Why Improve Patient Experience with Healthcare?

For a few decades now, concerted efforts to measure and improve patient experience have become increasingly common throughout the healthcare system. Yet some people in your organization—whether clinicians, staff, administrators, or board members—may be new to this effort or even question its necessity. This topic brief reviews six reasons you can use to explain your organization’s investment in measuring and improving patient experience.

Reason #1. A positive patient experience is an important outcome of care. 

We are all patients—if not now, then probably at some point in the past and almost certainly some point in the future. When we seek and receive healthcare, we all want a positive, patient-centered experience, however we may define it based on our individual needs, values, and preferences. At a minimum, we want to be able to: 

• Get the care we need when we need it.
• Feel heard and respected.
• Receive clear, pertinent, and timely information about our health and the care we need.
• Move through the process of arranging for, receiving, and paying for care with as little friction as possible.

Since the 2001 publication of “Crossing the Quality Chasm: A New Health System for the 21st Century,”¹ patient-centered care has become widely recognized as a critical domain of healthcare quality in the U.S. and beyond our borders.²

Read Don Berwick’s take on the meaning of patient-centered care: Berwick DM. What 'Patient-Centered' Should Mean: Confessions of an Extremist. Health Aff (Millwood) 2009 Jul-Aug;28(4):w555-65. https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.28.4.w555

A good patient experience has an inherent value to patients and families and is an important outcome in its own right. In fact, in some settings, patient experience is regarded as the most critical outcome of care.³ Thus, while there may be external organizations and other goals driving your organization’s efforts to assess and improve patient experience, the most compelling reason for action is simply to do a better job of meeting patients’ needs.

Reason #2. Measuring and improving patient experience helps to reduce variations in quality of care among different patient populations.

As with other measures of healthcare quality, assessments of patient experience have revealed differences in performance across different patient populations. AHRQ’s 2023 National Healthcare Quality and Disparities Report, for example, revealed differences in adult patients’ experiences with communication in the hospital.⁴

For a healthcare organization, identifying differences in patient experience – by oversampling patients from population groups with consistently lower scores, adding additional survey questions, and/or analyzing survey data by demographic characteristics – is an important step in determining where and how to focus improvement efforts. At the same time, identifying targeted ways to overcome barriers to access and improve communication and service for those with poor experiences helps to improve patient experience for all. 

Reason #3. A good patient experience is associated with high-quality clinical care. 

While essential to healthcare quality on its own merits, patient experience is also important because of its positive relationship with clinical processes, health outcomes, and patient safety.⁵ Improving patient experience can help to improve these other critical aspects of healthcare quality:

• Several studies have found a relationship between patient experience scores and process measures for prevention, screening, and disease management.⁶⁷ For example:
  • A study of women’s choices for therapy after a lumpectomy for breast cancer found that patient experience was associated with the decision to get radiation therapy rather than hormonal therapy.⁸
  • Another study found that positive patient experiences were associated with more appropriate use of guideline-concordant treatment for colorectal cancer.⁹
• Previous findings that patient-provider communication is associated with health outcomes¹⁰ are reinforced by more recent studies:
  • A study of lung cancer survivors found differences in mortality risk associated with racial and ethnic differences in patient experience.¹¹
  • An analysis of patients hospitalized for heart attacks showed that patients with more positive reports about their experiences with care had better health outcomes a year after discharge.¹²
  • In a study of adult hospital patients with acute myocardial infarction, heart failure, and pneumonia, higher scores on the CAHPS Hospital Survey were associated with lower 30-day readmission rates.¹³
• Studies suggest a relationship between patient experience and patient safety. For example:
  • One analysis concluded that ratings of patient experience are positively associated with several indicators of hospital patient safety.¹⁴
  • Another study found a relationship between hospital staff’s positive perceptions of patient safety culture with patients’ reports of positive experiences with care.¹⁵

Researchers have also found that positive patient experience is associated with both lower healthcare utilization and greater adherence to clinician recommendations.

• Patients' experiences with care, particularly communication with providers, correlate with adherence to medical advice and treatment plans.¹⁶,¹⁷ This is especially true among patients with chronic conditions, where a strong commitment from patients to work with their providers is essential for achieving positive results.¹⁸
• One study found lower utilization of healthcare services, specifically specialist visits, hospitalizations, and laboratory and diagnostic tests, when primary care practices adopted a patient-centered approach to care.¹⁹ 

Measures of patient experience also can reveal important system problems, such as delays in returning test results and gaps in communication, that may have broad implications for clinical quality, safety, and efficiency.

Many articles in the healthcare press document the relationship between patient experience scores and other measures of healthcare quality. 

• Review a bibliography for journal articles on the value of assessing patient experience.
• Learn more in this literature review: Anhang Price R, Elliott MN, Zaslavsky AM, Hays RD, Lehrman WG, Rybowski L, Edgman-Levitan S, Cleary PD. Examining the role of patient experience surveys in measuring health care quality. Med Care Res Rev 2014 Oct;71(5):522-54. doi: 10.1177/1077558714541480. Epub 2014 Jul 15. PMID: 25027409; PMCID: PMC4349195.

Reason #4. Measuring and improving patient experience can contribute to the well-being of clinicians and staff.

Analyses support the theory that there is a two-way relationship between patient experience and provider burnout.²⁰ In particular, burnout is negatively associated with provider-patient communication—an important aspect of patient experience across all care settings.^21,22,23

At the same time, there is growing evidence that efforts to assess and improve patient experience can contribute to greater employee satisfaction, improving retention and reducing burnout and turnover.^24,25 There are a few reasons for this positive impact: 

• Staff benefit from the reporting of patient feedback that is typically part of the improvement process. In one study, clinic staff exposed to positive comments from patients, such as compliments and/or comments that expressed appreciation or empathy, had less self-reported burnout than staff who saw all comments or didn’t see comments at all.²⁶   
• Improving the experience of patients and families requires improving work processes and systems that enable clinicians and staff to provide more effective care and experience greater joy in their work.²⁷ 

Reason #5. Payers, purchasers, and other external organizations are paying attention to how well healthcare organizations deliver patient-centered care. 

Many healthcare organizations collect information about different aspects of healthcare quality for their own purposes, but external demands for the information are also a motivation. Your organization may be assessing patient experience in response to reporting requirements or payment incentives of the Centers for Medicare & Medicaid Services (CMS), state agencies, accreditors, and/or private and public payers and purchasers of healthcare. In one prominent example, Blue Cross Blue Shield of Massachusetts includes patient experience measures among the quality measures in its Alternative Quality Contract, a population-based payment model for physician organizations and hospitals. You may also be participating in a state, regional, or local effort to collect and report data on patient experience. 

These kinds of requirements and requests have made a difference.²⁸ A study of trends in hospitals’ HCAHPS (CAHPS Hospital Survey) scores found that scores improved thanks to both the initial public reporting effort and the subsequent value-based purchasing program.²⁹

CMS uses financial incentives to place a greater emphasis on the need for improvement. Reward and compensation systems have shifted their focus from (1) simply collecting and reporting the data to (2) achieving a comparatively strong performance to (3) demonstrating improvement over time. For example:

• To determine Medicare payments to hospitals, CMS’s Hospital Value-Based Purchasing Program creates a score that incorporates both the hospitals’ relative patient experience scores and the extent to which the scores have improved.³⁰
• The CMS Innovation Center has been testing payment models for physicians, accountable care organizations, and other healthcare providers that reward them for improving patient experience.

Reason #6. Cultivating a positive patient experience supports the business objectives of healthcare organizations. 

Many organizations conduct surveys and gather patient feedback in other ways because delivering a good patient experience is good for business, too. Higher levels of patient experience are associated with marketing goals such as increased likelihood of recommendations, higher levels of patient retention,³¹ and fewer complaints.³² The quality of patients’ relationships with their providers is a major predictor of patient loyalty.

Patient experience is also associated with medical malpractice risk.^33,34,35 One study found that for each drop in patient-reported scores along a five-step scale of "very good" to "very poor," the likelihood of a provider being named in a malpractice suit increased by 21.7 percent.³⁶

^1. “Crossing the Quality Chasm” is available at https://nap.nationalacademies.org/catalog/10027/crossing-the-quality-chasm-a-new-health-system-for-the.

^2. Quality of Care. World Health Organization. https://www.who.int/health-topics/quality-of-care#tab=tab_1. Accessed 6/19/24.

^3. Parast L. Leveraging patient experience measures as surrogate outcomes to evaluate health care interventions. Patient Experience Journal 2023, 10(2): 7-9.  https://pxjournal.org/cgi/viewcontent.cgi?article=1836&context=journal 

^4. 2023 National Healthcare Quality and Disparities Report. Rockville, MD: Agency for Healthcare Research and Quality; December 2023. P. 147. AHRQ Pub. No. 23(24)-0091-EF.

^5. 2023 National Healthcare Quality and Disparities Report. Rockville, MD: Agency for Healthcare Research and Quality; December 2023. P. 147. AHRQ Pub. No. 23(24)-0091-EF. doi: 10.1136/bmjopen-2012-001570. PMID: 23293244; PMCID: PMC3549241.

^6. Sequist TD, Von Glahn T, Li A, Rogers WH, Safran DG. Measuring chronic care delivery: patient experiences and clinical performance. Int J Qual Health Care 2012 Jun;24(3):206-13. doi: 10.1093/intqhc/mzs018. Epub 2012 Apr 6. PMID: 22490300.

^7. Sequist TD, Schneider EC, Anastario M, et al. Quality monitoring of physicians: Linking patients' experiences of care to clinical quality and outcomes. J Gen Intern Med 2008;23(11):1784–90. 

^8. Halpern MT, McNeel TS, Kozono D, Mollica MA. Association of Patient Experience of Care and Radiation Therapy Initiation Among Women With Early-Stage Breast Cancer. Pract Radiat Oncol 2023 Sep-Oct;13(5):434-443. doi: 10.1016/j.prro.2023.04.011. Epub 2023 May 6. PMID: 37150319; PMCID: PMC10524855.

^9. Navarro S, Tsui J, Barzi A, Stern MC, Pickering T, Farias AJ. Associations Between Patient Experience With Care, Race and Ethnicity, and Receipt of CRC Treatment Among SEER-CAHPS Patients With Multiple Comorbidities. J Natl Compr Canc Netw 2023 Dec 27;22(1D):e237074. doi: 10.6004/jnccn.2023.7074. PMID: 38150827; PMCID: PMC10872498.

^10. Stewart MA. Effective physician-patient communication and health outcomes: A review. CMAJ 1995;152(9):1423-33.

^11. Farias AJ, Chan E, Navarro S, David EA, Eguchi M, Cockburn M. Lung Cancer Mortality Racial/Ethnic Disparities in Patient Experiences with Care: a SEER-CAHPS Study. J Racial Ethn Health Disparities 2023 Aug;10(4):1745-1755. doi: 10.1007/s40615-022-01358-8. Epub 2022 Jun 29. PMID: 35767217.

^12. Meterko M, Wright S, Lin H, et al. Mortality among patients with acute myocardial infarction: The influences of patient-centered care and evidence-based medicine. Health Serv Res 2010 Oct;45(5):1188-204.

^13. Boulding W, Glickman SW, Manary MP, Schulman KA, Staelin R. Relationship between patient satisfaction with inpatient care and hospital readmission within 30 days. American Journal of Managed Care 2011;17(1):41–48. 

^14. Isaac T, Zaslavsky AM, Cleary PD, et al. The relationship between patients’ perception of care and measures of hospital quality and safety. Health Serv Res 2010;45:1024–40. 

^15. Sorra J, Khanna K, Dyer N, Mardon R, Famolaro T. Exploring relationships between patient safety culture and patients' assessments of hospital care. J Nurs Adm 2014 Oct;44(10 Suppl):S45-53. doi: 10.1097/NNA.0000000000000118. PMID: 25279513.

^16. Zolnierek KB, Dimatteo MR. Physician communication and patient adherence to treatment: A meta-analysis. Med Care 2009;47(8):826-834.

^17. Donneyong MM, Bynum M, Kemavor A, Crossnohere NL, Schuster A, Bridges J. Patient satisfaction with the quality of care received is associated with adherence to antidepressant medications. PLoS ONE 2024; 19(1): e0296062. https://doi.org/10.1371/journal.pone.0296062

^18. Beach MC, Keruly J, Moore RD. Is the quality of the patient-provider relationship associated with better adherence and health outcomes for patients with HIV? J Gen Intern Med 2006;21(6):661-5.

^19. Bertakis KD, Azari R. Patient-centered care is associated with decreased health care utilization. J Am Board Fam Med: JABFM. 2011;24(3):229–239. - PubMed 

^20. McKee KE, Tull A, Del Carmen MG, Edgman-Levitan S. Correlation of Provider Burnout With Patient Experience. J Patient Exp 2020 Dec;7(6):931-936. doi: 10.1177/2374373520902006. Epub 2020 Jan 30. PMID: 33457523; PMCID: PMC7786687.

^21. Chung S, Dillon EC, Meehan AE, Nordgren R, Frosch DL. The relationship between primary care physician burnout and patient-reported care experiences: A cross-sectional study. J Gen Intern Med 2020;35(8):2357-64. doi:10.1007/s11606-020-05770-w

^22. Willard-Grace R, Knox M, Huang B, Hammer H, Kivlahan C, Grumbach K. Primary care clinician burnout and engagement association with clinical quality and patient experience. J Am Board Fam Med 2021;34(3):542-552. doi:10.3122/jabfm.2021.03.200515

^23. McKee KE, Tull A, Del Carmen MG, Edgman-Levitan S. Correlation of Provider Burnout With Patient Experience. J Patient Exp 2020 Dec;7(6):931-936. doi: 10.1177/2374373520902006. Epub 2020 Jan 30. PMID: 33457523; PMCID: PMC7786687.

^24. Boissy A, Windover AK, Bokar D, et al. Communication Skills Training for Physicians Improves Patient Satisfaction. J Gen Intern Med 2016 Jul;31(7):755-61. doi: 10.1007/s11606-016-3597-2. Epub 2016 Feb 26. PMID: 26921153; PMCID: PMC4907940.

^25. Rave N, Geyer M, Reeder B, et al. Radical systems change: Innovative strategies to improve patient satisfaction. J Ambul Care Manage 2003;26(2):159-74. 

^26. Nembhard I. Impact of the Intervention on Staff Experience. Presentation at Learning from Patient Narratives Through Innovative Feedback Reporting Methods, CAHPS Webcast, May 2023. 

^27. Quigley DD, Slaughter ME, Qureshi N, et al. Associations of Primary Care Provider Burnout with Quality Improvement, Patient Experience Measurement, Clinic Culture, and Job Satisfaction. J Gen Intern Med 2024 Jan 25: 1-8.

^28. Zhou RA, McIntosh N, Rajan R, Courtemanche J, Cutler D. Association between use of clinician performance information and patient experience. Am J Manag Care 2023 Feb 1;29(2):e51-e57. doi: 10.37765/ajmc.2023.89321. PMID: 36811988.

^29. Beckett MK, Quigley DD, Cohea CW, Lehrman WG, Russ C, Giordano LA, Goldstein E, Elliott MN. Trends in HCAHPS Survey Scores, 2008-2019: A Quality Improvement Perspective. Med Care 2024 Jun 1;62(6):416-422. doi: 10.1097/MLR.0000000000002001. Epub 2024 Apr 12. PMID: 38728680.

^30. https://www.cms.gov/medicare/quality/value-based-programs/hospital-purchasing

^31. Shaller D, Kanouse DE, Schlesinger M. Context-based strategies for engaging consumers with public reports about health care providers. Med Care Res Rev. 2014 Oct;71(5 Suppl):17S-37S. doi: 10.1177/1077558713493118. Epub 2013 Jul 1. PMID: 23819945; PMCID: PMC5494710.

^32. Quigley DD, Reynolds K, Dellva S, et al. Examining the business case for patient-centered care: A systematic review. Journal of Healthcare Management 2021 May-Jun, 66(3): 200-224. 

^33. Ioan BG, Ciuhodaru T, Velnic AA, Crauciuc D, Hanganu B, Manoilescu IS. The role of doctor-patient communication in preventing malpractice complaints. International Journal of Communication Research 2017; 7(4), 303–307.

^34. Stelfox HT, Gandhi T, Orav EJ, Gustafson ML. The relation of patient satisfaction with complaints against physicians and malpractice lawsuits. The American Journal of Medicine 2005;118(10), 1126-1133. https://doi.org/10.1016/

^35. Schleiter, K. Difficult patient-physician relationships and the risk of medical malpractice litigation. Virtual Mentor. 2009 Mar 1;11(3):242-6. doi: 10.1001/virtualmentor.2009.11.3.hlaw1-0903. PMID: 23194907.

^36. Fullam F, Garman AN, Johnson TJ, et al. The use of patient satisfaction surveys and alternate coding procedures to predict malpractice risk. Med Care 2009 May;47(5):1-7.