Patient Experience: Perception Equals Reality
Patient experience is not synonymous with patient satisfaction.
The phrase “patient experience” has become so ubiquitous that it’s lost its meaning and its original intent is seemingly inexplicable.
A simple definition of patient experience is whether something that should have occurred, actually occurred. For example, did the provider “listen carefully” or “explain things clearly”?
A patient who understands their plan of care is more likely to adhere to recommended treatments and medications.
How It Started
In 2006, hospitals first began voluntary use the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey developed by the Center for Medicare and Medicaid Services (CMS) and the Agency for Healthcare Research and Quality (AHRQ). Why now does CMS require that hospitals and some medical practices collect and report CAHPS data in order to receive their full annual payment update? Because patient experience measures are those most closely associated with patient engagement and positive clinical outcomes. CMS is basically placing a dashcam in every “vehicle” they insure, where the “vehicle” is the patient’s brain. Payment is based on dashcam data. This is the core of value-based purchasing.
Perception vs. Reality
Here’s where perception and reality intersect: the patient experience is the patient’s perception of their care. Whether the provider feels they communicated effectively or spent enough time with the patient is irrelevant. What matters is the patient’s perception of your communication style or how much time was spent together.
Reality: The provider spent 15 minutes 1:1 with the patient (within the national average).
Patient’s Perception: The provider may have spent much of the time focused on the EMR and documentation. Perhaps they didn’t sit down during the encounter. Or worse, they stood at the doorway with a hand on the door knob for the last half of the visit.
Patient’s Interpretation: The provider was too busy to actually engage with them during the time they had together.
Often, open-text comments from patient experience surveys offer a wealth of insight into the gap between perception and reality. The “hand on the doorknob” was a harsh awakening comment for one such provider.
Make A Change
There are simple methods to change patients’ perceptions without disrupting your workflow. For example, research indicates that sitting down during an encounter reduces visit time by 20 seconds while simultaneously sending a message that you have all the time in the world. Making eye contact, mirroring back what the patient has stated and asking open-ended questions are also ways to connect with patients and convey that you are listening to them.
Clarifying the definition of patient experience should help practices reset their actions and more clearly define the end goal of improving outcomes. Maybe patient experience surveys should be rebranded “patient perception” surveys.
About Author
Stephanie Sargent
As the Chief Clinical and Quality Officer, Stephanie oversees the continued development of the Physician Empowerment Suite©, and ensures the ongoing growth and success of the Suite and other related SE Healthcare programs. Stephanie is a seasoned clinical and Lean Six Sigma professional with more than 22 years of experience in health care. As a certified Lean Six Sigma Black Belt, she is skilled in identifying clinical and operational performance gaps to decrease professional liability risk, meet regulatory and accreditation requirements, improve clinical quality and patient outcomes and reduce waste and inefficiencies.
This is ridiculous to call it the patient perception. As a patient, I too have had the “hand on the door knob.” There is NO WAY my provider is really listening when the body language says I am leaving this room. So it is my actual experience, that my problems were not taken seriously and attentively.
Another time I had a surgeon’s PA explain a surgery incorrectly- so that was not a perception- it was a medical mistake. Own up to it medical profession- you can do better. Do not like it? Change careers. But stop harming the very people who pay you their hard earned monies and give up their days and their health (their time over and over again) for your medical care.
Hi Jean,
Thank you for contributing to the commentary. It sounds like you too have experienced the “hand on the door knob”. That is disheartening to hear and something that some well-meaning clinicians do without really knowing that they are sending a strong and negative message to the patient. It demonstrates that even though a clinician may feel that they are being empathetic and kind, their non-verbal behaviors often speak louder than words.
It also demonstrates the mis-match between perception and reality. The clinician may have indeed “explained things well” and believed that they spent sufficient time with their patient, but the patient’s perception was quite different. By the clinician placing their hand on the doorknob, it sent the clear signal that they wanted to exit the room. Based on information the clinician shared, the patient may have had more questions, but didn’t feel comfortable to burden the clinician any longer. Had the clinician spent those final minutes seated, the patient would have felt comfortable asking a question or two more – possibly critical questions.
There is a strong association between patient engagement and positive clinical outcomes. Hopefully my blog helped shed some light on the importance of how patients interpret (or perceive) their care experience and how it impacts the patient.