians I have encountered. She is never hurried. She listens and hears my questions and concerns with compassion. Most important to me, she gives me the best professional instructions and guidance, and leaves me with the confidence I need to take better and better care of my health. Dr. Smith is a stellar example of what physicians should be; she is pragmatic about her decisions to affect my healthcare courses of actions. I have and will continue to recommend her to professional and community associates, and friends.”
What if our first attempt at a patient experience program isn't yielding the results we anticipated?
Assess accountability and don't give up. Take a step back and regroup with your team. Review the feedback you've received so far from patients, staff and clinicians. Allow this to serve as a guide to identify what's not working and how to move forward. If you started with service excellence training, but have found that staff behavior has not changed, consider trying leadership rounding. This can help keep your program moving in a positive direction, while setting an example for others in the practice. Keeping a patient experience program going is the same as maintaining momentum for any quality improvement project.
When should we consider adding to our patient experience program?
Once you've implemented your first patient experience strategy and your staff and patients seem to be responding positively, you could consider adding another component. There really is no roadmap, which is both the joy and pain of improving the patient experience. The best approach is to work closely with patients and families to guide the evolution of your program.
Building a patient experience program is a team effort that requires dedication along with an openness and desire for change. The voices of patients and their loved ones can provide valuable input on what a practice is doing effectively and where improvement opportunities exist throughout the patient journey. Using this information and partnering with patients allows practices and organizations to design services that transform clinical care, enhance patient loyalty, and most importantly, bring more meaning and joy to patients and caregivers.
“I have learned so many skills that will not only aid me in teaching this curriculum but are highly applicable to leadership endeavors and professional interactions. Not only will it improve the patient experience but it has the potential to really restore a joy in patient care that so many physicians are lacking and desiring. I am happy to see that this initiative has such strong support amongst the leadership of this institution. It will be successful if we continue to model that support to our colleagues.”Physician feedback about the patient experience program at the Cleveland Clinic
“I have learned so many skills that will not only aid me in teaching this curriculum but are highly applicable to leadership endeavors and professional interactions. Not only will it improve the patient experience but it has the potential to really restore a joy in patient care that so many physicians are lacking and desiring. I am happy to see that this initiative has such strong support amongst the leadership of this institution. It will be successful if we continue to model that support to our colleagues.”
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About the Professional Satisfaction, Practice Sustainability Group: The AMA Professional Satisfaction and Practice Sustainability group has been tasked with developing and promoting innovative strategies that create sustainable practices. Leveraging findings from the 2013 AMA/RAND Health study, “Factors affecting physician professional satisfaction and their implications for patient care, health systems and health policy,” and other research sources, the group developed a series of practice transformation strategies. Each has the potential to reduce or eliminate inefficiency in broader office-based physician practices and improve health outcomes, increase operational productivity and reduce health care costs.
The project described was supported by Funding Opportunity Number CMS-1L1-15-002 from the U.S. Department of Health & Human Services, Centers for Medicare & Medicaid Services. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.
Disclaimer: AMA STEPS Forward® content is provided for informational purposes only, is believed to be current and accurate at the time of posting, and is not intended as, and should not be construed to be, legal, financial, medical, or consulting advice. Physicians and other users should seek competent legal, financial, medical, and consulting advice. AMA STEPS Forward® content provides information on commercial products, processes, and services for informational purposes only. The AMA does not endorse or recommend any commercial products, processes, or services and mention of the same in AMA STEPS Forward® content is not an endorsement or recommendation. The AMA hereby disclaims all express and implied warranties of any kind related to any third-party content or offering. The AMA expressly disclaims all liability for damages of any kind arising out of use, reference to, or reliance on AMA STEPS Forward® content.
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