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The patient satisfaction chasm

Quality is a central component of any discussion around health care and one of the key dimensions and measurements of quality care is the patient experience. However, many healthcare organizations struggle to become 'patient focused' and fail to score well on patient satisfaction surveys. New research from Brigham and Women's Hospital, published in the March edition of British Medical Journal Quality and Safety, offers a potential explanation -- insufficient support from hospital management to improve the patient experience by engaging physicians and nurses in the process.

"Twelve years after the Institute of Medicine's Quality Chasm report called for fundamental improvement to patient-centered care, our findings raise concern as to whether hospital management is actively engaging clinicians in enhancing patient satisfaction," said Ronen Rozenblum, PhD, MPH, lead author of the study and a researcher in the Center of Patient Safety Research & Practice at BWH.

The research findings are based on a survey of 1004 physicians and nurses at four academic hospitals in Denmark, Israel, the UK and the United States. Results indicate that despite expanding initiatives, and the belief of most healthcare organizations that patient experience and satisfaction is important, the majority do not have a structured plan for how frontline providers can improve patient satisfaction during hospitalization.

Specifically researchers report that while 90.4 percent of clinicians surveyed believed improving patient satisfaction during hospitalization was achievable, only 9.2 percent of the clinicians said their department had a structured plan for improving patient satisfaction during hospitalization. Additionally researchers found that of the clinicians surveyed:

  • 38 percent remembered targeted actions that were conducted in their department in order to improve patient satisfaction.

  • 34 percent stated that during the last twelve months they had received feedback from hospital management regarding the level of patient satisfaction in their department.

  • 85 percent thought hospital management should take a more active role in patient satisfaction improvement programs.

  • 83 percent believed achieving high level of patient satisfaction was important for the clinical success of healthcare organizations.

"Organizations that are successful in fostering a culture of patient-centered care have incorporated it as a strategic investment priority by committed leadership, active measurement, feedback of patient satisfaction and engagement of patients and staff," said David Bates, MD, Chief Quality Officer at BWH and senior author of the paper. "We, in healthcare organizations, need to take a more active role in developing and implementing programs to improve patient experience and satisfaction and also in identifying ways to engage frontline clinicians in this process as well as ensuring they get routine feedback about patient experience and satisfaction. Ultimately, the patient experience is at the bedside."

Now that this chasm has been identified and defined, Drs. Bates and Rozenblum are working to address it. They created a framework for a patient experience culture and have begun to take the next steps to test and implement this structured patient satisfaction model.

Rozenblum said, "In order to improve, we need a systematic approach that starts at the bedside and grows up through hospital management levels to policy makers, all of whom should be committed to shifting healthcare organizations toward a culture of patient experience by making patient experience a strategic investment priority."


Contact: Lori J. Schroth
Brigham and Women's Hospital

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