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How to Use Patient Experience Ratings to Prioritize Your Hospital's Improvement Initiatives

Patient experience (PX) has become an important topic for US hospitals. The Centers for Medicare & Medicaid Services (CMS) will be using patient feedback about their care as part of their reimbursement plan for acute care hospitals (see Hospital Value-Based Purchasing Program). Not surprisingly, hospitals are focusing on improving the patient experience to ensure they receive the maximum of their incentive payments.

State of Patient Experience from Hospital's Perspective

Figure 1. State of Patient Experience in American Hospitals. Figure is from a 2011 study by The Beryl Institute and Catalyst Healthcare Research. The research summary can be found here.

The Beryl Institute and Catalyst Healthcare Research conducted a 2011 benchmarking study, The State of Patient Experience in American Hospitals, to understand what hospitals are doing to improve the patient experience (I recommend you read the study report.). This study collected responses from 790 respondents (representing 660 individual hospitals or hospital groups/systems).

The researchers found that (see Figure 1) respondents said their organization's top 3 priorities to improve the patient experience are (in descending order of importance):

  1. Reduce Noise
  2. Patient Rounding
  3. Discharge Process and Instructions

Are those the right PX areas in which hospitals should be focused if they want to optimize the value of their PX improvement efforts?

Let's take a look from the patient's perspective.

State of Patient Experience from Patient's Perspective

Acute Care Hospitals

Figure 2. Descriptive statistics of and correlations among PX areas and patient loyalty.

We can get the patients' perspective of their hospital experience through HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems). HCAHPS is a national, standardized survey of hospital patients and was developed by a partnership of public and private organizations.

What I found in my PX research on acute care hospitals is that, of the 8 PX areas being measured by HCAHPS - and used for CMS reimbursements (see Figure 2), the three PX areas that received the lowest ratings (possible scores can range from 0 to 100) are:

  • Area around room quiet (~58)
  • Staff explains medicines before dispensing (~60)
  • Staff responsiveness (~63)

It appears that hospital improvements in reducing noise parallels patients' low ratings in that exact area.  Additionally, improvement of patient rounding might improve patient satisfaction with responsiveness. However, even though hospitals' are focusing on process discharge and instructions, this PX area receives the highest rating (~82) of the 8 PX areas in the HCAHPS. Note: The correlations among the HCAHPS 10 questions show roughly the same relative pattern whether the data are analyzed at the hospital level or patient level.

Setting Priorities for Improving the Patient Experience

One thing struck me about the Beryl Institute findings; different hospitals focus on different things as their top priorities. I would be very interested to learn how hospitals prioritize improvements in patient experience. Why did some hospitals focus on noise reduction and others focus on nurse communication or cleanliness? What organizational factors did hospital executives weigh when prioritizing their investment dollars? Did they use patient experience data? If so, how did they use patient experience data to arrive at their improvement decisions?

The CMS reimbursement incentive plan might encourage hospital executives to look solely at ways to maximize/increase PX ratings with a limited budget. While improving patient experience is a positive outcome for the hospital in and of itself (100% reimbursement), you need to consider PX improvements' long-term impact on outcomes like patient loyalty. Here is one way to prioritize PX improvements.

Figure 3. Patient Loyalty Driver Matrix for Acute Care Hospitals. To maximize ROI on improvement efforts, consider focusing on PX dimensions in upper left quadrant (these have room for improvement and are highly linked to patient loyalty).

Using Patient Experience Ratings to Prioritize Improvement Initiatives

As I wrote about in a prior blog post, a good way to prioritize PX improvement initiatives is to understand the performance of PX areas and their impact on patient loyalty.  To maximize ROI of improvement efforts, we identify PX areas that 1) have much room for improvement and 2) are highly linked to patient loyalty.

Using this approach to prioritize improvement initiatives (see Figure 3), the hospital industry might consider these three PX areas as their top improvement priorities:

  1. Staff explains medicines before dispensing
  2. Staff responsiveness
  3. Pain management

While "area around room quiet" is the lowest rated PX dimension, it also has he weakest relationship with patient loyalty. Consequently, improving this PX area will have a relatively small impact on improving patient loyalty, especially when other PX areas are highly linked to patient loyalty like pain management and remain unchanged.

Noise around room is really not as important to patient loyalty compared to all other patient experience attributes. If  hospitals are focusing on noise reduction as their primary objective of the PX program, they should not expect a substantial increase in patient loyalty. Quiet surroundings is not how the patient primarily defines their hospital experience.


Hospitals' improvement priorities do not seem to match up with what patients want. Hospital executives' top priorities for improving the patient experience are: 1) Reduce Noise, 2) Patient Rounding and 3) Discharge Process and Instructions. Patients, however, say they are least satisfied with the following areas: 1) Area around room quiet, 2) Staff explains medicines before dispensing and 3) Staff responsiveness.

Hospital executives are tasked with improving the patient experience. Their priorities are driven by short-term monetary metrics (e.g., CMS reimbursement) and long-term hospital growth metrics (e.g., patient loyalty). Hospital executives can use their hospital's PX survey data (e.g., HCAHPS) to help priorities PX improvement opportunities to maximize both metrics to optimize the ROI of their decision.

I need to note that patient loyalty is only one of many different outcomes a hospital can use to prioritize their improvements around the patient experience. Executives can even look at how patient experience is related to other outcome metrics like hospital mortality rates and readmission rates to understand how their PX improvement dollars improve different types of key hospital outcomes.

How does your hospital set their priorities for improving the patient experience?

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