I lead a double life. On days when I’m not wearing a suit and tie and meeting with clients, I’m spending my weekends and holidays on our farm in Oregon – clad in a t-shirt, faded jeans, and work boots – where we raise certified organic lambs, chickens and eggs, and vegetables. Over the past several years, I’ve watched farming undergo a transformation. A new generation of farmers is responding to customers who want locally grown organic produce, and humanely raised, hormone-free meat. Farmers also grow nutritious foods that our customers aren’t familiar with, so we educate them…usually with great success.
Health care is undergoing a similar transformation where customers are helping drive change. Some hospitals are responding – and reaping better patient-experience scores and higher revenue. Last June, we reported that hospitals with high patient-satisfaction scores tend to be more profitable than lower-rated facilities. This association is strongest for aspects of patient experience most likely to be associated with better clinical care, particularly the patient’s interaction with nursing staff.
But that doesn’t tell us the full story. A patient might walk out of the hospital completely satisfied with the overall experience, despite not having received high-quality care.1 The second part of our analysis, which we released this week, explores the link between the patient experience and clinical care quality. The Deloitte Center for Health Solutions conducted regression analyses to examine the association between patient perceptions and a broad range of hospital quality measures – both process of care measures and clinical outcomes.
To examine the relationship between patient experience and hospital clinical quality, we combined hospital-level patient experience ratings from the most widely used hospital experience survey – the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) – with clinical outcome and process-of-care quality measures from the Centers for Medicare and Medicaid Services (CMS).
When rating a hospital experience, patients tend to focus on the tangible aspects of the visit, such as waiting times in the emergency room, or how quickly the nurse responds to the call button. Better communication with the staff, for example, might lead to fewer errors or a more personalized course of treatment. But those factors might not be related to the care the patient received. A doctor’s skill and judgement, staff teamwork, and compliance with surgical protocols cannot be directly observed by an anaesthetized patient, for example, and cannot be accurately reflected by experience metrics.2
Hospitals turn their attention to improving customer experiences
While there can be costs involved in improving the patient experience, the investment could help boost clinical outcomes. Here’s a look at three hospitals that have altered their care processes in an effort to improve the patient experience:
- Ohio-based Mercy Health rolled out bedside tablets with an in-house “MyChart” app at one of its hospitals. The app allowed patients to access their own data, including medication interaction information and test results. This helped reduce staff overload by decreasing the number of questions patients had for medical staff. It also helped patients regain a sense of control over their care, which ultimately improves their experience of care.
- Florida Hospital Tampa, part of the Adventist Health System, had one of the highest emergency department (ED) patient volumes in the region. Staff engagement and patient experience ratings were low. The hospital introduced a flexible patient flow strategy (Doc1stER) combining immediate bedding and team triage to reduce patient wait times. A year after the program’s implementation, patient ratings of ED doctors increased to the top 15th percentile, and the median door-to-provider ED wait time was reduced by 10 minutes, even as ED volume grew by 30 percent.
- Wisconsin-based ThedaCare was one of the first health systems to implement a “collaborative-care” model to improve quality and patient experience, and reduce costs. Under this model, a bedside-care team is created for each patient (e.g., case physician, nurses, pharmacist, and a dedicated discharge planner). When a patient is admitted, the team analyzes the patient’s medical history, reviews the current diagnosis and potential complications, and anticipates a discharge date. The team then builds a coordinated plan of care and elicits input from patients and their family to develop a “single-care” plan, which is updated daily during “team huddles.” Clinical quality measures such as readmissions and mortality (from pneumonia) have improved by more than 40 percent, and patient experience scores increased by 50 percent.3
Many farmers, like hospitals, have recently begun to place more emphasis on the customer experience. Patient experience scores might not always or fully reflect hospital care quality, just as not all farms grow high-quality and nutritious foods. Some farms produce fruits and vegetables that look gorgeous and have incredibly long shelf-lives, but shoppers might discover the blemish-free vegetables they bought don’t have much flavor despite their outward appearance.
Results of our most recent analysis indicate a strong correlation between the patient experience and hospital quality, even after controlling for hospital and local area characteristics. Our findings suggest that investments in patient experience and quality can be mutually reinforcing strategies for hospitals.
1 Alexandra Robbins, The Atlantic, “The Problem with satisfied patients,” April 17, 2015,
2 Theresa Weldring and Sheree M.S. Smith, “Patient-Reported Outcomes (PROs) and Patient-Reported Outcome Measures (PROMs)”, Health Serv Insights, 2013; 6: 61–68, doi: 10.4137/HSI.S11093
3 Health Affairs, “The Triple Aim: Care, Health, And Cost,” May 2008