Patient Experience Key Element in Safety and Quality Improvement Initiatives

Accounting for patient perspectives adds value to safety and quality improvement initiatives.

Patient experience is a valuable element of addressing patient safety incidents and conducting quality improvement initiatives.

After decades of operating with provider-centric care, healthcare organizations are becoming increasingly patient-centric. Evaluating and improving patient experience is a core component of patient-centric care.

"When you are defining patient experience, the most important factor is the patient perspective. There are many different levels. There is the one-on-one encounter that generates patient experience. There may be a sampling tool or survey tool to understand at a broader level the experience of the patients," says Pat Merryweather-Arges, MA, executive director of Chicago-based Project Patient Care.

Patient experience can play an essential role when there are patient safety incidents, she says. "The patient experience is extremely valuable when there has been harm because patients can comment on a missed diagnosis, on not being listened to, or other factors. You can answer important 'what if' questions. 'What if the clinician had acted differently?' 'What if the clinician had listened to me?' 'What if the clinician had taken me seriously?' 'What if the pain that I was feeling was addressed?' "

Patient experience can motivate care teams and other healthcare organization stakeholders when there are patient safety incidents, says Stephanie Mercado, CEO and executive director of the Chicago-based National Association of Healthcare Quality.

"Bringing in the patient experience humanizes a safety event. A safety event can be approached without the patient experience—it can be approached in a very linear way that focuses on the process and how improvements can be achieved. But when you bring in the patient perspective on a serious medical error, you get emotion. That emotion can move the hearts and minds of practitioners and other stakeholders toward a cause," she says.

Including patient experience in the process of addressing a patient safety incident elevates the effort, Mercado says. "The patient experience gives practitioners and other stakeholders an opportunity to reflect repeatedly in public and private settings about what went wrong and how badly they felt about it. Maybe next time they will slow down, double-check, or use the learning to make sure that the error does not happen again. The human element of involving patients makes a lasting impression."

When a patient safety incident occurs, patients and their family members often want to be involved in the response to the incident, she says. "Patients are looking to help make healthcare better. They are very motivated; and if they have had a very serious loss, they have a sense of commitment and resolve to make sure that loss does not happen to any other patient. If there has been harm, patients do not want another family to experience harm. Patients and families that have experienced harm can find themselves in a rewarding situation by partnering with a healthcare organization to make things better."

Healthcare organizations should be delicate and intentional about incorporating the patient experience in the response to a patient safety incident, Merryweather-Arges says.

"Patients who have experienced harm or family members who have experienced harm of a loved one need a span of time to heal and for the experience to be less raw. If you have had an error occur in your facility or in your care delivery as a clinician, you want to learn from that experience and the best person to teach you is the patient or the affected family. So, you integrate them into the learning process. It can be very emotional because they often relive the experience, which can be difficult. But if everyone is committed to change, the people who participate in these initiatives are very grateful. They are very forgiving of what has occurred as long as there is a commitment to change," she says.

Patient experience and quality improvement initiatives

Accounting for patient experience is a major factor in quality improvement initiatives, Merryweather-Arges says.

"When you are talking about patient experience, it is the experience of not only the outcomes of care but also the patients' experience while they are with a provider or a facility. Patient experience relates directly to quality because quality initiatives are oftentimes focused on improving health outcomes. You really cannot improve health outcomes without patient participation and engagement," she says.

Patient experience should be included in quality improvement initiatives, Mercado says. "There is patient engagement in successful quality initiatives. For example, when a hospital decides they want to improve something or a primary care practice decides they want to improve something, they engage the patients for input and to get their perspectives. That is where the patient experience is related to a quality initiative."

Surveys and patient-family advisory councils are effective tools to incorporate patient experience in quality improvement initiatives, Merryweather-Arges says.

"For example, the HCAHPS surveys ask patients about their experience in the care setting. Those experiences can help drive improvements—whether they are care improvements or improvements of the physical experience of being at a facility. Patients can be part of patient-family advisory councils, where their voice is heard," she says.

When including patient experience in quality improvement initiatives, patient contributions must be meaningful, Merryweather-Arges says. "Most importantly, patients do not want to be just a sounding board or a rubber stamp. They want a commitment to change. They are investing their time and their experience, which can be very emotional, to see change."

Related: Patient Experience Excellence