Healthcare as a whole has become a consumer-driven industry. Hospital systems must compete to maintain the loyalty of patients they serve, build their reputation, and gain referrals, all by earning high patient satisfaction scores. A recent 5-year study that observed over 3,500 hospitals showed that a positive patient experience is associated with increased profitability and a negative patient experience is even more strongly associated with decreased profitability, highlighting the importance of patient experience in hospitals. 
Since this realization, healthcare facilities around the United States have added job positions such as Patient Experience Officer, Patient Advocates, and Patient Liaisons to help earn higher patient satisfaction scores, show their value to consumers, and obtain higher reimbursement rates. Furthermore, research has shown that better patient experience correlates with lower medical malpractice risk for physicians and lower staff turnover ratios. 
Assessing the Importance of Patient Experience in Hospitals
The HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems), also known as CAHPS Hospital Survey, is the first national, standardized 29-item patient satisfaction survey required by the Centers for Medicare and Medicaid Services (CMS) for all United States hospitals. HCAHPS has been able to showcase quantitative comparisons from hospitals locally, regionally, and nationally since 2008.  The HCAHPS patient experience of care domain score is then used for the hospital Value-Based Purchasing (VBP) program. There are nine measures from HCAHPS used in the hospital VBP program: Communication with nurses, communication with doctors, staff responsiveness, communication about medicines, care transition, discharge information, cleanliness of hospital environment, quietness of hospital environment, and hospital rating. 
A recent study showed that hospitals with “excellent” HCAHPS patient ratings had higher profitability, with an average net margin of 4.7%. Compare that to a net margin of 1.8% for hospitals with “low” ratings.  This study shows the strong association between enhancing the patient experience and improving hospital performance.
4 Values to Improve the Patient Experience
To prioritize the importance of patient experience in hospitals, it is important to first understand the 4 values of a positive patient experience:
1. Human Value
Patients want to be treated with respect and feel that their concerns and feelings are being listened to and taken into consideration. Patients, as a whole, want to be spoken to as an equal and in a way, they understand, and not treated as a number or “disease case.”
2. Quality and Safety Value
It is extremely important for patients to feel they are given care that is delivered safely with positive health outcomes. All patients want to feel and know that the care given to them is administered with a high degree of focus on quality.
3. Reputational Value
During a recent survey, 1 of every 2 patients noted brand and reputation were important in choosing a hospital.  Nearly 50% of millennials and Gen-Xers, 40% of baby boomers, and 28% of seniors used online reviews to select care providers. 
4. Financial Value
A 2019 study found that a 5-point increase in overall hospital rating (based on HCAHPS survey data) led to, on average, a 1% increase in profit margin.  While reimbursement can play a role in improving a hospital’s bottom line, the real value is found in increasing consumer loyalty. Estimates place the lifetime value of a patient at approximately $1.4 million . If and when the patient has a bad experience and chooses to go elsewhere, that money goes with them — along with anyone influenced by their negative reviews.
5 Steps to a Positive Patient Experience
Encompassing the 4 values of a positive patient experience, improving the patient satisfaction scores will be best achieved through a multifaceted approach of creating an environment in which patients have a positive overall experience with each medical team member. Below are 5 cost-effective straightforward steps in which to do so:
1. Strive for Better Communication
Physicians and medical team members that spend a few minutes prior to the clinical treatment to gain rapport with the patients help to form a sense of trust between each other. Healthcare leaders should always strive to hire and foster individuals that have strong communication skills and a positive attitude. They should also support their workers in the pursuit of being more empathic and culturally sensitive by continuing education courses. Lastly, keeping the patients informed of updates on wait times, next steps, and treatment plans can help stabilize the patient and help them feel safe and calm.
2. Improve the Hospital Environment
Patients will continue to rate hospitals poorly when high levels of noise disrupt their sleep and add to their current stress while trying to recuperate at the hospital. Hospital leaders should implement and enforce rules about quiet hours during the day and lights-out at night. Instituting a board that has patients, their families, and/or parents to help decide on improvements and features of new wings of the hospital will also help to keep the hospital system “growing” in the right direction of a patient-friendly environment.
According to a study from the AHRQ (Agency for Healthcare Research and Quality), policy changes to increase patient and family engagement allowed one medical center to decrease medication errors by 62%, decrease falls by 40%, and decrease length of stay by 50%. 
3. Streamline the Discharge and Follow-up Process
It is imperative to give clear and precise discharge and post-discharge care to each and every patient. A medical team member should be appointed to follow-up on the post-discharge care to help mitigate readmissions and worsening overall condition.
4. Spend More Time with the Patient
One study showed that patients were more likely to rate their visit at the highest satisfaction level as their perceived visit length increased. The same study also found that a patient’s expectation of visit length predicted their satisfaction. 
Due to the added administrative tasks on the EHR, it is difficult for the 21st-century physician to spend the time needed for high patient satisfaction and high quality of care.
One solution to this problem is an increasing way to bring back humanization to healthcare — medical scribes. Medical scribes allow the physicians to increase face-to-face time with patients, reduce physician documentation time, and improve workplace satisfaction which can reduce burnout. This is a cost-effective way to have many advantages. An Annals of Internal Medicine study showed only an average of 1.34 additional new patients or 2.15 additional returning patients are needed to recover the scribe costs. To make it easier to note, the addition of only 2 new patients (or 3 returning) visits per day made it profitable for all specialties involved in the study. 
5. Upgrade Outdated Systems
Outdated, low quality and/or slow systems and medical devices can cause frustration to the patients, medical team, delay treatment, cause decreased productivity, inefficiencies and medical negligence issues. There is no “one-size-fits” all formula for upgrading systems or medical devices but it is important to keep watch of the age, cost to service, cost to repair and replace each item. Also, looking at the “pros” of upgrading such as automations for appointment times, interoperability between EHRs (electronic health records), and healthcare pricing transparency can only add to improving the overall patient experience.
Hospital leaders must be able to focus on their ability to prioritize the importance of patient experience in hospitals from the moment they walk into the facility to discharge and post-discharge. The healthcare experience truly reaches beyond the clinical interactions to all the touchpoints from the beginning to the end of the continuum of care. To gain and maintain a positive patient experience, any healthcare system will benefit from a multifaceted approach to be able to set the foundation for success — for the safety, quality of care and overall experience of the patients they serve.
Written by: Nicole Bramblett, MHA
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