The conventional wisdom among many of my closest physician colleagues is that the current surge in interest in measuring “patient experience” is a bit of a fad, and that the measures are not always central to the real work of improving patient care. My take is that the opposite is true. Measurement of what matters to patients is here to stay, and I think it is making health care better and will ultimately drive a renewed sense of professionalism for clinicians.
First, a few words about what I mean by “patient experience,” which is quite different from the focus of the patient satisfaction surveys that hospitals began commissioning a few decades ago. Dramatic changes are underway in what is being measured, how much data are collected, and how those data are used.
The focus of patient experience measurement today is not amenities, like food and parking. Those factors do matter to patients, of course, but it turns out that they are not important drivers of whether patients feel like their needs are being met. Analyses of patients’ likelihood of recommending hospitals or doctors to family/friends show that what really matters to patients is their overall level of confidence in their clinicians, perceptions of care coordination, and whether they feel that their clinicians are listening to and absorbing their concerns.
When I showed some data demonstrating these relationships to one of my colleagues (a great guy and a wonderful physician, but a chronic skeptic), he paused, and said, “My gosh, these are things that actually are important.” For the first time, he was ready to concede that the “action” in measurement of patient experience has moved to issues that are much more fundamental to taking care of people than food/parking.
Then there is the amount of data that is being collected. Rather than limit the number of surveys distributed, many organizations are electronically surveying every patient after every single encounter. The goal is to get more data faster so that organizations can get meaningful reports of performance at an individual-physician or patient level, segmented by shift, or day of week. Through e-surveys, organizations receive these data quickly enough so they are relevant to clinicians.
And, finally, there is what happens with the data. They are being used for true targeted improvement, not just as a means of meeting regulatory requirements. They are being used in incentive systems to drive improvement. They are being used by hospitals and physician groups who know that they need to meet patients’ needs in order to hold on to market share. Regardless of how contracts look a few years from now, if they don’t have patients, they cannot be successful.
The connection between patient experience and professionalism. All of these changes suggest that measuring patient experience is good business strategy for health care delivery organizations, but what does it have to do with professionalism and the sense of pride that motivates individual clinicians to make that extra effort on behalf of patients? Clinicians don’t want to tailor their efforts to the test that is being administered. They don’t want to see themselves as “performers” who are being evaluated by people who do not fully grasp the complexity of what they do. They want to take care of patients, and they want the respect of others for doing so.
My strong belief is the emerging focus on measurement of the patient experience takes health care in the right direction, one that will restore and give new pride to physicians and other clinicians. After all, it shines the light on what really matters in medicine: Are we reducing patients’ suffering — their pain, their fears, their confusion, their anxiety? Yes, we need to do all we can to help them live longer and maintain their functional capacities. But to do a really wonderful job — the kind of job we do for the patients with whom we identify most — we need a more ambitious task. We need to meet their needs.
Meeting patients’ needs is the right focus for physicians and other clinicians. It is the essence of professionalism. What is not the core of professionalism is performing high volumes of services that are reimbursed under the fee-for-service system. Nor is reducing spending on populations of patients under capitated contracts. Neither of these business objectives are inherently wrong, but these financial strategies are of limited relevance to any thoughtful sense of professionalism for clinicians.
Defining professionalism for our times. Measurement of patient experience data is of course just a step, but it is a step that sets good things in motion. Around the country, I see clinicians organizing to meet patients’ needs, and to do so more and more efficiently. They are defining concepts of professionalism that match the needs of our times. Professionalism in this century means readiness to work on teams with other types of clinicians with the goal of meeting patients’ needs. It means not wasting resources as you do so. And it means seeing yourself as a member of a community, so that if your data look worse than those of your colleagues, you at least stop to wonder if you have something to learn from others.
Those concepts may be new nuances for professionalism in medicine, and they may seem like they conflict with traditional notions of physician autonomy. But they do not conflict with the higher value of doing everything possible on behalf of patients. Indeed, part of the definition of professionalism is willingness to make sacrifices on behalf of others — a willingness that is a major reason why society accords such respect to physicians and other professionals.
Are clinicians ready to make changes in how they work if it will help reduce patients’ suffering and better meet their needs? There is no question in my mind – they are. They need the data on that suffering and those needs, however, to start the change in motion and then sustain it. When clinicians work together in new ways to meet patients’ needs, the satisfaction and sense of pride will seem as old as time and remind them of why they went into medicine.