There is little question that patient satisfaction is important. But are “satisfied” hospital patients actually engaged?
Several for-profit organizations use patient satisfaction scores as one criterion (among others) to measure “patient engagement” in hospitals. Hospitals with higher HCAHPS scores, for example, are seen in these measures as having greater patient engagement. To be clear, HCAHPS is a patient experience survey – and not a patient satisfaction survey. Unfortunately, for many in health care, these terms are still synonymous – a good patient experience score often is interpreted as high patient satisfaction.
Positive patient experience – and patient satisfaction – are both important goals for health care delivery organizations to achieve. But these measures are only telling us how patients feel about what is being done FOR them, and not necessarily what health care could look like if patients could help design and develop the health care experience as true partners.
The Center for Patient and Consumer Engagement at the American Institutes for Research defines engagement as “patients, families, their representatives, and health professionals working in active partnership at various levels across the health care system—direct care, organizational design and governance, and policy making—to improve health and health care.”
HCAHPS allows patients to report on 11 aspects of hospital care ranging from the quietness and cleanliness of the hospital to the amount of communication with doctors and nurses. Questions in the survey ask patients to rate the degree to which doctors and nurses treated them with “courtesy and respect”, “listened carefully” to them, or “explain things in a way (the patient) could understand.”
These are important markers of patient experience, certainly, although they set the bar rather low. An unsanitary or loud hospital filled with doctors and nurses who are disrespectful and who don’t explain their actions would be unsatisfying to most of us. High ratings of these factors might indicate the foundation for a partnership between the health care professional and the patient; it would be hard to imagine a partnership without adequate communication or courtesy and respect. But high ratings in these areas don’t translate into partnership. In other words, a hospital stay that is courteous and respectful, quiet and clean, and filled with ample communication from care professionals about what they have decided to do is not the same as a hospital stay that is determined by a carefully crafted blend of evidence-based medical practices, physician and nurse experience treating acute aspects of a condition and a patient’s long-term health outcomes and preferences, with involvement in small and large decisions all along the way.
Our current scales do not yet measure the degree that a patient (or family caregiver) felt like they actively participated in their care – including being involved in determining the outcomes of their hospitalization and building a hospital stay care plan based on those outcomes rather than simply understanding and accepting the plans created by health care professionals (or, as is more common, on the day’s lab results). More importantly, they don’t express the partnership of patients and families in shaping the care experience in the first place through board and advisory panel membership.
Imagine, for example, what might happen if a patient and their hospital care team—complete with family members—had a conversation within the first three hours of hospital admission about what the patient wants as an outcome of the hospital stay? What if the care plan was designed around a patient’s desire to return to work as soon as possible, or increase functionality for a specific activity that holds great meaning to the patient? Patients and family members, if engaged, will create care that always provides a valued experience.
The truth is that the conversations may be time consuming, and at times heated. Partners sometimes have to disagree to find a collaborative solution that meets all the needs of the situation. A well informed debate may ensue around what is and is not possible under the specific circumstances of the illness or condition that required hospitalization. A patient could feel like their hospital experience was created to accomplish their own goals rather than the goals of the doctors, nurses, administrators, or payers.
Now, that would be truly satisfying.