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As national pediatric associations call for a national emergency response to unprecedented levels of respiratory syncytial virus (RSV) and influenza that are overwhelming U.S. health care systems with hospitalizations of children and seniors, it is critical to examine what good health care looks like.
Almost every health care setting utilizes a patient experience survey, whether by choice or by force. In the hospital inpatient setting, hospitals are required to administer the Hospital Consumer Assessment of Healthcare Providers and Systems, or HCAHPS, survey, a patient experience feedback form in use for a decade.
These surveys are meant to measure a patient’s experience with caregiving that cannot be captured any other way. A patient’s electronic health record or insurance claims do not reflect their personal experiences with health care providers.
In my former position as a senior statistician at RAND Corporation for 10 years, my research focused on testing and analyzing data from these surveys. I led a multimillion-dollar project funded by the Centers for Medicaid & Medicare Services to develop and test a patient experience survey for the emergency department (ED) setting.
Data from this survey, the ED CAHPS survey, are used to calculate validated scores measuring multiple aspects of a patient’s experience in the ED, including communication with doctors and nurses about medications and follow-up, and a patient’s willingness to recommend the ED to friends and family.
However, my graduate school training in biostatistics at Harvard University involved analyzing “hard” outcomes — death, heart attack, cancer metastatic, infection. I was not as familiar with analysis of “soft” outcomes, or what some call “touchy feely” outcomes.
Who cares if your doctor is nice to you? If the job of a doctor and health care provider is to save your life, diagnose you, cure you, why does it matter if they are nice to you?
Research shows that patients who have better experiences, who say their doctors and nurses listened to them, treated them with courtesy and respect, and explained things clearly, are more likely to fill their prescriptions, get their recommended follow-up care, and to follow advice from their medical providers.
I’ve witnessed this reticence in my 69-year-old father, who did not fill his prescription because he didn’t think the doctor was really listening to him. I’ve seen it with my 7-year-old son, who is unwilling to answer a question if the doctor isn’t looking him in the eye.
So yes, patient experience matters. It matters at an outpatient visit, during an inpatient stay, during a surgery, during an emergency department visit — and in some settings, it is the only thing that matters. In hospice care, doctors and nurses are not trying to save lives, they are trying to make the experience of dying less awful for the patient and their family.
In hospice, where patients expect to die, experience is rated higher than hospital stays. Just because the health outcome or procedure is bad or painful, it doesn’t mean the human experience has to be doomed. In that environment, experience is the outcome — and the only outcome that matters.
To be sure, hospitals are not hotel rooms. But that doesn’t mean it’s wrong for patients to expect to be treated with kindness and respect.
Results from patient experience surveys are publicly reported and, in some cases, they inform provider payment. Of course it is uncomfortable to have your work quality rated by hundreds of people, publicly posted online, and have your pay affected by it.
Now as a professor, this describes my job in response to student surveys, and I can sympathize with health care professionals.
Importantly, we should not place blame on doctors and nurses. The expectations that patients and the health care system place on these professionals can be crushing. Many people expect health care providers to not only provide care, they also expect them to be social workers, spiritual counselors and administrative assistants.
These expectations persist in the face of inadequate staffing, increased workloads, and lack of organizational support. Doctor and nurse burnout has been a chronic issue and is at an all-time high, exacerbated by the stressors of COVID-19 on the health care system. A new poll shows nine in 10 nurses say patient care suffers because of the nurse shortage.
Policymakers, hospital administrators, health care providers, medical associations and medical schools need to make purposeful changes in priorities and expectations at the organizational and policy levels to allow doctors and nurses to have the time and the space for kindness. It literally makes patients feel better.
Layla Parast, PhD, is an associate professor in the Department of Statistics and Data Sciences at the University of Texas at Austin and former senior statistician at the RAND Corporation. She is a Public Voices Fellow through The OpEd Project. Follow her on Twitter @mslaylap.
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