Measuring patient experience

How do you measure how they feel?

For the longest time, patient experience was simply measured with a patient satisfaction survey. But we know now that that’s not enough to capture the complexity of patient experience in a typical hospital stay. So what do you do?

It turns out there are a number of ways to figure out what a patient goes through, and a recent study by a research scientist at the VA looked at some of the options out there in the hopes that organizations will help to figure out what combination works best in determining something as ephemeral as patient experience.

The study, led by Sherri LaVela, PhD, MPH, MBA, who is also an assistant professor at the Feinberg School of Medicine at the University of Chicago, was published in the Journal of Patient Experience in June (http://pxjournal.org/cgi/viewcontent.cgi?article=1003&context=journal). It noted that patient-reported measures are problematic in that they are not objective. So what do you do? Potential measurements involve patient care mapping, patient observation, ethnographic studies and patient shadowing programs, mystery shopping, rounding, and videotaping encounters.

Many of the answers of what to do are time-consuming or intrusive or both. Others are expensive. But some combination of objective and subjective measurement will undoubtedly have to be created to get to some accurate measure of patient experience, the article notes.

Other issues of concern are when to measure — when the patient is in the midst of the encounter or when it’s over? And if it’s over, how long afterward?

"There just is no agreed way to measure it right now," LaVela says. "We need some operational definition." The key point is that it’s more than patient satisfaction, which is still often used interchangeably with patient experience as a term. "Even in the literature search, we found that they used them that way."

The other thing to note is that what matters to the patient is what’s important — which means that the measurement may be a moving target, she says.

Hopefully, there will be a point in the future when many of these options have been tried, and they can be correlated to key outcomes measures, LaVela says. Maybe there will be one set of actions that together come up with both a good measurement for patient experience, as well as a good subjective outcome for the patient.

"The idea of tying patient experience to clinical outcomes is complex," she says. "You can have excellent patient experience, great interactions and shared decision-making, and your cancer can still be worse. I think for all facilities to be on the same page with measuring patient experience, they must understand the true concept of the entirety of experience, the personal situation of the patient, the patient’s perception of the entire healthcare experience."

Some of the methodologies that LaVela talks about in her paper — photovoice, guided tours — are participatory and help get to the patient voice. "They get a chance to be stakeholders in their own care," she says. That can provide actionable data, too, that goes right back to the quality department so that changes can be made. It can be done with patients, and also with staff members as if they were patients. LaVela says they have incorporated it into rounds every month to see if things are as they should be from the patient perspective.

If some methods seem too expensive to do all the time, remember, she says, the startup costs are one time only. You buy the video equipment once and continue to use it for years. Tours can take as little as a half hour. Provide a tape recorder to the "tourist" so that they can ask questions and make comments for later consideration and answer, she suggests.

Regardless of what methods you choose to use to measure patient experience, the most important thing is that you elicit feedback in an unprescribed way. "Let them tell you what matters most to them in an experience, rather than you using predetermined questions in a constrained manner," says LaVela.

It’s important for large organizations to get on board with a move away from just patient satisfaction surveys, she says, to a place where they understand that patient experience is more than that. To different patients it means different things, and sometimes, the things that are meaningful to one person can be at odds with each other — a same-day appointment and seeing my regular provider, for instance. But one of them is more important on a given day. That’s what you have to find out, LaVela says.

For more information on this topic, contact Sherri LaVela, PhD, MPH, MBA, Assistant Professor, Feinberg School of Medicine, University of Chicago, Chicago, IL. Email: sherri.lavela@va.gov.