Ratcheting Up Patient Experience Has a Downside

The push toward patient satisfaction can jumble organizational priorities. It can put new pressures on providers, whose primary focus should be "on staying financially afloat—then quality, and [then] safety," says one observer.

Kathleen Bartholomew, RN, MN, an independent educator, consultant, and nurse leader based in the Seattle area recalls a scene she has seen play out in clinics, hospitals and doctor's offices across the country.

The details involve a senior surgeon and a child who had recently suffered her second ear infection.

The child's mother, hoping to avoid more time away from work due to her child's illness, insisted that the surgeon put tubes in the girl's ears to ward off future infections. But the surgeon refused to do so, citing best practice guidelines. "A child has to have three ear infections before they become a candidate for ear tubes," he stated. This child had had only two, and there was no reason to believe that she was particularly susceptible to them.

The child's mother left in a huff to find another clinic that would do what she wanted.

But the story doesn't end there.

Within days, the surgeon learned that he'd been given an awful review on the patient satisfaction survey by the patient's mother—and would have to explain himself to hospital management. It was a double blow. His actions would affect the hospital's HCAHPS scores and his compensation that year, which was tied to patient satisfaction measures.

"That kind of stuff is happening right now. If the patient doesn't get what they want, they go somewhere else," says Bartholomew.

RN Named Chief Patient Experience Officer

The story underscores the growing emphasis on patient experience and the accelerating demand for patient experience officers. Virtually nonexistent ten years ago, 30% of executives surveyed in Healthleaders Media Intelligence Report: Patient Experience Transformation: Engaged Patients, Measurable Standards reported employing a patient experience officer.

But Bartholomew casts a cool eye. "You want to focus on the patient experience?" she asks. "It's just the new flavor of the month."

While some health systems are investing in amenities designed to improve the quality of a patient's stay, patient experience initiatives are ultimately about reimbursement, says Bartholomew. Thirty percent of the Centers for Medicare & Medicaid Services Value-based purchasing program, which can affect up to 1.5% of a hospital's Medicare revenue, is currently tied to patient experience scores. By 2017, the VBP program will affect up to 2% of a hospital's Medicare revenue, and patient experience component of that score drops to 25%

At best, Bartholomew sees the push toward patient satisfaction as a confusion of organizational priorities. "The hospital's primary focus is on staying financially afloat—then quality, and [then] safety. Sometimes, [these priorities] conflict."

Marshall Maglothin, MHA, MBA, a Washington, D.C.-based former executive director of health systems and physician practices and now a consultant, sees the move toward patient experience generally as a positive for healthcare professionals, but has some reservations.

"It's not so much [about] having to cater to patients," he says. "It's patients' expectations and [them] learning how to work the system. Some use satisfaction as a lever now."

Maglothin says clinicians are under increased pressures to be available directly to patients around the clock through cell phones, Twitter, email and other means. Another pressure is patients who diagnose themselves based on information they find online.

If a clinician does not agree with the patients' self-diagnoses, they may simply look for another doctor willing to agree with them, and leave low scores for the physician and the organization on their way out.

Hospital Hospitality
Another controversial patient experience issue is the increasingly common practice of employing patient experience officers from hospitality backgrounds, often with little or no healthcare experience on their resumes. Maglothin, believes recruiting from outside healthcare is a good way to get an out-of-the-box perspective.

"I've always found [candidates from outside healthcare] innovative… In this field, we're very conservative—and rightly so—but we have our workflows set." Someone from the hospitality industry can shake things up, says Maglothin.

"Some leaders in the industry have adopted hospitality standards, which they can combine with good quality care itself," resulting in satisfied and healthy patients, he says. He agrees concedes, however, that it is important that such leaders be well acclimated to the healthcare environment.

"It's essential that someone coming from the hospitality industry spend time in the trenches with doctors," suggests Maglothin. "They should have formal rounds. It doesn't have to be a lot of time—maybe two hours in each of the different clinical settings."

Bartholomew, however, is skeptical of the ability of former hospitality workers to become healthcare leaders. "We're hiring people from hospitality to make the facilities nice when 400,000 patients are dying each year due to hospital error? What's wrong with that picture?"

The most important thing, she maintains, is that organizations remain supportive of their employees, and give them what they need to do the most important part of their job; keeping patients alive. "Being alive is the best patient experience of all, and right now, that's not happening," she says.