Why patient experience matters more than ever

Thomas H. Lee, MD, has been Press Ganey’s chief medical officer since 2013, and is an internist and cardiologist, practicing primary care at Brigham and Women’s Hospital in Boston.

As chief medical officer, he is responsible for developing clinical and operational strategies to help providers across the nation measure and improve the patient experience, with an overarching goal of reducing the suffering of patients as they undergo care, and improving the value of that care. He has more than three decades of experience in healthcare performance improvement as a practicing physician, a leader in provider organizations, researcher, and health policy expert.

Medical Economics spoke to Lee about the growing importance of the patient experience and how it can affect care outcomes. The conversation has been edited for length and clarity.

Medical Economics: How important is the patient experience in today’s healthcare environment?Lee: I think it’s huge. There’s lots of change in healthcare as you know well and I think it’s changed for the better overall. But as we deal with the effects of tremendous medical progress, aging of our population and economic challenges, we have a perfect storm of good things that create pressure for change. It means we have to ask: what are we trying to do in healthcare?

Clearly because of all the frailty of our aging population and the incredible amount of things we can do and limited resources, that question of what are we trying to do has become something that has to be addressed. We just can’t keep doing more and more and more and assuming it’s all good. We’re trying to meet patients’ needs, and among their needs is peace of mind that things are as good as they can be. Among their needs is to minimize the fear that they have, minimize the anguish that they have, preventable anguish from confusion and chaos. Patient experience defines what we’re trying to accomplish.

ME: How does the patient experience impact patient outcomes?

Lee: Patients want a good experience. It’s not about parking, it’s not about something as simple as waiting time. It’s about how they feel. Do they feel peace of mind? Do they feel like everyone is doing all they can for them and working well together? These are the big drivers of patient’s likelihood to recommend. Do patients feel the teamwork is good, the communication is good, the empathy is real?

The reason I go into this is because these are outcomes. I mean obviously, mortality is the most important outcome if you’re about to have cardiac surgery. But the truth is, mortality has really limited value as an outcome measure in healthcare for two reasons. Number one, none of us are going to live forever so that not preventing mortality doesn’t necessarily mean failure of healthcare. And the second reason is that a whole lot of healthcare, we do things not to prevent death but to try to help people feel better. 

In life there are all these conditions like ALS, you know Parkinson’s Disease-we’re never going to restore patients to perfect health, but we want to give them peace of mind that they are as healthy as they can be given the cards that they’ve been dealt. So that peace of mind is in fact an outcome.

The key thing I would emphasize is that physicians have this suspicion that there’s conflict between patient experience and the performance measures they think of as real quality. And I think business people in healthcare sometimes have a concern that there is a tension between patient experience and financial performance. We’ve looked at a ton of data at Press Ganey, and there is actually alignment that organizations that have better patient experience also have better technical quality, they have better safety records, and they also have better engagement of data from their doctors, nurses, and other employees. By engagement I mean how they feel about working where they work. Are they happy there? Will they stay there? 

You know regardless of where you are, if you are getting better, that is good business and it’s also good for patient care. 

ME: If a doctor or health organization wants to improve their patient experience, how can they do that?  Where do they start?Lee: If you measure things you’ve got a chance at improving them, and if you don’t measure things, there’s a very good chance that they won’t improve. I think that we’re moving into a world where it’s not about quality assurance, it’s about quality improvement. Quality assurance is you just want to make sure that something terrible is not going on. Quality improvement is where no matter where you are, you’re trying to get better. And if you’re trying to get better, then you don’t just measure samples of patients, you try to get data from everyone. That takes you down a road where you start sampling electronically rather than using telephone or paper, because it’s just too expensive.

But then what do you do with the data and which data are most useful? The comments are really even more compelling than the numbers. Using transparency, put the comments out there on the internet. Like if you Google me, and if you scroll down that page you’ll see all the comments from my patients. There was a new comment up there from someone who went into great detail about the things I do that the patient likes. That was good for me in that it makes me realize I should do those things all the time. But that’s like a more tactical aspect of the bigger thing that I would bring up, which is the real goal has to be culture change-trying to be highly reliable about delivering care the way we think it should be delivered. So it’s reliably empathic, reliably safe, you know doing no harm, reliably coordinated, and technically excellent. Increasingly, my colleagues and I are realizing these things are integrated. Patient experience isn’t just one thing.  It’s part of a package that organizations have to pursue. 

ME: What happens if a practice or an organization doesn’t embrace the changes that are sweeping through healthcare? What are the consequences?Lee: On a very short-term basis, they may feel like, “Well, at least we don’t have to disrupt ourselves. We can come to work and we know what we’re going to do and we know how we’re going to do it.”  So there’s a sort of peace of mind on a very short-term basis. There’s probably nervousness, “Am I missing the boat?”  But you know on a medium-term basis, and I don’t think we’re talking about a decade, I think we’re talking about two, three, four years, there is a real risk of business performance suffering because patients are going to move to get care where their needs are being met. I mean there is a generational change afoot and the younger people are not as loyal to brand as older people are. Younger people tend to be healthier, so they’re not dominating and filling the office yet. But the baby boomers they’re adapting. They’re not behaving like their parents. They are looking online and reading about the doctors where they are getting care and even after they pick the doctor, they keep going back and reading the doctor’s comments. 

That’s one of the interesting insights is that patients aren’t just using data to pick physicians, but they’re looking online; it’s like a relationship-management tool, something akin to Facebook more than Yelp. Physicians ought to be worried about the business implications. But then, I actually think the more important thing is their own morale, their own burnout issues. What lifts doctors and nurses and others in the long run is feeling proud of their work and feeling like they’re really meeting patients’ needs and that’s what sustains them. 

When I look at the comments from patients about me, it also helps me understand, OK, these are things I should be darn sure I do reliably. And this is the kind of thing that keeps you from getting burned out. It’s feedback and if you do a good job, it’s positive feedback. 
ME: In the past, physicians may have felt like being a great doctor is all they needed to do. But you are saying there is more to it now, and doctors that aren’t cognizant of that are going to lose patients and possibly go out of business.

Lee: That is the way that I look at it. Plunging in is a smarter thing to do than pushing back. I have a sense of your readers and I know a lot of them are in practices for whom these changes are very disruptive and threatens their current business models.

But you know, helping them listen to their better angels and see a path forward that they might have their best shot at medium and long-term business success as well as pride is the best thing to do. You know the morale issue, the engagement stuff, the burnout stuff-that’s the case that I would make to them. I talk a lot to physicians and a lot of them are in a bad mood. But I actually find that they respond to imperative and the opportunity to give patients peace of mind even more than financial issues.

Whenever you ask physicians and other healthcare providers about instances where the care made you proud, you never get them bringing up instances where it was because they did something that was really, really new in the way of treatment techniques. The technical advances, the new drugs, new procedures, I think that stuff is cool, but they never bring that up. What they always bring up is old fashioned stuff about they work together, they’re really timely and they really met a patient’s psychological needs.

The values that come out are really old school values. But then how do you deliver old school values in the world we live in with very complex care with many people involved?  That’s a lot of the real work that we have to do in healthcare.

ME: Is there anything else that primary care doctors need to know about the patient experience or how things are changing?

Lee: You know on this transparency issue, they really should plunge in. They should do it because of the way people make choices today. In the old days, someone would say, “Who should I go see?” and they would get a recommendation and they would go to that doctor.  Today, they get three or four names and they go to the internet and they see what they can read about them. When they look if they’ve got comments, they read the comments, and if there are no comments, that’s not a good thing.

For example, when people look on Amazon, if a book’s got four reviews and they’re superb but another book’s got 50 reviews and it’s like two-thirds good, one-third bad, they buy the book that’s got 50 reviews because this is a well-documented phenomenon.

The same thing is true how consumers respond to the data that’s online. Primary care physicians should recognize that consumers are going to look online for information about them and they should be responsive to that and recognize that plunging in will make them better, and it will make them reliably be at their best.