The “Problem” with Satisfied Patients
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The “Problem” with Satisfied Patients

I just came upon an article by the title, “The Problem with Satisfied Patients” in the April 17, 2015 Atlantic. I found this article disconcerting. Author Alexandra Robbins equates “patient satisfaction” with “patient experience.” She then makes the case that satisfaction and the patient experience have no relationship to outcomes by quoting a Missouri clinical instructor who said, “Patients can be very satisfied and dead an hour later.” Further, she states, “The concept of patient experience has mischaracterized patients as customers and nurses as automatons.”

I couldn’t agree more that “satisfaction” is not an effective driver of important improvement in healthcare. However, the patient experience is NOT about satisfaction. It is about the nature of people’s experience, not their feelings about it. It is about the actions we are taking with patients and whether they contribute to the best possible outcomes for the patient and family. And there is a growing body of evidence that has demonstrated the STRONG links between patient experience and clinical safety and effectiveness in a wide variety of disease areas, study designs, settings, population groups, and outcome measures. (See for example: “A systematic review of evidence on the links between patient experience and clinical safety and effectiveness”; by Doyle et al. BMJ; 2013:3.)

Robbins argues further that the focus on patient experience has largely led to expensive consultants who teach nurses “customer service,” to memorize and use scripts in their interactions, and to become automatons—all for the sake of satisfying patients as customers. She suggests that this is disrespectful to nurses and also leads to inauthentic interactions between caregivers and patients, leading to worse, not better outcomes.

Fifteen years ago, yes, healthcare leaders sought “customer service training”, but that is not the focus today. First of all, scripting is not a widely recognized evidence-based practice, and consultants and most organizations have gone far beyond the technique of scripting over the last several years. The patient experience movement is so much more than that, and in most organizations, scripting doesn’t even play a role in their improvement strategies.

There have been substantive improvements in the worldwide patient experience movement. Today, the focus is on creating cultures of caring in which patients and families receive not only safe, appropriate and excellent clinical care, but also effective communication and compassion which have been proven to lead to better clinical outcomes. Do these improved communication practices improve the patient experience and patient satisfaction? Yes. We’ve demonstrated that in the Language of Caring® programs. Beyond that, better communication–compassionate communication–reduces anxiety (which in turn aids healing), helps people engage in care planning and adherence to their care plans, and thus leads to improved outcomes.

The bottom line in Ms. Robbins article is that if we want to improve patient outcomes, we should stop “tricking patients into thinking they’re getting better care,” and instead, hire more nurses. We should stop catering to patients’ wishes and instead focus on their needs. And we should stop focusing on smiles over substance.

I also would like to see more nurses. Nurses are pivotal to safe and effective patient care and a positive patient experience. But adding nurses is not enough. There are currently nurses who are not as effective as they could be, because they have not developed or they don’t regularly use the communication skills that create terrific rapport with patients, that ease patient and family anxiety, that lead to care plan adherence and better outcomes, that foster harmonious relationships with coworkers, and that make the nurse’s work more gratifying. I applaud the patient experience champions worldwide who are making transformative, not cosmetic, changes in healthcare services, processes, the patient experience, patient and family engagement, and outcomes.

I welcome  your comments below.

Categories: Accountability, Caring and Empathy, Patient Experience Strategies, Patient-Family Engagement

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